Infectious Disease

Decline in CV tests at the start of the pandemic varies by region

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Hirschfeld, Lehenbauer and Thompson do not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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At the onset of the COVID-19 pandemic, diagnostic CV volumes declined, but the declines varied by US region, according to data from the INCAPS-COVID registry.

“The global reduction in diagnostic cardiovascular testing has raised concerns about the impact of reduced testing on morbidity and mortality from cardiovascular disease.” Cole B. Hirschfeld, MD, Resident Internal Medicine at Irving Medical Center, Columbia University and New York-Presbyterian Hospital, and colleagues wrote in JACC: Cardiovascular Imaging. “We compared laboratory characteristics, practices, and volume of procedures between US and non-US facilities, and between US geographic regions, and identified factors associated with volume reductions in the United States.”

The data were provided by Hirschfeld CB, et al. JACC cardiovascular imaging. 2021; doi: 10.1016 / j.jcmg.2021.03.007.

Decrease in diagnostic tests

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

Diagnostic CV procedures declined globally in April 2020, with similar rates inside and outside the US (US, 68%; non-US, 63%; P = 0.237), the researchers said.

However, they found that invasive coronary angiography procedures decreased more in the US compared to other countries (69% vs. 53%; P <0.001).

US centers reported more frequently than non-US centers about increased use of telemedicine (90% vs. 65%; P <0.001), of temperature controls in on-site patients (87% vs. 77%; P = 0.008.). ), symptom screening (97% vs. 86%; p <0.001) and the COVID-19 test (46% vs. 26%; p <0.001).

In the US, the decrease in the volume of diagnostic cardiovascular procedures varied by region, with the decreases being greater in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Researcher.

Factors associated with a decline in procedures included COVID-19 prevalence (mean volume change 0.6%; 95% CI 0.1-1.1; P = 0.011), staff transfers (mean volume change 11th , 5%; 95% CI 5.3-17.7.). ; P <0.001), status as an outpatient center (mean volume change 12.5%; 95% CI 6.3-18.7; P <0.001) and urban location (mean volume change 9.7%; 95% CI 3.3- 16.1.); P = 0.003)).

“The significant reduction in cardiovascular testing in the early stages of the pandemic underscores the need for strategies to gain access to this vital resource in the areas hardest hit by COVID-19 outbreaks and the predicted burden of CVD morbidity and mortality in the wake of the pandemic, ”wrote Hirschfeld and colleagues.

“Reasonable Decline”

In a related editorial Randall C. Thompson, MD, and Kyle R. Lehenbauer, MD, from both 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 the number of cardiovascular procedures completed in the US has indeed declined appropriately is peak month of the pandemic, both in the United States (68% overall procedure reduction) and globally (63% reduction). These cuts were highest in the regions most affected by the pandemic, in outpatient rather than inpatient facilities, more in elective interventions and apparently not affected by regional policy. “

However, they noted, “It is unknown from INCAPS COVID whether a large number of patients had long delays or never received diagnostic tests, cardiovascular treatments and preventive therapies after the early pandemic lockdowns, or whether these procedures

returned relatively quickly to the previous baseline values. If the former is the case, we expect a great wave of cardiovascular diseases in the coming months and years. “

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