Heart failure is a leading cause of illness and death worldwide, yet outcomes appeared to be improving in many countries before COVID-19. During the pandemic’s acute phases, healthcare systems saw notable changes in how patients sought care and how resources were used, including a marked drop in emergency department visits and hospital admissions for non-COVID conditions. Whether these changes were temporary disruptions or the start of lasting shifts in care and outcomes for people with heart failure is unclear.
In a recent JACC: Advances study, researchers examined province-wide health records for adults living with heart failure across Alberta, Canada. The team evaluated population-level data across three distinct phases: pre-pandemic (March 2018-March 2020), intra-pandemic (March 2020-May 2023), and post-pandemic (May 2023-May 2024), using statistical models that accounted for trends already underway.
Patient demographics and underlying health conditions remained similar across all three periods. Emergency department visits and hospital admissions dropped during the pandemic and stayed lower afterward. However, statistical modeling showed that post-pandemic rates were consistent with long-term downward trajectories established before 2020. Notably, patients who did seek acute care post-pandemic were sicker upon arrival, as measured by Canadian Triage and Acuity Scale scores.
Yet despite higher presentation severity, mortality in patients with HF who did not have COVID-19 was lower after the pandemic. This matched pre-pandemic trends of declining HF mortality with no sign of lasting harm to survival, though a higher proportion of non-COVID HF deaths occurred at home.
These findings suggest that while the pandemic left no lasting negative mark on survival, overall use of acute hospital care has remained lower. The authors suggest that the wider adoption of newer heart failure medications over the past decade may be contributing to reduced acute care reliance, though the study did not have access to medication data to test this. They also propose that future studies should examine whether these persistent utilization patterns reflect barriers to accessing care, differences between virtual and in-person outpatient care, shifts in patient care-seeking behavior, or the appropriate redirection of less acute patients away from emergency departments.
This study was led by CVC faculty member Finlay McAlister, MD, MSc. Co-authors include fellow CVC faculty member Jason Weatherald, MD, MSc, as well as Chuan Wen, PhD and Jeffrey Bakal, PhD (AbSPORU); Mohit Bhutani, MD, Michael Stickland, PhD, and Grace Lam, MD, PhD (University of Alberta); and Paul Ronksley, PhD (University of Calgary).
