Patients wait longer for heart surgery now than pre-pandemic

Overview

NHS patients now typically wait longer for non-urgent heart surgery than before the pandemic, and more die as a result. These findings, from an HDR UK-supported study of nearly 100,000 people’s health data, highlight flaws in how risk is currently predicted for waiting list patients. AI tools and better integrated care at a smaller number of large heart units could better pinpoint those patients at greatest risk, the findings suggest.

The challenge

The COVID-19 pandemic caused huge upheavals in the NHS. To reallocate resources, less urgent surgeries were postponed, including heart valve and coronary artery bypass operations. An HDR UK-supported study set out to investigate trends in surgery waiting times, disease severity and deaths among these non-urgent heart surgery patients, by looking at data from before, during and after the pandemic.

The solution

Dr Tim Dong, Data Science Lead from the Bristol Heart Institute, led an analysis of data from 91,371 adults in England who had heart surgery between January 2018 and March 2022. The research team aimed to understand trends and changes before, during and after the pandemic years. To get a full picture of patients’ experiences and outcomes, they linked data from the National Adult Cardiac Surgery (NACSA) database, GP and hospital records, COVID testing and pandemic planning data and ONS and death registration data. Data access and linkage was enabled by the HDR UK-supported BHF Data Science Centre.

Waiting times for non-urgent heart surgery have gradually increased since the pandemic began, findings showed, peaking at 202 days in February 2022 compared with a pre-pandemic peak of 193 days in March 2019. Significantly more people now die while on surgery waiting lists, with their disease worsening during the wait.

“The study showed that the pandemic has changed the nature of cardiac surgical practice so that now 50% of the work done is now urgent work on patients being admitted acutely,” says co-author Dr Norman Briffa, NICE Guideline Committee Member.

He believes there could be several reasons for this, including a biological change that makes cardiac conditions more severe; patients coming to accident and emergency departments because they struggle to access healthcare in any other way; or that the longer wait is causing heart conditions to deteriorate to the extent that they require an emergency admission to hospital.

“COVID-19 had a significant negative impact on adult cardiac surgical case mix and volume. Regrettably, this has not recovered to the pre-pandemic levels,” adds study co-author Professor Gianni Angelini from the Bristol Heart Institute.

The impact

The NHS is still under severe strain in the wake of the pandemic, this study shows. It also reveals flaws in the current system for predicting which patients on waiting lists are at risk of worsening disease and death. Despite a rise in deaths, the risk score that clinicians currently use to prioritise patients for surgery actually showed a decline in patient risk after the pandemic.

Dr Dong believes that pre-pandemic risk scores are no longer fit for purpose, because they don’t factor in wait time, the case mix of patients or the pandemic itself. Instead, AI machine learning approaches may more accurately group and pinpoint higher-risk patients.

“Increased wait times are not beneficial for patients and something needs to be done about this,” remarks Dr Dong. “The government has already highlighted the need for digitalisation strategies and investments. We also need to have better digital strategies in place to plan for future situations— for example to cover for the junior doctors when they’re away on strikes.”

The researchers also suggest the need for clinicians to better integrate emergency care, GP care, diagnostic lab test results and post-surgical care into one, holistic plan for each patient.

“We need to monitor patients more efficiently and in more personalised ways after they have surgery so that we can proactively identify those patients most at risk of disease recurrence,” says Dr Dong.

Following on from the findings, there are plans to integrate the University Hospital (UH) Bristol NHS Trust with the North Bristol NHS Trust. The merge provides a new opportunity to link not only the service across the two Trusts, but also the diagnostic department’s data with data on UH Bristol’s heart patients. Patients’ clinical outcomes and diagnostic results can be connected and the systems and strengths of both Trusts brought together.

“That would allow us to build more comprehensive datasets for effective machine learning tools and AI systems for healthcare,” adds Dr Dong.

Proposals are already in place at the two Trusts to link patients’ genomics data with tools to predict atrial fibrillation; a common heart condition. This would allow doctors to prepare and plan more personalised anticoagulant (blood thinning) treatment for these patients—bringing more integrated care a step closer.