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; Renée 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

doi:10.1148/ryct.220288

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, Renée P. Bullock-Palmer, Marcus Y. Chen, Michael P. Dilorenzo, Rami DoukkyMaros 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

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Background: Disruptions in healthcare early in the COVID-19 pandemic led to a marked decline in diagnostic cardiovascular testing. This study aims to characterize subsequent recovery of procedure volumes in US and non-US facilities in the year following the initial outbreak.

Methods: The International Atomic Energy Agency (IAEA) coordinated a worldwide survey, collecting data from 669 facilities in 107 countries (including 93 facilities in 34 US states) to determine the pandemic’s impact on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic modality utilized at their facility for March 2019 (baseline), April 2020, and April 2021. We evaluated changes in procedure volume between US and non-US facilities and between US regions, and analyzed factors associated with return of procedure volume to pre-pandemic baseline in the US.

Results: Reduction in procedure volumes in April 2020 was similar for US and non-US facilities (-66% vs. -71%, p=0.27). US facilities reported greater return to baseline in April 2021 than all non-US facilities (4% vs. -6% p=0.01), but there was no difference when comparing US facilities to non-US high-income country (NUHIC) facilities (4% vs. 0%, p=0.18). Regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, p=0.03). No studied factors were significant predictors of 2021 change from pre-pandemic baseline in a multivariable regression analysis.

Conclusions:
The marked reductions in cardiac testing during the early pandemic have recovered within a year to pre-pandemic baselines in the US and NUHIC, while procedure volumes remain depressed in lower-income countries.

Original language	English
Journal	Radiology: Cardiothoracic Imaging
Early online date	21 Sept 2023
DOIs	https://doi.org/10.1148/ryct.220288
Publication status	Published - 1 Oct 2023

Keywords / Materials (for Non-textual outputs)

COVID-19
cardiovascular imaging
diagnostic cardiovascular procedure
cardiovascular disease
cardiac testing

Access to Document

10.1148/ryct.220288

2023 INCAPS COVID 2 - US Manuscrip_Revised PUREAccepted author manuscript, 643 KBLicence: Creative Commons: Attribution (CC-BY)

Cite this

Hirschfeld, C. B., Dorbala , S., Shaw, L. J., Villines, T. C., Choi, A. D., Better , N., Cerci, R. J., Karthikeyan, G., Vitola , J. V., Williams, M. C., Al-mallah, M., Berman, D. S., Bernheim, A., Biederman, R. W., Bravo, P. E., Budoff, M. J., Bullock-Palmer, R. P., Chen, M. Y., Dilorenzo, M. P., ... Einstein, A. J. (2023). Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison. Radiology: Cardiothoracic Imaging. https://doi.org/10.1148/ryct.220288

@article{46583bc7902345128d31f6dca6985047,

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

abstract = "Background: Disruptions in healthcare early in the COVID-19 pandemic led to a marked decline in diagnostic cardiovascular testing. This study aims to characterize subsequent recovery of procedure volumes in US and non-US facilities in the year following the initial outbreak.Methods: The International Atomic Energy Agency (IAEA) coordinated a worldwide survey, collecting data from 669 facilities in 107 countries (including 93 facilities in 34 US states) to determine the pandemic{\textquoteright}s impact on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic modality utilized at their facility for March 2019 (baseline), April 2020, and April 2021. We evaluated changes in procedure volume between US and non-US facilities and between US regions, and analyzed factors associated with return of procedure volume to pre-pandemic baseline in the US.Results: Reduction in procedure volumes in April 2020 was similar for US and non-US facilities (-66% vs. -71%, p=0.27). US facilities reported greater return to baseline in April 2021 than all non-US facilities (4% vs. -6% p=0.01), but there was no difference when comparing US facilities to non-US high-income country (NUHIC) facilities (4% vs. 0%, p=0.18). Regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, p=0.03). No studied factors were significant predictors of 2021 change from pre-pandemic baseline in a multivariable regression analysis.Conclusions: The marked reductions in cardiac testing during the early pandemic have recovered within a year to pre-pandemic baselines in the US and NUHIC, while procedure volumes remain depressed in lower-income countries.",

keywords = "COVID-19, cardiovascular imaging, diagnostic cardiovascular procedure, cardiovascular disease, cardiac testing",

