Edinburgh Imaging

18 Jan 21. Featured Paper

International impact of COVID-19 on the diagnosis of heart disease.

Link to paper on Journal of the American College of Cardiology



Andrew J. Einstein, Leslee J. Shaw, Cole Hirschfeld, Michelle C. Williams, Todd C. Villines, Nathan Better, Joao V. Vitola, Rodrigo Cerci, Sharmila Dorbala, Paolo Raggi, Andrew D. Choi, Bin Lu, Valentin Sinitsyn, Vladimir Sergienko, Takashi Kudo, Bjarne Linde Nørgaard, Pál Maurovich-Horvat, Roxana Campisi, Elisa Milan, Lizette Louw, Adel H. Allam, Mona Bhatia, Eli Malkovskiy, Benjamin Goebel, Yosef Cohen, Michael Randazzo, Jagat Narula, Thomas N.B. Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, and on behalf of the INCAPS COVID Investigators Group



Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis & treatment of noncommunicable diseases.

Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.

Objectives: The study sought to assess COVID-19’s impact on global cardiovascular diagnostic procedural volumes & safety practices.

Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes & safety practices resulting from COVID-19.

Noninvasive & invasive cardiac testing volumes were obtained from participating sites for March & April 2020 & compared with those from March 2019.

Availability of personal protective equipment & pandemic-related testing practice changes were ascertained.

Results: Surveys were submitted from 909 inpatient & outpatient centers performing cardiac diagnostic procedures, in 108 countries.

Procedure volumes decreased 42% from March 2019 to March 2020, & 64% from March 2019 to April 2020.

Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, & stress tests 78%, which varied between stress modalities.

Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure).

In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product.

Location in a low-income & lower–middle-income country was associated with an additional 22% reduction in cardiac procedures & less availability of personal protective equipment & telehealth.

Conclusions: COVID-19 was associated with a significant & abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world’s economically challenged.

Further study of cardiovascular outcomes & COVID-19–related changes in care delivery is warranted.





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Featured paper: International impact of COVID-19 on the diagnosis of heart disease.

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