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.

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.
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
Declines in cardiovascular procedure volumes observed early in the COVID-19 pandemic greatly recovered in 2021 in the United States and other high-income countries, but not in facilities in lower-income countries.

Key Points
■ U.S. facilities reported a 4% increase in cardiovascular testing volumes in April 2021 compared with prepandemic baseline volumes, while non-U.S. facilities reported a 6% decline in procedure volumes (P = .008), attributable to markedly lower recovery in lower-middle- (−41%) and low- (−50%) income countries.
■ Significant variations were observed among U.S. regions, with greater return of procedure volumes observed in the Midwest (11%) and Northeast (9%) compared with the South (1%) and West (−7%, P = .03).
■ No factors were independently associated with procedure volume recovery in U.S. facilities in a multivariable model.


This content is not covered by the Open Government Licence. Please see source record or item for information on rights and permissions.

Cite as

Hirschfeld, C., Dorbala, S., Shaw, L., Villines, T., Choi, A., Better, N., Cerci, R., Karthikeyan, G., Vitola, J., Williams, M., Al-Mallah, M., Berman, D., Bernheim, A., Biederman, R., Bravo, P., Budoff, M., Bullock-Palmer, R., Chen, M., Dilorenzo, M., Doukky, R., Ferencik, M., Geske, J., Hage, F., Hendel, R., Koweek, L., Murthy, V., Narula, J., Rodriguez lozano, P., Shah, N., Shah, A., Soman, P., Thompson, R., Wolinsky, D., Cohen, Y., Malkovskiy, E., Randazzo, M., Lopez-Mattei, J., Parwani, P., Shetty, M., Pascual, T., Pynda, Y., Dondi, M., Paez, D., Einstein, A., Einstein, A., Paez, D., Dondi, M., Better, N., Cerci, R., Dorbala, S., Karthikeyan, G., Pascual, T., Shaw, L., Villines, T., Vitola, J., Williams, M., Pynda, Y., Hinterleitner, G., Lu, Y., Morozova, O., Xu, Z., Hirschfeld, C., Cohen, Y., Malkovskiy, E., Randazzo, M., Choi, A., Lopez-Mattei, J. & Parwani, P. 2023, 'Cardiovascular Testing in the United States during the COVID-19 Pandemic: Volume Recovery and Worldwide Comparison', Radiology: Cardiothoracic Imaging, 5(5). https://doi.org/10.1148/ryct.220288

Downloadable citations

Download HTML citationHTML Download BIB citationBIB Download RIS citationRIS
Last updated: 10 January 2024
Was this page helpful?