author = "Hirschfeld, {Cole B.} and Sharmila Dorbala and Shaw, {Leslee J.} and Villines, {Todd C.} and Choi, {Andrew D.} and Nathan Better and Cerci, {Rodrigo J.} and Ganesan Karthikeyan and Vitola, {Jo{\~a}o V.} and Williams, {Michelle C} and Mouaz Al-mallah and Berman, {Daniel S.} and Adam Bernheim and Biederman, {Robert W.} and Bravo, {Paco E.} and Budoff, {Matthew J.} and Bullock-Palmer, {Ren{\'e}e P.} and Chen, {Marcus Y.} and Dilorenzo, {Michael P.} and Rami Doukky and Maros Ferencik and Geske, {Jeffrey B.} and Hage, {Fadi G.} and Hendel, {Robert C.} and Lynne Koweek and Murthy, {Venkatesh L.} and Jagat Narula and {Rodriguez Lozano}, {Patricia F.} and Shah, {Nishant R.} and Amee Shah and Prem Soman and Thompson, {Randall C.} and David Wolinsky and Cohen, {Yosef A.} and Eli Malkovskiy and Randazzo, {Michael J.} and Juan Lopez-Mattei and Purvi Parwani and Mrinali Shetty and Pascual, {Thomas N. B.} and Yaroslav Pynda and Maurizio Dondi and Diana Paez and Einstein, {Andrew J.}",

note = "Funding Information: 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{\textquoteright}s Hospital, Boston, Mass (S.D.); Blavatnik Family Women{\textquoteright}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{\textquoteright}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{\textquoteright}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.). Received November 17, 2022; revision requested January 20, 2023; revision received June 27; accepted August 8. Address correspondence to A.J.E. (email: [email protected]). Study supported by the International Atomic Energy Agency. M.C.W. supported by the British Heart Foundation (grant no. FS/ICRF/20/26002). 1Members of the INCAPS COVID 2 Investigators Group are listed in Appendix S1. Publisher Copyright: {\textcopyright} RSNA, 2023.",

year = "2023",

month = oct,

day = "1",

doi = "10.1148/ryct.220288",

language = "English",

journal = "Radiology: Cardiothoracic Imaging",

issn = "2638-6135",

publisher = "Radiological Society of North America Inc.",

}

Hirschfeld, CB, Dorbala , S, Shaw, LJ, Villines, TC, Choi, AD, Better , N, Cerci, RJ, Karthikeyan, G, Vitola , JV, Williams, MC, Al-mallah, M, Berman, DS, Bernheim, A, Biederman, RW, Bravo, PE, Budoff, MJ, Bullock-Palmer, RP, Chen, MY, Dilorenzo, MP, Doukky, R, Ferencik, M, Geske, JB, Hage, FG, Hendel, RC, Koweek, L, Murthy, VL, Narula, J, Rodriguez Lozano, PF, Shah, NR, Shah, A, Soman, P, Thompson, RC, Wolinsky, D, Cohen, YA, Malkovskiy, E, Randazzo, MJ, Lopez-Mattei, J, Parwani, P, Shetty, M, Pascual, TNB, Pynda , Y, Dondi, M, Paez , D & Einstein, AJ 2023, 'Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison', Radiology: Cardiothoracic Imaging. https://doi.org/10.1148/ryct.220288

TY - JOUR

T1 - Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison

AU - Hirschfeld, Cole B.

AU - Dorbala , Sharmila

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Choi, Andrew D.

AU - Better , Nathan

AU - Cerci, Rodrigo J.

AU - Karthikeyan, Ganesan

AU - Vitola , João V.

AU - Williams, Michelle C

AU - Al-mallah, Mouaz

AU - Berman, Daniel S.

AU - Bernheim, Adam

AU - Biederman, Robert W.

AU - Bravo, Paco E.

AU - Budoff, Matthew J.

AU - Bullock-Palmer, Renée P.

AU - Chen, Marcus Y.

AU - Dilorenzo, Michael P.

AU - Doukky, Rami

AU - Ferencik, Maros

AU - Geske, Jeffrey B.

AU - Hage, Fadi G.

AU - Hendel, Robert C.

AU - Koweek, Lynne

AU - Murthy, Venkatesh L.

