The impact of the COVID-19 pandemic on individuals with Fontan circulation: Focus on gaps in care.

Abstract

Background:

Gaps in subspecialty cardiology care could potentially delay identification and care for multi-organ complications common in patients with Fontan circulation. This study analyzed the frequency of gaps in care for individuals with Fontan circulation during the COVID-19 pandemic and associated demographic and clinical factors.

Methods:

This retrospective study evaluated individuals with Fontan circulation followed at our center since 2010. A gap in care was defined as an absence of any formal cardiology provider-patient contact (clinic visit or telehealth) for >15 months.

Results:

Over a third of 308 patients with Fontan circulation experienced at least one gap in care between 2010 and 2022, and 77 experienced a gap in care during the COVID-19 pandemic. Of this latter group, 27 (35%) had never experienced a prior gap in cardiology care until the pandemic. Those who experienced gaps in care during the pandemic were on average older (18.0 [IQR 9.6-25.6] vs. 14.2 [7.2-21.2] years, p = 0.01), more likely to be of Black/African American race (23.4% vs 7.4%, p = 0.001), and less likely to have a diagnosis of protein-losing enteropathy or plastic bronchitis (0% vs. 8.6%, p = 0.005). Those without a gap in care during the pandemic were more likely to have utilized telehealth visits (13% vs 3%, p = 0.02).

Conclusion:

Gaps in care are common and appear to have been exacerbated by the COVID-19 pandemic in those with a Fontan circulation. Such gaps are particularly common among African American and adult patients, and may potentially be mitigated by expanding telehealth access.

• Authors: Arjun Mahendran, Sarah Fahnhorst, Craig Alexander, Nicole Brown, James F Cnota, Allison Divanovic, Haleh Heydarian, Russel Hirsch, Alexander R Opotowsky, Joseph J Palermo, Cassandra Szugye, Adam M Lubert
• Journal: International journal of cardiology. Congenital heart disease (Int J Cardiol Congenit Heart Dis) Vol. 11 Pg. 100439 (Mar 2023) ISSN: 2666-6685 [Electronic] Netherlands
• PMID: 36643287 (Publication Type: Journal Article)
• Copyright: © 2023 Published by Elsevier B.V.