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Health care delivery, economics and global health care
Original research
Impact of COVID-19 on the imaging diagnosis of cardiac disease in Europe
  1. Michelle Claire Williams1,
  2. Leslee Shaw2,
  3. Cole B Hirschfeld3,
  4. Pal Maurovich-Horvat4,
  5. Bjarne L Nørgaard5,
  6. Gianluca Pontone6,
  7. Amelia Jimenez-Heffernan7,
  8. Valentin Sinitsyn8,
  9. Vladimir Sergienko9,
  10. Alexey Ansheles9,
  11. Jeroen J Bax10,
  12. Ronny Buechel11,
  13. Elisa Milan12,
  14. Riemer H J A Slart13,
  15. Edward Nicol14,
  16. Chiara Bucciarelli-Ducci15,16,
  17. Yaroslav Pynda17,
  18. Nathan Better18,
  19. Rodrigo Cerci19,
  20. Sharmila Dorbala20,
  21. Paolo Raggi21,
  22. Todd C Villines22,
  23. Joao Vitola19,
  24. Eli Malkovskiy3,
  25. Benjamin Goebel23,
  26. Yosef Cohen24,
  27. Michael Randazzo3,
  28. Thomas N B Pascual25,
  29. Maurizio Dondi17,
  30. Diana Paez17 and
  31. Andrew J Einstein26
  32. On behalf of INCAPS COVID Investigators Group
  1. 1 Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2 Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
  3. 3 Columbia University Irving Medical Center, New York, New York, USA
  4. 4 MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary
  5. 5 Cardiology, Aarhus University Hospital, Aarhus, Denmark
  6. 6 Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
  7. 7 Hospital Juan Ramón Jiménez, Huelva, Spain
  8. 8 Lomonosov Moscow State University, Moscow, Russian Federation
  9. 9 National Medical Research Center of Cardiology of Healthcare Ministry, Moscow, Russian Federation
  10. 10 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  11. 11 Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
  12. 12 UOC Nuclear Medicine- Ospedale Cà Foncello, Treviso, Italy
  13. 13 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, The Netherlands
  14. 14 Department of Imaging, Royal Brompton Hospital, London, UK
  15. 15 Royal Brompton and Harefield Hospitals, London, UK
  16. 16 Guys and St Thomas NHS Trust and King’s College London, London, UK
  17. 17 International Atomic Energy Agency, Vienna, Austria
  18. 18 Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
  19. 19 Quanta Diagnostico, Curitiba, Brazil
  20. 20 Brigham and Women's Hospital, Boston, Massachusetts, USA
  21. 21 Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
  22. 22 Medicine (Cardiology), Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  23. 23 Weill Cornell Medical College, New York, New York, USA
  24. 24 Technion Israel Institute of Technology, Haifa, Israel
  25. 25 Philippine Nuclear Research Institute, Quezon City, Philippines
  26. 26 Columbia University Medical Center, New York, New York, USA
  1. Correspondence to Dr Michelle Claire Williams; michelle.williams{at}ed.ac.uk

Abstract

Objectives We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe.

Methods The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries.

Results Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors.

Conclusion The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.

  • COVID-19
  • cardiac imaging techniques
  • coronary artery disease

Data availability statement

No data are available. As data were provided in confidence to the IAEA by survey respondents, sharing of the underlying data is not possible.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2021-001681

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    Data availability statement

    No data are available. As data were provided in confidence to the IAEA by survey respondents, sharing of the underlying data is not possible.