AU - Narula, Jagat

AU - Rodriguez Lozano, Patricia F.

AU - Shah, Nishant R.

AU - Shah, Amee

AU - Soman, Prem

AU - Thompson, Randall C.

AU - Wolinsky, David

AU - Cohen, Yosef A.

AU - Malkovskiy, Eli

AU - Randazzo, Michael J.

AU - Lopez-Mattei, Juan

AU - Parwani, Purvi

AU - Shetty, Mrinali

AU - Pascual, Thomas N. B.

AU - Pynda , Yaroslav

AU - Dondi, Maurizio

AU - Paez , Diana

AU - Einstein, Andrew J.

N1 - Funding Information: 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.). Received November 17, 2022; revision requested January 20, 2023; revision received June 27; accepted August 8. Address correspondence to A.J.E. (email: [email protected]). Study supported by the International Atomic Energy Agency. M.C.W. supported by the British Heart Foundation (grant no. FS/ICRF/20/26002). 1Members of the INCAPS COVID 2 Investigators Group are listed in Appendix S1. Publisher Copyright: © RSNA, 2023.

PY - 2023/10/1

Y1 - 2023/10/1

N2 - Background: Disruptions in healthcare early in the COVID-19 pandemic led to a marked decline in diagnostic cardiovascular testing. This study aims to characterize subsequent recovery of procedure volumes in US and non-US facilities in the year following the initial outbreak.Methods: The International Atomic Energy Agency (IAEA) coordinated a worldwide survey, collecting data from 669 facilities in 107 countries (including 93 facilities in 34 US states) to determine the pandemic’s impact on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic modality utilized at their facility for March 2019 (baseline), April 2020, and April 2021. We evaluated changes in procedure volume between US and non-US facilities and between US regions, and analyzed factors associated with return of procedure volume to pre-pandemic baseline in the US.Results: Reduction in procedure volumes in April 2020 was similar for US and non-US facilities (-66% vs. -71%, p=0.27). US facilities reported greater return to baseline in April 2021 than all non-US facilities (4% vs. -6% p=0.01), but there was no difference when comparing US facilities to non-US high-income country (NUHIC) facilities (4% vs. 0%, p=0.18). Regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, p=0.03). No studied factors were significant predictors of 2021 change from pre-pandemic baseline in a multivariable regression analysis.Conclusions: The marked reductions in cardiac testing during the early pandemic have recovered within a year to pre-pandemic baselines in the US and NUHIC, while procedure volumes remain depressed in lower-income countries.

AB - Background: Disruptions in healthcare early in the COVID-19 pandemic led to a marked decline in diagnostic cardiovascular testing. This study aims to characterize subsequent recovery of procedure volumes in US and non-US facilities in the year following the initial outbreak.Methods: The International Atomic Energy Agency (IAEA) coordinated a worldwide survey, collecting data from 669 facilities in 107 countries (including 93 facilities in 34 US states) to determine the pandemic’s impact on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic modality utilized at their facility for March 2019 (baseline), April 2020, and April 2021. We evaluated changes in procedure volume between US and non-US facilities and between US regions, and analyzed factors associated with return of procedure volume to pre-pandemic baseline in the US.Results: Reduction in procedure volumes in April 2020 was similar for US and non-US facilities (-66% vs. -71%, p=0.27). US facilities reported greater return to baseline in April 2021 than all non-US facilities (4% vs. -6% p=0.01), but there was no difference when comparing US facilities to non-US high-income country (NUHIC) facilities (4% vs. 0%, p=0.18). Regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, p=0.03). No studied factors were significant predictors of 2021 change from pre-pandemic baseline in a multivariable regression analysis.Conclusions: The marked reductions in cardiac testing during the early pandemic have recovered within a year to pre-pandemic baselines in the US and NUHIC, while procedure volumes remain depressed in lower-income countries.

KW - COVID-19

KW - cardiovascular imaging

KW - diagnostic cardiovascular procedure

KW - cardiovascular disease

KW - cardiac testing

U2 - 10.1148/ryct.220288

DO - 10.1148/ryct.220288

M3 - Article

SN - 2638-6135

JO - Radiology: Cardiothoracic Imaging

JF - Radiology: Cardiothoracic Imaging

ER -

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

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Keywords / Materials (for Non-textual outputs)

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