Disparities in Noninvasive Traditional and Advanced Testing for Coronary Artery Disease: Findings from the INCAPS-COVID 2 Study

Todd C. Villines, University of Virginia Health System, Charlottesville, Virginia. Electronic address: tv4bc@uvahealth.org.
Patricia Rodriguez-Lozano, University of Virginia Health System, Charlottesville, Virginia.
Indika Mallawaarachchi, University of Virginia Health System, Charlottesville, Virginia.
Michelle C. Williams, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Cole Hirschfeld, Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York.
Nathan Better, Department of Cardiology and Nuclear Medicine, Cabrini Health, Royal Melbourne Hospital, University of Melbourne, Australia.
Leslee J. Shaw, Blavatnik Family Women'S Health Research Institute, Mount Sinai Medical Center, New York, New York.
Joao V. Vitola, Quanta Diagnóstico, Brazil.
Rodrigo J. Cerci, Quanta Diagnóstico, Brazil.
Sharmila Dorbala, Brigham and Women's Hospital, Boston, Massachusetts.
Chiara Bucciarelli-Ducci, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Trust and King's College London, London, United Kingdom.
Ganesan Karthikeyan, Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Yosef A. Cohen, Department of Epidimiology, Columbia-Mailman School of Public Health, New York, New York.
Eli Malkovskiy, Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York; Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York.
Michael J. Randazzo, Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois.
Andrew D. Choi, Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, District of Columbia.
Thomas N. Pascual, Philippine Nuclear Research Institute, Quezon City, Philippines.
Yaroslav Pynda, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
Maurizio Dondi, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
Diana Paez, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
Andrew J. Einstein, Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York; Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York.

Document Type

Journal Article

Publication Date

3-1-2024

Journal

The American journal of cardiology

Volume

214

DOI

10.1016/j.amjcard.2023.12.048

Keywords

COVID-19; cardiac testing; coronavirus; health disparities; health equity

Abstract

The COVID-19 pandemic disrupted the delivery of cardiovascular care, including noninvasive testing protocols and test selection for the evaluation of coronary artery disease (CAD). Trends in test selection in traditional versus advanced noninvasive tests for CAD during the pandemic and in countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess the pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (prepandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities, such as exercise electrocardiography, stress echocardiography, and stress single-photon emission computed tomography, and advanced testing modalities, such as stress cardiac magnetic resonance, coronary computed tomography angiography, and stress positron emission tomography. Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared with 2019, traditional tests were performed 14% less frequently (recovery rate 82%) in 2021 versus advanced tests, which were performed 15% more frequently (128% recovery rate). Coronary computed tomography angiography, stress cardiac magnetic resonance, and stress positron emission tomography showed 14%, 25%, and 25% increases in volumes from 2019 to 2021, respectively. The increase in advanced testing was isolated to high- and upper middle-income countries, with 132% recovery in advanced tests by 2021 compared with 55% in lower income nations. The COVID-19 pandemic exacerbated economic disparities in CAD testing practice between wealthy and poorer countries. Greater recovery rates and even new growth were observed for advanced imaging modalities; however, this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing because of economic status are warranted.

Department

Medicine

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