TY - JOUR
T1 - Disparities in Noninvasive Traditional and Advanced Testing for Coronary Artery Disease
T2 - Findings from the INCAPS-COVID 2 Study
AU - Villines, Todd C
AU - Rodriguez-Lozano, Patricia
AU - Mallawaarachchi, Indika
AU - Williams, Michelle C
AU - Hirschfeld, Cole
AU - Better, Nathan
AU - Shaw, Leslee J
AU - Vitola, Joao V
AU - Cerci, Rodrigo J
AU - Dorbala, Sharmila
AU - Bucciarelli-Ducci, Chiara
AU - Karthikeyan, Ganesan
AU - Cohen, Yosef A
AU - Malkovskiy, Eli
AU - Randazzo, Michael J
AU - Choi, Andrew D
AU - Pascual, Thomas N B
AU - Pynda, Yaroslav
AU - Dondi, Maurizio
AU - Paez, Diana
AU - Einstein, Andrew J
AU - INCAPS COVID 2 Investigators Group
AU - Morrissey, Brian
N1 - The INCAPS-COVID 2 investigators group, listed by name in the Appendix, thank the cardiology and imaging professional societies worldwide for their assistance in disseminating the survey to their memberships. These include, alphabetically, but are not limited to, the American Society of Nuclear Cardiology, Arab Society of Nuclear Medicine, Australasian Association of Nuclear Medicine Specialists, Australia-New Zealand Society of Nuclear Medicine, Belgian Society of Nuclear Medicine, Brazilian Nuclear Medicine Society, British Society of Cardiovascular Imaging, Conjoint Committee for the Recognition of Training in CT Coronary Angiography, Consortium of Universities and Institutions in Japan, Gruppo Italiano Cardiologia Nucleare, Indonesian Society of Nuclear Medicine, Japanese Society of Nuclear Cardiology, Philippine Society of Nuclear Medicine, Russian Society of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Thailand Society of Nuclear Medicine. Dr. Williams (FS/ICRF/20/26002) is supported by the British Heart Foundation.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - The COVID-19 pandemic disrupted the delivery of cardiovascular care, including noninvasive testing protocols and test selection for the evaluation of coronary artery disease (CAD). Trends in test selection in traditional versus advanced noninvasive tests for CAD during the pandemic and in countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess the pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (prepandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities, such as exercise electrocardiography, stress echocardiography, and stress single-photon emission computed tomography, and advanced testing modalities, such as stress cardiac magnetic resonance, coronary computed tomography angiography, and stress positron emission tomography. Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared with 2019, traditional tests were performed 14% less frequently (recovery rate 82%) in 2021 versus advanced tests, which were performed 15% more frequently (128% recovery rate). Coronary computed tomography angiography, stress cardiac magnetic resonance, and stress positron emission tomography showed 14%, 25%, and 25% increases in volumes from 2019 to 2021, respectively. The increase in advanced testing was isolated to high- and upper middle-income countries, with 132% recovery in advanced tests by 2021 compared with 55% in lower income nations. The COVID-19 pandemic exacerbated economic disparities in CAD testing practice between wealthy and poorer countries. Greater recovery rates and even new growth were observed for advanced imaging modalities; however, this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing because of economic status are warranted.
AB - The COVID-19 pandemic disrupted the delivery of cardiovascular care, including noninvasive testing protocols and test selection for the evaluation of coronary artery disease (CAD). Trends in test selection in traditional versus advanced noninvasive tests for CAD during the pandemic and in countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess the pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (prepandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities, such as exercise electrocardiography, stress echocardiography, and stress single-photon emission computed tomography, and advanced testing modalities, such as stress cardiac magnetic resonance, coronary computed tomography angiography, and stress positron emission tomography. Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared with 2019, traditional tests were performed 14% less frequently (recovery rate 82%) in 2021 versus advanced tests, which were performed 15% more frequently (128% recovery rate). Coronary computed tomography angiography, stress cardiac magnetic resonance, and stress positron emission tomography showed 14%, 25%, and 25% increases in volumes from 2019 to 2021, respectively. The increase in advanced testing was isolated to high- and upper middle-income countries, with 132% recovery in advanced tests by 2021 compared with 55% in lower income nations. The COVID-19 pandemic exacerbated economic disparities in CAD testing practice between wealthy and poorer countries. Greater recovery rates and even new growth were observed for advanced imaging modalities; however, this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing because of economic status are warranted.
U2 - 10.1016/j.amjcard.2023.12.048
DO - 10.1016/j.amjcard.2023.12.048
M3 - Article
C2 - 38218393
SN - 0002-9149
VL - 214
SP - 85
EP - 93
JO - The American Journal of Cardiology
JF - The American Journal of Cardiology
ER -