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

https://doi.org/10.1016/j.jacc.2022.03.348Get rights and content
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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.

Key Words

cardiac testing
cardiovascular disease
coronavirus
COVID-19
global health

Abbreviations and Acronyms

CMR
cardiac magnetic resonance
CT
computed tomography
CTA
computed tomographic angiography
IAEA
International Atomic Energy Agency
PET
positron emission tomography
SPECT
single-photon emission computed tomography
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

Khurram Nasir, MD, MPH, served as the Guest Associate Editor for this paper. Christie Ballantyne, MD, served as the Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.