Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

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, USA; Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA. Electronic address: andrew.einstein@columbia.edu.
Cole Hirschfeld, Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, New York, USA.
Michelle C. Williams, BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Joao V. Vitola, Quanta Diagnostico, Curitiba, Brazil.
Nathan Better, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia.
Todd C. Villines, University of Virginia, Charlottesville, Virginia, USA.
Rodrigo Cerci, Quanta Diagnostico, Curitiba, Brazil.
Leslee J. Shaw, Blavatnik Family Women's Health Research Institute, Mount Sinai Medical Center, New York, New York, USA.
Andrew D. Choi, The George Washington University School of Medicine, Washington, District of Columbia, USA.
Sharmila Dorbala, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Ganesan Karthikeyan, Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Bin Lu, National Center for Cardiovascular Diseases, Beijing, China.
Valentin Sinitsyn, University Hospital, Lomonosov Moscow State University, Moscow, Russian Federation.
Alexey A. Ansheles, National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation.
Takashi Kudo, Nagasaki University, Nagasaki, Japan.
Chiara Bucciarelli-Ducci, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Trust and King's College London, London, United Kingdom.
Bjarne Linde Nørgaard, Aarhus University Hospital, Aarhus, Denmark.
Pál Maurovich-Horvat, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
Roxana Campisi, Diagnóstico Maipú, Buenos Aires, Argentina.
Elisa Milan, Ospedale Cà Foncello, Treviso, Italy.
Lizette Louw, University of the Witwatersrand, Johannesburg, South Africa.
Adel H. Allam, Al Azhar University, Cairo, Egypt.
Mona Bhatia, Fortis Escorts Heart Institute, New Delhi, India.
Lorenzo Sewanan, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
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, USA; Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
Yosef Cohen, Technion Israel Institute of Technology, Haifa, Israel.
Michael Randazzo, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
Jagat Narula, Mount Sinai Medical Center, New York, New York, USA.
Olga Morozova, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
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.

Document Type

Journal Article

Publication Date

5-24-2022

Journal

Journal of the American College of Cardiology

Volume

79

Issue

20

DOI

10.1016/j.jacc.2022.03.348

Keywords

COVID-19; cardiac testing; cardiovascular disease; coronavirus; global health

Abstract

BACKGROUND: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. OBJECTIVES: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. RESULTS: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing. CONCLUSIONS: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.

Department

Medicine

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