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Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study

Takashi Kudo et al. JACC Asia. .

Abstract

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known.

Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia.

Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison.

Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020.

Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Keywords: CMR, cardiac magnetic resonance; COVID-19; COVID-19, coronavirus disease-19; CTA, computed tomographic angiography; ICA, invasive coronary angiography; PET, positron emission tomography; SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; TTE, transthoracic echocardiography; cardiac testing; cardiovascular disease; coronavirus; global health.

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Conflict of interest statement

This work was supported by the International Atomic Energy Agency (IAEA). The INCAPS-COVID study was led by the IAEA, which provided the required infrastructure for data collection. Information from participating centers was provided on a voluntary basis and no compensation was paid. The IAEA covers the cost of open access of any published manuscript. Dr Kudo has received consulting fees from Nihon mediphysics and FUJIFILM Toyama Chemical; and his institution has received grants from Nihon mediphysics and FUJIFILM Toyama Chemical, all unrelated to the current work. Dr Dorbala has received honoraria from Pfizer and GE Healthcare; and her institution has received grants from Pfizer and GE Healthcare, all unrelated to the current work. Dr Einstein has received consulting fees from W. L. Gore and Associates; has received fees for lecturing from Ionetix; and his institution has grants/grants pending from Canon Medical Systems, Eidos Therapeutics, GE Healthcare, Roche Medical Systems, W. L. Gore and Associates, and XyloCor Therapeutics, all unrelated to the current work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Reductions in Cardiovascular Disease Diagnostic Testing Volumes by Asian Region The numbers of included countries and facilities in each subregion are shown in the bottom table.
Figure 1
Figure 1
Asian Map Showing Reductions in Total Cardiovascular Procedural Volumes (Top) Change from March 2019 to April 2020, indicating total change during this study period. (Middle) Change from March 2019 to March 2020, indicating the impact of the very early phase of the pandemic. (Bottom) Change from March 2020 to April 2020, indicating short-term trends during the very early phase of pandemic. Countries or territories of a country in gray did not have data available. Darker blue color indicates severe reduction. Warmer color indicates recovery.
Figure 2
Figure 2
Reductions in Each Cardiac Procedure Modality The number of each procedure type in Asia (left) and in the rest of the world (ROW) (right) at March 2019, March 2020, and April 2020. All types of stress test modalities (exercise electrocardiography, stress echocardiography, nuclear stress imaging [single-photon emission computed tomography and positron emission tomography], and stress cardiac magnetic resonance [CMR]) are grouped together. Note the recovery of coronary computed tomography angiography (CTA) was observed in Asia but not in the rest of the world. CAC = coronary artery calcium; TEE = transesophageal echocardiography; TTE = transthoracic echocardiography.
Figure 3
Figure 3
Reductions in Stress Test Volumes The number of each stress procedure in Asia (left) and in the ROW (right) at March 2019, March 2020, and April 2020. ECG = electrocardiogram; Echo = echocardiography; PET = positron emission tomography; SPECT = single-photon emission computed tomography; other abbreviations as in Figure 2.
Figure 4
Figure 4
Reductions in Individual Cardiac Procedure Modality in Each Subregion Reductions in the number of each procedure type in each Asian subregion. Note the different y-axis for each subregion. Abbreviations as in Figure 2.
Figure 5
Figure 5
Reductions in Stress Tests Volume in Each Subregion Reductions in the number of each stress procedure in each Asian subregion. Note the different y-axis for each subregion. Abbreviations as in Figures 2 and 3.
Figure 6
Figure 6
Reductions in Cardiac Diagnostic Procedures by Income Levels Reductions in the number of cardiac diagnostic procedures in low, lower-middle, upper-middle, and high-income countries between March 2019 and April 2020. ICA = invasive coronary angiography; other abbreviations as in Figure 2.
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