Impact of the COVID-19 Pandemic on Healthcare Access and Diagnosis of Pulmonary Arterial Hypertension Among Patients with Systemic Sclerosis.

Abstract

Regular clinical assessment for complications of systemic sclerosis (SSc) such as pulmonary arterial hypertension (PAH), is essential for early institution of therapy and improved outcomes. The objective of this study was to determine the impact of COVID-19 pandemic-related restrictions on healthcare access of SSc patients, including screening for PAH. South Australian and Victorian patients enrolled in the Australian Scleroderma Cohort Study were surveyed about their perceptions of the impact of the pandemic on mental well-being, access to medications, investigations and management of SSc. Frequency of annual rheumatology assessments, pulmonary function tests (PFT) and transthoracic echocardiography (TTE) to screen for PAH were compared with pre-pandemic rates. 312/810 SSc patients responded (38.5% response). 273 (87.5%) were female, median age 64.7 years, 77.2% had limited disease, median illness duration 15.6 years, 15.7% were immunosuppressed, 32.1% had interstitial lung disease and 6.4% had PAH. 65.7% of consultations were by telehealth, of which 81.2% were by telephone. Compared with respondents in SA (n=109), VIC respondents (n=203) experiencing prolonged lockdown, reported reduced access to their rheumatologist (49.3% vs 27.9%, p=0.004), greater use of consultation by video (17.3% vs 2.1%, p=0.008), greater healthcare disruption (49.0% vs 23.2%, p<0.001) and worse mental health (p=0.002). Respondents reported reduced access to PFT and TTE (31.7% and 22.5% respectively). Annual visits, PFT, TTE and new diagnoses of PAH were reduced in 2020-2022 compared with 2011-2019. COVID-19 pandemic-related disruption to healthcare for SSc patients was associated with worse mental health and reduced screening and diagnosis of PAH which may impact long-term outcomes. This article is protected by copyright. All rights reserved.