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    Footnotes

    • Twitter @imagingmedsci, @chiarabd

    • Collaborators INCAPS COVID Investigators Group: Mohammad Nawaz Nasery; Artan Goda; Ervina Shirka; Rabie Benlabgaa; Salah Bouyoucef; Abdelkader Medjahedi; Qais Nailli; Mariela Agolti; Roberto Nicolas Aguero; Maria del Carmen Alak; Lucia Graciela Alberguina; Guillermo Arroñada; Andrea Astesiano; Alfredo Astesiano; Carolina Bas Norton; Pablo Benteo; Juan Blanco; Juan Manuel Bonelli; Jose Javier Bustos; Raul Cabrejas; Jorge Cachero; Roxana Campisi; Alejandro Canderoli; Silvia Carames; Patrícia Carrascosa; Ricardo Castro; Oscar Cendoya; Luciano Martin Cognigni; Carlos Collaud; Carlos Collaud; Claudia Cortes; Javier Courtis; Daniel Cragnolino; Mariana Daicz; Alejandro De La Vega; Silvia Teresa De Maria; Horacio Del Riego; Fernando Dettori; Alejandro Deviggiano; Laura Dragonetti; Mario Embon; Ruben Emilio Enriquez; Jorge Ensinas; Fernando Faccio; Adolfo Facello; Diego Garofalo; Ricardo Geronazzo; Natalia Gonza; Lucas Gutierrez; Miguel Angel Guzzo; Miguel Angel Guzzo; Victor Hasbani; Melina Huerin; Victor Jäger; Julio Manuel Lewkowicz; Maria Nieves A López De Munaín; Jose Maria Lotti; Alejandra Marquez; Osvaldo Masoli; Osvaldo Horacio Masoli; Edgardo Mastrovito; Matias Mayoraz; Graciela Eva Melado; Anibal Mele; Maria Fernanda Merani; Alejandro Horacio Meretta; Susana Molteni; Marcos Montecinos; Eduardo Noguera; Carlos Novoa; Claudio Pereyra Sueldo; Sebastian Perez Ascani; Pablo Pollono; Maria Paula Pujol; Alejandro Radzinschi; Gustavo Raimondi; Marcela Redruello; Marina Rodríguez; Matías Rodríguez; Romina Lorena Romero; Arturo Romero Acuña; Federico Rovaletti; Lucas San Miguel; Lucrecia Solari; Bruno Strada; Sonia Traverso; Sonia Simona Traverzo; Maria del Huerto Velazquez Espeche; Juan Sebastian Weihmuller; Juan Wolcan; Susana Zeffiro; Mari Sakanyan; Scott Beuzeville; Raef Boktor; Patrick Butler; Jennifer Calcott; Loretta Carr; Virgil Chan; Charles Chao; Woon Chong; Mark Dobson; D’Arne Downie; Girish Dwivedi; Barry Elison; Jean Engela; Roslyn Francis; Anand Gaikwad; Ashok Gangasandra Basavaraj; Bruce Goodwin; Robert Greenough; Christian Hamilton-Craig; Victar Hsieh; Subodh Joshi; Karin Lederer; Kenneth Lee; Joseph Lee; John Magnussen; Nghi Mai; Gordon Mander; Fiona Murton; Dee Nandurkar; Johanne Neill; Edward O’Rourke; Patricia O’Sullivan; George Pandos; Kunthi Pathmaraj; Alexander Pitman; Rohan Poulter; Manuja Premaratne; David Prior; Lloyd Ridley; Natalie Rutherford; Hamid Salehi; Connor Saunders; Luke Scarlett; Sujith Seneviratne; Deepa Shetty; Ganesh Shrestha; Jonathan Shulman; Vijay Solanki; Tony Stanton; Murch Stuart; Michael Stubbs; Ian Swainson; Kim Taubman; Andrew Taylor; Paul Thomas; Steven Unger; Anthony Upton; Shankar Vamadevan; William Van Gaal; Johan Verjans; Demetrius Voutnis; Victor Wayne; Peter Wilson; David Wong; Kirby Wong; John Younger; Gudrun Feuchtner; Siroos Mirzaei; Konrad Weiss; Natallia