Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison

Cole B Hirschfeld; Sharmila Dorbala; Leslee J Shaw; Todd C Villines; Andrew D Choi; Nathan Better; Rodrigo J Cerci; Ganesan Karthikeyan; João V Vitola; Michelle C Williams; Mouaz Al-Mallah; Daniel S Berman; Adam Bernheim; Robert W Biederman; Paco E Bravo; Matthew J Budoff; Renee P Bullock-Palmer; Marcus Y Chen; Michael P DiLorenzo; Rami Doukky; Maros Ferencik; Jeffrey B Geske; Fadi G Hage; Robert C Hendel; Lynne Koweek; Venkatesh L Murthy; Jagat Narula; Patricia F Rodriguez Lozano; Nishant R Shah; Amee Shah; Prem Soman; Randall C Thompson; David Wolinsky; Yosef A Cohen; Eli Malkovskiy; Michael J Randazzo; Juan Lopez-Mattei; Purvi Parwani; Mrinali Shetty; Thomas N B Pascual; Yaroslav Pynda; Maurizio Dondi; Diana Paez; Andrew J Einstein; INCAPS COVID 2 Investigators Group

doi:10.1148/ryct.220288

Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison

Radiol Cardiothorac Imaging. 2023 Sep 21;5(5):e220288. doi: 10.1148/ryct.220288. eCollection 2023 Oct.

Authors

Cole B Hirschfeld¹, Sharmila Dorbala¹, Leslee J Shaw¹, Todd C Villines¹, Andrew D Choi¹, Nathan Better¹, Rodrigo J Cerci¹, Ganesan Karthikeyan¹, João V Vitola¹, Michelle C Williams¹, Mouaz Al-Mallah¹, Daniel S Berman¹, Adam Bernheim¹, Robert W Biederman¹, Paco E Bravo¹, Matthew J Budoff¹, Renee P Bullock-Palmer¹, Marcus Y Chen¹, Michael P DiLorenzo¹, Rami Doukky¹, Maros Ferencik¹, Jeffrey B Geske¹, Fadi G Hage¹, Robert C Hendel¹, Lynne Koweek¹, Venkatesh L Murthy¹, Jagat Narula¹, Patricia F Rodriguez Lozano¹, Nishant R Shah¹, Amee Shah¹, Prem Soman¹, Randall C Thompson¹, David Wolinsky¹, Yosef A Cohen¹, Eli Malkovskiy¹, Michael J Randazzo¹, Juan Lopez-Mattei¹, Purvi Parwani¹, Mrinali Shetty¹, Thomas N B Pascual¹, Yaroslav Pynda¹, Maurizio Dondi¹, Diana Paez¹, Andrew J Einstein¹; INCAPS COVID 2 Investigators Group

Affiliation

¹ From the Division of Cardiology, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY (C.B.H.); Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Mass (S.D.); Blavatnik Family Women's Health Research Institute, Mount Sinai Medical Center, New York, NY (L.J.S.); Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Va (T.C.V.); The George Washington University School of Medicine, Washington, DC (A.D.C.); Cabrini Health, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia (N.B.); Quanta Diagnostico por Imagem, Curitiba, Brazil (R.J.C., J.V.V.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India (G.K.); BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland (M.C.W.); Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (M.A.M.); Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B.); Division of Cardiology, Centre for Cardiac MRI, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pa (R.W.B.); Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (P.E.B.); Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.); Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.P.B.P.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY (M.P.D., A.S.); Division of Cardiology, Cook County Health, Chicago, Ill (R.D.); Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore (M.F.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn (J.B.G.); University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Ala (F.G.H.); Section of Cardiology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, La (R.C.H.); Duke University Medical Center, Durham, NC (L.K.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (V.L.M.); Division of Cardiology, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (J.N.); Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Va (P.F.R.L.); Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, RI (N.R.S.); Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (P.S.); St Luke's Mid America Heart Institute, Kansas City, Mo (R.C.T.); Cleveland Clinic Florida, Weston, Fla (D.W.); Technion Israel Institute of Technology, Haifa, Israel (Y.A.C., A.J.E.); Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, 622 W 168th St, PH 10-203, New York, NY 10032 (E.M., A.J.E.); Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY (M.J.R.); Lee Health Heart & Vascular Institute, Fort Myers, Fla (J.L.M.); Department of Cardiology, Loma Linda University Health, Loma Linda, Calif (P.P.); University of Chicago (NorthShore), NorthShore University Health System, Evanston, Ill (M.S.); Department of Science and Technology, Philippine Nuclear Research Institute, Quezon City, Philippines (T.N.B.P.); International Atomic Energy Agency, Vienna, Austria (Y.P., M.D., D.P.); and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY (A.J.E.).

Abstract

Purpose: To characterize the recovery of diagnostic cardiovascular procedure volumes in U.S. and non-U.S. facilities in the year following the initial COVID-19 outbreak.

Materials and methods: The International Atomic Energy Agency (IAEA) coordinated a worldwide study called the IAEA Noninvasive Cardiology Protocols Study of COVID-19 2 (INCAPS COVID 2), collecting data from 669 facilities in 107 countries, including 93 facilities in 34 U.S. states, to determine the impact of the pandemic on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic imaging modality used at their facility for March 2019 (baseline), April 2020, and April 2021. This secondary analysis of INCAPS COVID 2 evaluated differences in changes in procedure volume between U.S. and non-U.S. facilities and among U.S. regions. Factors associated with return to prepandemic volumes in the United States were also analyzed in a multivariable regression analysis.

Results: Reduction in procedure volumes in April 2020 compared with baseline was similar for U.S. and non-U.S. facilities (-66% vs -71%, P = .27). U.S. facilities reported greater return to baseline in April 2021 than did all non-U.S. facilities (4% vs -6%, P = .008), but there was no evidence of a difference when comparing U.S. facilities with non-U.S. high-income country (NUHIC) facilities (4% vs 0%, P = .18). U.S. regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, P = .03), but no studied factors were significant predictors of 2021 change from prepandemic baseline.

Conclusion: The reductions in cardiac testing during the early pandemic have recovered within a year to prepandemic baselines in the United States and NUHICs, while procedure volumes remain depressed in lower-income countries.Keywords: SPECT, Cardiac, Epidemiology, Angiography, CT Angiography, CT, Echocardiography, SPECT/CT, MR Imaging, Radionuclide Studies, COVID-19, Cardiovascular Imaging, Diagnostic Cardiovascular Procedure, Cardiovascular Disease, Cardiac Testing Supplemental material is available for this article. © RSNA, 2023.

Keywords: Angiography; COVID-19; CT; CT Angiography; Cardiac; Cardiac Testing; Cardiovascular Disease; Cardiovascular Imaging; Diagnostic Cardiovascular Procedure; Echocardiography; Epidemiology; MR Imaging; Radionuclide Studies; SPECT; SPECT/CT.

Abstract

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