Fears for patient outcomes as cardiac diagnostic procedures plummet

A more than 50% plunge in cardiac diagnostic procedures in Australia and New Zealand in the first year of the pandemic points to health impacts from the COVID-19 pandemic that could linger into the future, researchers say.

A new report shows the volume of cardio diagnostic services shrank by 52% between March 2019, taken as a pre-COVID benchmark, and April 2020 when the pandemic was starting to bite.

“COVID-19 has not only been associated with specific cardiac complications, particularly in patients with pre-existing cardiac disease, but has impacted on service provision,” the authors write.

“At the time of writing, 939 deaths have occurred within Oceania due to COVID-19 – the impact of COVID-19 on cardiovascular mortality due to disruption of cardiac care may prove to be even more significant than direct mortality from the virus.”

The percentage drop in services in Oceania is far less dramatic than a 76% contraction observed in the rest of the world reported by the IAEA Non-Invasive Cardiology Protocol Survey (INCAPS) on which the Oceanian study was modelled.

From their analysis of 63 healthcare facilities in the Oceanian survey, researchers concluded that an estimated 14,293 cardiac procedures were not performed in April 2020 which would have gone ahead in normal times.

Global slowdown

Dr Patricia O’Sullivan, a cardiologist at Royal Melbourne Hospital, said local researchers seized the opportunity to examine changes in cardiac diagnostics in the region.

“They’d done the initial international survey. Then we specifically analysed the data from the Oceanian side.  We thought it would be interesting to see how we compared internationally.”

She said the results for Oceania were in step with a global slowdown as governments cut back on non-urgent procedures and doctors avoided invasive testing and aerosol-generating procedures. New triaging protocols for tests and procedures and patient reticence may also have influenced demand.

“Interestingly, we didn’t really find a significant increase in one area over another in the course of our study.  It was more of a moderate and significant drop across the board in almost every test type, rather than seeing one went down and another went up,” Dr O’Sullivan said.

All procedure types in Oceania showed significant reductions in volumes, other than CMR and PET.  Transthoracic echocardiography decreased by 52%, transoesophageal echocardiography by 74%, and stress tests went down by 65% overall.  Invasive coronary angiography fell by 37%.

The Oceanian research paper says the reduction in testing procedures has helped with a rearrangement of resources during the COVID-19 pandemic, but concern remains as to whether it will contribute to adverse patient outcomes in the future.

“Care must be taken to avoid ignoring cardiac conditions while attention and resources are diverted to COVID-19, especially given the likelihood of the pandemic remaining for months or years to come,” the authors write.

“Longer -term evaluation will be important to assess if patient outcomes have been negatively affected by the reduction in services and deferral of usual modes of care.”

The Oceanian data was drawn from 51 facilities in Australia, 11 in New Zealand and one in PNG.  Percentage reductions were calculated for each test modality and compared across various groups: metropolitan vs regional, public vs private, hospitals vs outpatients, and teaching vs non-teaching sites.

The 52% drop in cardiac procedure volume in the Oceanian region is far less dramatic than a 76% decline recorded in the rest of the world over the same period.  The international INCAPS report collected data from more than 900 centres in 108 countries and found the steepest falls were recorded in Latin American and the Middle East.

The INCAPS report series is published in Heart, Lung and Circulation.

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