Globally, cardiovascular diseases - disorders of the heart and blood vessels - are the leading cause of death, killing about 18 million people each year, according to the World Health Organization. More than three quarters of those deaths take place in low- and middle-income countries.
"The pandemic disrupted healthcare services across all regions and affected services to manage chronic conditions, like heart disease," said Diana Paez, Head of the IAEA Nuclear Medicine and Diagnostic Imaging Section. "However, the recovery of cardiac diagnostic services, in particular, differed across the globe, with significant rebound in higher income countries in contrast to depressed levels in lower income countries."
Quantifying the impact of COVID-19
More than two years ago, in March 2020, the WHO declared the COVID-19 outbreak a pandemic. On the outset of the pandemic, the IAEA conducted a worldwide survey that quantified the global decrease in cardiovascular diagnostic procedures from 2019 to 2020. The survey found standard diagnostic procedures for heart disease, such as echocardiograms, angiographies and stress tests, decreased by 64 per cent from March 2019 to April 2020.
Since then, by April 2021, diagnostic procedures in low-income countries had only recovered by 30 per cent and in lower-middle income countries by 46 per cent, according to a follow-up survey conducted by the IAEA using the International Research Integration System (IRIS). The results, published in May 2022 in the Journal of the American College of Cardiology, evaluated the volume and types of cardiac imaging from 669 inpatient and outpatient centres in 107 countries. Upper-middle-income countries had recovery - and growth - rates of 99 per cent, and high-income countries recovery and growth rates of 108 per cent.
"This decline in cardiac diagnostic imaging has the real potential to lead to worsened cardiovascular outcomes in low- and lower-middle income countries in the years ahead and, thus, increased disparities in cardiovascular health worldwide," said Andrew Einstein, a cardiologist and researcher at Columbia University in New York. Einstein and Paez were co-authors of both studies.
Of the different diagnostics tests, the follow-up survey revealed that stress testing was used less frequently by 12 per cent, while advanced imaging tests were used more frequently - cardiac computed tomography (CT) increased by 14 per cent and positron emission tomography (PET) and magnetic resonance imaging (MRI) by 22 and 25 per cent, respectively.
"We will need to see whether the decreased use of stress tests and growth of advanced cardiac imaging persists in the years ahead," Einstein said. "I regard this as a potentially positive development with wider use of a more diverse portfolio of imaging modalities and tests. No one test is right for all patients, rather we strive to find the right test for the right patient at the right time."
The study also found that pandemic-related psychological stress was estimated to have affected nearly 40 per cent of staff, subsequently affecting patient care at 78 per cent of healthcare centres. The levels of stress were almost equally prevalent across income groups, with about 38 per cent of physicians in lower income countries and 37 per cent in higher income countries reporting excess stress because of the pandemic.
