Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

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Background: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. Objectives: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. Results: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians’ psychological stress were significant in predicting recovery of cardiac testing. Conclusions: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.

Original languageEnglish
Pages (from-to)2001-2017
Number of pages17
JournalJournal of the American College of Cardiology
Issue number20
StatePublished - May 24 2022

Bibliographical note

Funding Information:
The INCAPS COVID 2 Investigators Group, listed by name in the Supplemental Appendix, thanks cardiology and imaging professional societies worldwide for their assistance in disseminating the survey to their memberships. These include, alphabetically and not limited to, the American Society of Nuclear Cardiology, the Arab Society of Nuclear Medicine, the Australasian Association of Nuclear Medicine Specialists, the Australia-New Zealand Society of Nuclear Medicine, the Belgian Society of Nuclear Medicine, the Brazilian Nuclear Medicine Society, the British Society of Cardiovascular Imaging, the Conjoint Committee for the Recognition of Training in CT Coronary Angiography, the Consortium of Universities and Institutions in Japan, Gruppo Italiano Cardiologia Nucleare, the Indonesian Society of Nuclear Medicine, the Japanese Society of Nuclear Cardiology, the Philippine Society of Nuclear Medicine, the Russian Society of Radiology, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Thailand Society of Nuclear Medicine.

Publisher Copyright:
© 2022 The Authors


  • COVID-19
  • cardiac testing
  • cardiovascular disease
  • coronavirus
  • global health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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