Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World


Cole B. Hirschfeld, Columbia University Irving Medical Center
Leslee J. Shaw, Weill Cornell Medicine
Michelle C. Williams, Edinburgh Medical School
Ryan Lahey, Columbia University Irving Medical Center
Todd C. Villines, University of Virginia School of Medicine
Sharmila Dorbala, Brigham and Women's Hospital
Andrew D. Choi, The George Washington University School of Medicine and Health Sciences
Nishant R. Shah, The Warren Alpert Medical School
David A. Bluemke, University of Wisconsin School of Medicine and Public Health
Daniel S. Berman, Cedars-Sinai Medical Center
Ron Blankstein, Brigham and Women's Hospital
Maros Ferencik, OHSU School of Medicine
Jagat Narula, The Mount Sinai Medical Center
David Winchester, University of Florida
Eli Malkovskiy, Columbia University Irving Medical Center
Benjamin Goebel, Weill Cornell Medicine
Michael J. Randazzo, Columbia University Irving Medical Center
Juan Lopez-Mattei, University of Texas MD Anderson Cancer Center
Purvi Parwani, Loma Linda University Health
Joao V. Vitola, Quanta Diagnóstico por Imagem
Rodrigo J. Cerci, Quanta Diagnóstico por Imagem
Rodrigo J. Cerci, Quanta Diagnóstico por Imagem
Nathan Better, Royal Melbourne Hospital
Paolo Raggi, University of Alberta
Bin Lu, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
Vladimir Sergienko, National Medical Research Center of Cardiology, Moscow
Valentin Sinitsyn, Lomonosov Moscow State University
Takashi Kudo, Nagasaki University
Bjarne Linde Nørgaard, Aarhus Universitetshospital
Pál Maurovich-Horvat, Semmelweis Egyetem
Yosef A. Cohen, Technion - Israel Institute of Technology
Thomas N.B. Pascual, Philippines Nuclear Research Institute
Yaroslav Pynda, International Atomic Energy Agency, Vienna

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JACC: Cardiovascular Imaging


Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.

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