Prioritizing elective cardiovascular procedures during the COVID-19 pandemic: The cardiovascular medically necessary, time-sensitive procedure scorecard

Catheter Cardiovasc Interv. 2020 Nov;96(6):E602-E607. doi: 10.1002/ccd.29093. Epub 2020 Jun 26.


Background: Following the surge of the coronavirus disease 2019 (COVID-19) pandemic, government regulations, and recommendations from professional societies have conditioned the resumption of elective surgical and cardiovascular (CV) procedures on having strategies to prioritize cases because of concerns regarding the availability of sufficient resources and the risk of COVID-19 transmission.

Objectives: We evaluated the use of a scoring system for standardized triage of elective CV procedures.

Methods: We retrospectively reviewed records of patients scheduled for elective CV procedures that were prioritized ad hoc to be either performed or deferred when New Jersey state orders limited the performance of elective procedures due to the COVID-19 pandemic. Patients in both groups were scored using our proposed CV medically necessary, time-sensitive (MeNTS) procedure scorecard, designed to stratify procedures based on a composite measure of hospital resource utilization, risk of COVID-19 exposure, and time sensitivity.

Results: A total of 109 scheduled elective procedures were either deferred (n = 58) or performed (n = 51). The median and mean cumulative CV MeNTS scores for the group of performed cases were significantly lower than for the deferred group (26 (interquartile range (IQR) 22-31) vs. 33 (IQR 28-39), p < .001, and 26.4 (SE 0.34) vs. 32.9 (SE 0.35), p < .001, respectively).

Conclusions: The CV MeNTS procedure score was able to stratify elective cases that were either performed or deferred using an ad hoc strategy. Our findings suggest that the CV MeNTS procedure scorecard may be useful for the fair triage of elective CV cases during the time when available capacity may be limited due to the COVID-19 pandemic.

Keywords: appropriate use; healthcare policy; risk stratification.

MeSH terms

  • COVID-19*
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / trends*
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / therapy*
  • Clinical Decision-Making*
  • Decision Support Techniques*
  • Health Services Needs and Demand / trends*
  • Humans
  • New Jersey
  • Pandemics*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time-to-Treatment / trends
  • Triage / trends*