Elsevier

JACC: Cardiovascular Imaging

Volume 14, Issue 9, September 2021, Pages 1787-1799
JACC: Cardiovascular Imaging

Original Research
Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World

https://doi.org/10.1016/j.jcmg.2021.03.007Get rights and content
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Abstract

Objectives

This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic.

Background

The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality.

Methods

Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States.

Results

Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis.

Conclusions

We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.

Key Words

cardiovascular disease
cardiovascular imaging
coronavirus
COVID-19
diagnostic cardiovascular procedure

Abbreviations and Acronyms

CAC
coronary artery calcium scan
CCTA
coronary computed tomographic angiography
CMR
cardiac magnetic resonance
COVID-19
coronavirus disease-2019
CVD
cardiovascular disease
IAEA
International Atomic Energy Agency
ICA
invasive coronary angiography
PET
positron emission tomography
SPECT
single-photon emission computed tomography
TEE
transesophageal echocardiogram
TTE
transthoracic echocardiogram

Cited by (0)

James Udelson, MD, served as Guest Editor 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.