Abstract 12067: the Impact of the COVID-19 Pandemic on Congenital Heart Defect-Related Healthcare by Age and Insurance Status

Objective: To examine congenital heart defect (CHD)-related healthcare for children and adults during the COVID-19 pandemic. Methods: IBM Marketscan® Commercial and Multi-State Medicaid Databases from 2018-2020 were used to examine outpatient and inpatient encounters and cardiac procedures/surgeries with ≥ 1 CHD ICD-10-CM codes (Q20-Q26; Z87.74), excluding isolated Q21.1 and encounters with a COVID-19 ICD-10-CM code. Monthly rates of encounter types per 5 mil enrolled children and 15 mil enrolled adults and percent telemedicine encounters were averaged across 2018-2019 and compared to 2020 by age (0-17y and 18-64y) using chi square tests. Results: Data included 583,069 commercial (private) and 796,579 Medicaid CHD-related encounters in 2018-2020. For all groups, rates of encounters were lowest in Mar-May 2020 (Fig). In Jun-Dec 2020, rates returned approximately to 2018-19 levels, but were lower than needed to offset fewer encounters in the spring. Per 5 mil enrolled children in private and public insurance, there were over 8,400 fewer CHD-related outpatient encounters, 5,300 fewer inpatient encounters, and 260 fewer cardiac procedures/surgeries in 2020 compared to 2018-19 (p<0.0001). In Jan-Feb 2020, adult Medicaid outpatient encounters were above 2018-19 levels. However, per 15 mil enrolled privately- and publicly-insured adults, there were over 5,600 fewer inpatient encounters and 460 fewer cardiac procedures/surgeries in 2020 compared to 2018-19. Telemedicine encounters were highest in Apr 2020 and remained above 2018-19 levels through Dec 2020, with the highest percentage among privately-insured adults (p<0.0001). Conclusion: In the second half of 2020, CHD-related encounters returned to 2018-19 levels, yet did not compensate for lower-than-expected encounters in the spring, resulting in fewer pediatric CHD-related encounters and fewer adult CHD-related inpatient encounters in 2020. Use of telemedicine differed by insurance and age.