Impact of COVID-19 on Diagnosis of Heart Disease Worldwide

Quick Takes

  • COVID-19 pandemic was associated with a rapid reduction in cardiovascular diagnostic procedures across the world.
  • Additional studies are indicated to assess the impact of these reductions in cardiovascular diagnostic care related to COVID-19, as they raise serious concerns for long-term worsening of cardiovascular health outcomes from lack of timely diagnosis.
  • Multiple stakeholders will need to work together to improve timely patient access to cardiovascular diagnosis and therapeutics in this ongoing and in future pandemics.

Study Questions:

What has been the impact of coronavirus disease 2019 (COVID-19) on global cardiovascular diagnostic procedural volumes and safety practices?

Methods:

The investigators in an effort led by the International Atomic Energy Agency (IAEA) Division of Human Health performed a large-scale global Web-based survey to assess changes in noninvasive and invasive diagnostic procedural volumes and in safety practices resulting from the COVID-19 pandemic. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment (PPE) and pandemic-related testing practice changes were ascertained. Nonparametric statistics using the Kruskal-Wallis test with asymptotic 2-sided p values were calculated when comparing differences in test volume between 2019 and 2020 and differences in continuous variables between world regions, and generalized linear models were performed.

Results:

Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and 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 and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of PPE and telehealth.

Conclusions:

The authors concluded that COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world’s economically challenged.

Perspective:

This global survey reports that the COVID-19 pandemic was associated with a rapid reduction in cardiovascular diagnostic procedures across the world. Of note, decreases in cardiac testing and the unavailability of PPE and telehealth were most notable in lower-income countries. Additional studies are indicated to assess the impact of these reductions in cardiovascular diagnostic care related to COVID-19, as they raise serious concerns for long-term worsening of cardiovascular health outcomes from lack of timely diagnosis. Multiple stakeholders will need to work together to improve timely patient access to cardiovascular diagnosis and therapeutics in this ongoing and in future pandemics, especially in low- and middle-income countries to avoid marked increases in cardiovascular morbidity and mortality.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Coronary Angiography, Coronavirus, COVID-19, Developing Countries, Diagnostic Imaging, Echocardiography, Echocardiography, Transesophageal, Exercise Test, Heart Diseases, Global Health, Inpatients, Myocardial Ischemia, Outcome Assessment (Health Care), Outpatients, Pandemics, Personal Protective Equipment, Primary Prevention, Telemedicine, Tomography


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