Maroz-Vadalazhskaya; Olivier Gheysens; Filip Homans; Rodrigo Moreno-Reyes; Agnès Pasquet; Veronique Roelants; Caroline M. Van De Heyning; Raúl Araujo Ríos; Valentina Soldat-Stankovic; Sinisa Stankovic; Maria Helena Albernaz Siqueira; Augusto Almeida; Paulo Henrique Alves Togni; Jose Henrique Andrade; Luciana Andrade; Carlos Anselmi; Roberta Araújo; Guilherme Azevedo; Sabbrina Bezerra; Rodrigo Biancardi; Gabriel Blacher Grossman; Simone Brandão; Diego Bromfman Pianta; Lara Carreira; Bruno Castro; Tien Chang; Fernando Cunali Jr.; Roberto Cury; Roberto Dantas; Fernando de Amorim Fernandes; Andrea De Lorenzo; Robson De Macedo Filho; Fernanda Erthal; Fabio Fernandes; Juliano Fernandes; Fabio Fernandes; Thiago Ferreira De Souza; Wilson Furlan Alves; Bruno Ghini; Luiz Goncalves; Ilan Gottlieb; Marcelo Hadlich; Vinícius Kameoka; Ronaldo Lima; Adna Lima; Rafael Willain Lopes; Ricardo Machado e Silva; Tiago Magalhães; Fábio Martins Silva; Luiz Eduardo Mastrocola; Fábio Medeiros; José Claudio Meneghetti; Vania Naue; Danilo Naves; Roberto Nolasco; Cesar Nomura; Joao Bruno Oliveira; Eduardo Paixao; Filipe Penna De Carvalho; Ibraim Pinto; Priscila Possetti; Mayra Quinta; Rodrigo Rizzo Nogueira Ramos; Ricardo Rocha; Alfredo Rodrigues; Carlos Rodrigues; Leila Romantini; Adelina Sanches; Sara Santana; Leonardo Sara da Silva; Paulo Schvartzman; Cristina Sebastião Matushita; Tiago Senra; Afonso Shiozaki; Maria Eduarda Menezes de Siqueira; Cristiano Siqueira; Paola Smanio; Carlos Eduardo Soares; José Soares Junior; Marcio Sommer Bittencourt; Bernardo Spiro; Cláudio Tinoco Mesquita; Jorge Torreao; Rafael Torres; Marly Uellendahl; Guilherme Urpia Monte; Otávia Veríssimo; Estevan Vieira Cabeda; Felipe Villela Pedras; Roberto Waltrick; Marcello Zapparoli; Hamid Naseer; Marina Garcheva-Tsacheva; Irena Kostadinova; Youdaline Theng; Gad Abikhzer; Rene Barette; Benjamin Chow; Dominique Dabreo; Matthias Friedrich; Ria Garg; Mohammed Nassoh Hafez; Chris Johnson; Marla Kiess; Jonathon Leipsic; Eugene Leung; Robert Miller; Anastasia Oikonomou; Stephan Probst; Idan Roifman; Gary Small; Vikas Tandon; Adwait Trivedi; James White; Katherine Zukotynski; Jose Canessa; Gabriel Castro Muñoz; Carmen Concha; Pablo Hidalgo; Cesar Lovera; Teresa Massardo; Luis Salazar Vargas; Pedro Abad; Harold Arturo; Sandra Ayala; Luis Benitez; Alberto Cadena; Carlos Caicedo; Antonio Calderón Moncayo; Antonio Calderón Moncayo; Sharon Gomez; Claudia T. 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Burke; Kelvin Bush; Candace Candela; Elizabeth Capasso; Joao Cavalcante; Donald Chang; Saurav Chatterjee; Yiannis Chatzizisis; Michael Cheezum; Tiffany Chen; Jennifer Chen; Marcus Chen; Andrew Choi; James Clarcq; Ayreen Cordero; Matthew Crim; Sorin Danciu; Bruce Decter; Nimish Dhruva; Neil Doherty; Rami Doukky; Anjori Dunbar; William Duvall; Rachael Edwards; Kerry Esquitin; Husam Farah; Emilio Fentanes; Maros Ferencik; Daniel Fisher; Daniel Fitzpatrick; Cameron Foster; Tony Fuisz; Michael Gannon; Lori