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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Disparities in Noninvasive Traditional and Advanced Testing for Coronary Artery Disease: Findings from the
Todd C Villines1, Patricia Rodriguez-Lozano1, Indika Mallawaarachchi1
1University of Virginia Health System, Charlottesville, Virginia.
Insights
The COVID-19 pandemic shifted cardiovascular care, increasing advanced coronary artery disease (CAD) testing in wealthy nations while traditional tests declined globally. This trend exacerbated disparities in CAD diagnostic access between high- and low-income countries.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- The COVID-19 pandemic significantly impacted cardiovascular care delivery, altering noninvasive testing protocols for coronary artery disease (CAD).
- Limited data exists on shifts in traditional versus advanced noninvasive CAD testing during the pandemic, especially concerning global income disparities.
Purpose of the Study:
- To assess pandemic-related changes in cardiovascular diagnostic testing practices globally.
- To analyze trends in traditional and advanced noninvasive CAD testing modalities across different country income levels during the COVID-19 pandemic.
Main Methods:
- A global survey conducted by the International Atomic Energy Agency collected procedural volumes for noninvasive CAD tests.
- Data was gathered from 669 centers in 107 countries for March 2019 (pre-pandemic), April 2020 (pandemic onset), and April 2021 (initial recovery).
- Testing modalities included traditional (exercise ECG, stress echo, SPECT) and advanced (stress CMR, CCTA, PET).
Main Results:
- Compared to 2019, traditional CAD tests decreased by 14% (82% recovery rate in 2021), while advanced tests increased by 15% (128% recovery rate).
- Coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and stress positron emission tomography (PET) volumes increased by 14%, 25%, and 25% respectively from 2019 to 2021.
- Advanced testing growth was concentrated in high- and upper-middle-income countries (132% recovery), contrasting sharply with lower-income nations (55% recovery).
Conclusions:
- The COVID-19 pandemic widened economic disparities in CAD testing practices, favoring advanced modalities in wealthier nations.
- While advanced imaging modalities showed recovery and growth, this was largely restricted to high-income countries.
- Efforts are needed to mitigate practice variations in CAD testing driven by economic status and ensure equitable access to diagnostic tools.
Abstract:
The COVID-19 pandemic disrupted the delivery of cardiovascular care, including noninvasive testing protocols and test selection for the evaluation of coronary artery disease (CAD). Trends in test selection in traditional versus advanced noninvasive tests for CAD during the pandemic and in countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess the pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (prepandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities, such as exercise electrocardiography, stress echocardiography, and stress single-photon emission computed tomography, and advanced testing modalities, such as stress cardiac magnetic resonance, coronary computed tomography angiography, and stress positron emission tomography. Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared with 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). Coronary computed tomography angiography, stress cardiac magnetic resonance, and stress positron emission tomography 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 compared with 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 were observed for advanced imaging modalities; however, this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing because of economic status are warranted.
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