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COVID-19 Resource Center

Disclosures: Hirschfeld, Lehenbauer and Thompson report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
June 17, 2021
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Decline in CV testing at start of pandemic varied by region

Disclosures: Hirschfeld, Lehenbauer and Thompson report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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At the beginning of the COVID-19 pandemic, diagnostic CV volumes declined, but the drops varied by U.S. region, according to data from the INCAPS-COVID registry.

“Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for CVD morbidity and mortality,” Cole B. Hirschfeld, MD, internal medicine resident at Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, and colleagues wrote in JACC: Cardiovascular Imaging. “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.”

Data were derived from Hirschfeld CB, et al. JACC Cardiovasc Imaging. 2021;doi:10.1016/j.jcmg.2021.03.007.

Decline in diagnostic tests

The researchers analyzed 1.3 million imaging studies from the INCAPS-COVID registry of 909 centers in 108 countries, including 155 centers in 40 U.S. states. They compared data from April 2020, at the start of the COVID-19 pandemic, with data from March 2019.

Diagnostic CV procedures fell in April 2020 across the globe, at rates similar in and outside of the U.S. (U.S., 68%; non-U.S., 63%; P = .237), according to the researchers.

However, they found, invasive coronary angiography procedures declined more sharply in the U.S. compared with elsewhere (69% vs. 53%; P < .001).

U.S. centers were more likely than non-U.S. centers to report increased use of telehealth (90% vs. 65%; P < .001), of temperature checks for on-site patients (87% vs. 77%; P = .008), of symptom screening (97% vs. 86%; P < .001) and of COVID-19 testing (46% vs. 26%; P < .001).

In the U.S., reduction in diagnostic CV procedure volume varied by region, with the decline higher in the Northeast (76%) and Midwest (74%) than in the South (62%) and the West (44%), according to the researchers.

Factors associated with decline in procedures included COVID-19 prevalence (mean volume change, 0.6%; 95% CI, 0.1-1.1; P = .011), staff redeployments (mean volume change, 11.5%; 95% CI, 5.3-17.7; P < .001), status as outpatient center (mean volume change, 12.5%; 95% CI, 6.3-18.7; P < .001) and urban location (mean volume change, 9.7%; 95% CI, 3.3-16.1; P = .003).

“The substantial reduction in cardiovascular testing during the early phase of the pandemic highlights the need for strategies to maintain access to this essential resource in areas most affected by COVID-19 outbreaks and to mitigate the predicted burden of CVD morbidity and mortality in the wake of the pandemic,” Hirschfeld and colleagues wrote.

‘An appropriate decrease’

In a related editorial, Randall C. Thompson, MD, and Kyle R. Lehenbauer, MD, both from Saint Luke’s Mid-America Heart Institute and the University of Missouri-Kansas City, wrote: “With recommendations to postpone less urgent cardiovascular procedures, INCAPS COVID showed that there was indeed an appropriate decrease in the number of cardiovascular procedures being completed in the peak month of the pandemic, both in the United States (68% total procedural reduction) and globally (63% reduction). These reductions were highest in regions most affected by the pandemic, greater in outpatient than inpatient facilities, greater for more elective procedures, and seemingly were not affected by regional politics.”

However, they noted, “From INCAPS COVID, it is not known if after the early pandemic lockdowns large numbers of patients had long delays or never received diagnostic tests, cardiovascular treatments, and preventive therapies, or whether those procedures

returned to the previous baseline numbers relatively quickly. If the former is the case, we anticipate seeing a large wave of cardiovascular illness in the coming months and years.”

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