Gastner; Myron Gerson; Brian Ghoshhajra; Alan Goldberg; Brian Goldner; Jorge Gonzalez; Rosco Gore; Sandra Gracia-López; Fadi Hage; Agha Haider; Sofia Haider; Yasmin Hamirani; Karen Hassen; Mallory Hatfield; Carolyn Hawkins; Katie Hawthorne; Nicholas Heath; Robert Hendel; Phillip Hernandez; Gregory Hill; Stephen Horgan; Jeff Huffman; Lynne Hurwitz; Ami Iskandrian; Rajesh Janardhanan; Christine Jellis; Scott Jerome; Dinesh Kalra; Summanther Kaviratne; Fernando Kay; Faith Kelly; Omar Khalique; Mona Kinkhabwala; George Kinzfogl Iii; Jacqueline Kircher; Rachael Kirkbride; Michael Kontos; Anupama Kottam; Joseph Krepp; Jay Layer; Steven H Lee; Jeffrey Leppo; John Lesser; Steve Leung; Howard Lewin; Diana Litmanovich; Yiyan Liu; Juan Lopez-Mattei; Kathleen Magurany; Jeremy Markowitz; Amanda Marn; Stephen E Matis; Michael Mckenna; Tony Mcrae; Fernando Mendoza; Michael Merhige; David Min; Chanan Moffitt; Karen Moncher; Warren Moore; Shamil Morayati; Michael Morris; Mahmud Mossa-Basha; Zorana Mrsic; Venkatesh Murthy; Prashant Nagpal; Kyle Napier; Jagat Narula; Katarina Nelson; Prabhjot Nijjar; Medhat Osman; Purvi Parwani; Edward Passen; Amit Patel; Pravin Patil; Ryan Paul; Lawrence Phillips; Venkateshwar Polsani; Rajaram Poludasu; Brian Pomerantz; Thomas Porter; Ryan Prentice; Amit Pursnani; Mark Rabbat; Suresh Ramamurti; Florence Rich; Hiram Rivera Luna; Austin Robinson; Kim Robles; Cesar Rodríguez; Mark Rorie; John Rumberger; Raymond Russell; Philip Sabra; Diego Sadler; Mary Schemmer; U. Joseph Schoepf; Samir Shah; Nishant Shah; Sujata Shanbhag; Gaurav Sharma; Steven Shayani; Jamshid Shirani; Pushpa Shivaram; Steven Sigman; Mitch Simon; Ahmad Slim; David Smith; Alexandra Smith; Prem Soman; Aditya Sood; Monvadi Barbara Srichai-Parsia; James Streeter; Albert T; Ahmed Tawakol; Dustin Thomas; Randall Thompson; Tara Torbet; Desiree Trinidad; Shawn Ullery; Samuel Unzek; Seth Uretsky; Srikanth Vallurupalli; Vikas Verma; Alfonso Waller; Ellen Wang; Parker Ward; Gaby Weissman; George Wesbey; Kelly White; David Winchester; David Wolinsky; Sandra Yost; Michael Zgaljardic; Omar Alonso; Mario Beretta; Rodolfo Ferrando; Miguel Kapitan; Fernando Mut; Omoa Djuraev; Gulnora Rozikhodjaeva; Ha Le Ngoc; Son Hong Mai; Xuan Canh Nguyen.

    • Contributors The study was designed by AJE, MCW, LS, YP, NB, RC, SD, PR, TCV, JV, TNBP, MD and DP. Data were provided by members of the INCAPS COVID Investigators Group. Data were curated by YP, CH, EM, BG and MR. Statistical analysis was performed by MCW and CH. MCW drafted the manuscript. All authors reviewed and edited the manuscript. AJE is the guarantor of the study.

    • Funding This study is supported by the International Atomic Energy Agency.

    • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care.

    • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

    • Competing interests PM-H is a shareholder of Neumann Medical. No other authors report conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.