- Published
- 24 January 2024
- Journal article
Disparities in Non-invasive Traditional and Advanced Testing for Coronary Artery Disease: Findings from the INCAPS-COVID 2 Study
- Authors
-
- Source
- American Journal of Cardiology
Abstract
The COVID-19 pandemic disrupted delivery of cardiovascular care including non-invasive testing protocols and test selection for evaluation of coronary artery disease (CAD). Trends in test selection among traditional versus advanced noninvasive tests for CAD during the pandemic and among countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (pre-pandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities exercise electrocardiography (ECG), stress echocardiography, and stress single-photon emission computed tomography (SPECT), and advanced testing modalities stress cardiac magnetic resonance (CMR), coronary computed tomography angiography (CCTA), and stress positron emission tomography (PET). Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared to 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). CCTA, stress CMR and stress PET 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 as compared to 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 was observed for advanced imaging modalities but this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing due to economic status are warranted.
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Cite as
Lozano, P., Mallawaarachchi, I., Williams, M., Hirschfeld, C., Better, N., Shaw, L., Vitola, J., Cerci, R., Dorbala, S., Bucciarelli-Ducci, C., Karthikeyan, G., Cohen, Y., Malkovskiy, E., Randazzo, M., Choi, A., Pynda, Y., Dondi, M., Paez, D., Einstein, A., Pascual, T. & Villines, T. 2024, 'Disparities in Non-invasive Traditional and Advanced Testing for Coronary Artery Disease: Findings from the INCAPS-COVID 2 Study', American Journal of Cardiology, 214, pp. 85-93. https://doi.org/10.1016/j.amjcard.2023.12.048