# Impact of COVID-19 Pandemic on Cardiovascular Healthcare in Croatia: A Comprehensive Nationwide Survey

## TL;DR

This study examines how the Croatian cardiovascular healthcare system adapted during the COVID-19 pandemic, showing resilience and some expansion in critical services.

## Contribution

The study provides the first comprehensive nationwide analysis of cardiovascular healthcare utilization changes in Croatia during the pandemic.

## Key findings

- Use of coronary angiographies decreased during the pandemic.
- Advanced heart failure treatments and percutaneous coronary interventions increased, especially for acute myocardial infarction.
- Transcatheter aortic valve implantations and laboratory tests for troponin and natriuretic peptides saw significant rises.

## Abstract

The impact of the COVID-19 pandemic on cardiovascular healthcare in Croatia remains largely unexplored. This study aimed to compare the utilization and provision of cardiovascular services during the pre-pandemic (2017–2019) and pandemic (2020–2021) periods, leveraging nationwide data from the Croatian Health Insurance Fund, which covers 95% of all insurance claims in the country. Our findings reveal that while the use of coronary angiographies decreased during the pandemic, there was a notable increase in the utilization of advanced heart failure treatment modalities and percutaneous coronary interventions, particularly in the context of acute myocardial infarction. Additionally, transcatheter aortic valve implantations saw a significant rise during the pandemic period. Furthermore, laboratory diagnostic testing for troponin and natriuretic peptides experienced a marked increase, while the utilization of most other cardiovascular services remained stable or showed only minor declines compared to the pre-pandemic era. These observations suggest that the Croatian cardiovascular healthcare system displayed resilience during the COVID-19 pandemic, successfully maintaining and even expanding access to various diagnostic and interventional procedures despite facing widespread societal and logistical challenges.