Admissions and readmissions among patients with congestive heart failure: the impact of pandemic waves in New South Wales, Australia.

OBJECTIVES

Australia is among the few large jurisdictions to experience more than one pandemic wave preceded by no incident COVID-19 cases. This enables research to estimate the immediacy, extent and duration of impact of those waves on initial admission and readmission rates for patients with congestive heart failure (CHF), as an example of high users of hospital services.

METHODS

We used single and controlled interrupted time series designs, segmented regression analyses, and linked administrative data from 2016 to 2021.

RESULTS

Patients with CHF experienced immediate and sizable reductions in weekly acute initial admissions of 26% and 16% for up to 3-5 months after the first and Delta waves in 2020 and 2021, respectively. Unplanned readmissions within 30 days declined by 2.30 and 3.59 percentage points (10-16% rate reduction) and remained lower than expected for more than 4-5 months after both waves. These reductions occurred after years of stability in these measures. Reductions commenced before the World Health Organization declaration in 2020 and coincided with stay-at-home orders in 2021. There was no significant change in the average length of stay.

CONCLUSIONS

Pandemic waves and restrictions in New South Wales resulted in rapid, sizable, and sustained reductions in initial admission and readmission rates among patients with CHF, suggesting that clinician, patient and/or family decisions reduced potentially preventable admissions, as these decisions occurred before or at the time of public health declarations. Future studies should explore the potential impact of this magnitude of reduction on the health outcomes of patients with CHF.