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COVID-19 Pandemic Causes Major Decrease in Heart Disease Tests, IAEA Survey Shows

Vienna, Austria

Procedures to diagnose and treat heart diseases decreased by nearly two-thirds across the world during the early months of the pandemic as countries and patients prioritized the fight against COVID-19, an International Atomic Energy Agency (IAEA) survey shows. The findings raise concern for patients at risk or who live with such conditions, as cardiovascular diseases remain the main cause of death worldwide, killing approximately 18 million people annually.

Published in the Journal of the American College of Cardiology this week, the study is the first large scale global assessment of its kind, including responses from over 900 institutions in 108 countries. It compares data from March-April 2020 with the same period in 2019 on a range of standard procedures to evaluate heart health, such as echocardiograms, angiographies and exercise stress tests.  

“The pandemic has markedly disrupted the delivery of healthcare globally, and naturally affected services to manage chronic conditions, like heart disease,” said Diana Paez, one of the authors and head of the IAEA Nuclear Medicine and Diagnostic Imaging Section. “There was a 64% reduction in cardiology diagnostic procedures compared to the previous year, and disruption of services were abrupt and significant across all regions.”

The survey showed that procedures most impacted included lengthier ones and those where the risk of exposure to COVID-19 infections could increase. Exercise stress tests, for example, where droplets of sweat and saliva are likely to be released in the air, was the most disrupted. This widespread method for determining heart fitness was reduced by 78% overall, while invasive procedures that include the insertion of tubes to obtain ultrasound images, such as transesophageal echocardiography, declined by 76%. More routine transthoracic echocardiograms – common heart ultrasound using electrodes placed on the chest – declined by 59 %, and more complex procedures such as coronary angiography decreased by 55%.

The decreases were mostly due to avoidance of tests by patients out of fear of possible exposure to COVID-19 in a hospital setting, fewer appointment slots due to extended disinfection measures between patients, and avoidance of tests that involve aerosolization to minimize personnel exposure risks. Shortages of personal protective equipment (PPE) for medical staff, including high filtration masks, were also reported in 22% of centres, hampering their ability to carry out procedures.

“The data showed most facilities across the world responded to COVID-19 with practices such as physical distancing, use of face masks, robust screening and temperature checks,” said Paez. “Nevertheless, compared to the previous year, around 718,000 cardiac diagnostic procedures were not performed in March-April 2020 in the participating centres due to COVID-19.”

The survey highlighted differences among countries concurrent with general global disparities in access to health care. In the four low-income countries participating in the survey, overall reduction in procedures was 81%. Advanced patient interaction options, such as telehealth for communicating and discussing results and treatment without the need for physical presence, was carried out in 60% of centres in high-income countries, about half of the centres in middle income countries, and in none of the centres in low-income countries.

“The results demonstrate the fragility of healthcare systems to deliver lifesaving cardiac care under stressed conditions and underscore the importance of supporting these systems with equipment, training, international cooperation, and infrastructure,” said co-author Andrew Einstein from Columbia University.

Cardiovascular diseases remain the leading cause of death worldwide, and like many chronic diseases, treatment outlook is linked to early detection and treatment. The disruption caused by COVID-19 could also impact strides made in the past decades, such as a decline in heart disease mortality in many regions of the world. “It is important that we don’t lose the gains that have been made in the past 20 years because of the pandemic,” said co-author Dr Michelle Williams from the University of Edinburgh. “We don’t want people with heart diseases to miss out on timely diagnosis and treatment or to develop serious life-threatening complications that could have been avoided.”

Diagnostic procedures using ionizing radiation play a central role in managing cardiovascular and many other non-communicable diseases. In September 2020, the IAEA published a survey on the impact on COVID-19 on nuclear medicine services for cancer care. The IAEA also produced technical guidance to help nuclear medicine departments continue services during COVID-19 and has been providing health professionals worldwide with related training and resources, including through webinars and open-access publications.  

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