The pandemic witnessed a steep drop in the number of cardiology assessments, according to the recently-published results of a survey.
Of particular concern throughout the COVID-19 has been the disruption to routine health services, ranging from routine immunisation to screening for and treatment of other diseases. In the case of cardiology, the International Atomic Energy Agency (IAEA) found that between March and April of 2020 alone, cardiology assessments such as diagnostic procedures dropped by 64 percent compared to the corresponding timeframe in 2019.
The IAEA’s survey’s results, published in the Journal of the American College of Cardiology (JACC), received responses from 909 institutions spanning 108 countries. The JACC study citing the survey by the IAEA found “procedure volumes decreased 42 percent from March 2019 to March 2020, and 64 percent from March 2019 to April 2020….significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product.
“Location in a low-income and lower–middle-income country was associated with an additional 22 percent reduction in cardiac procedures and less availability of personal protective equipment and telehealth. COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world’s economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted.”
In a press release, the IAEA outlined the study’s findings 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 percent overall, while invasive procedures that include the insertion of tubes to obtain ultrasound images, such as transesophageal echocardiography, declined by 76 percent.
“More routine transthoracic echocardiograms – common heart ultrasound using electrodes placed on the chest – declined by 59 percent, and more complex procedures such as coronary angiography decreased by 55 percent.” Fear of contracting COVID-19 deterred many patients, it added, with other contributing factors including fewer appointment slots and avoiding certain tests involving aerosolisation.
“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,” Paez added. “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.”
Delayed or avoided screening for heart disease and accompanying procedures are a major concern for India, whose heart disease burden accounts for its biggest killer. The pandemic overwhelmed an already-overburdened and underresourced health system – and the cracks showed almost immediately with the abrupt change in focus from India’s myriad health concerns to COVID-19 leaving many in the cold.
As a study published in December last year put it, “reorienting the already overburdened health system to the exclusive needs of coronavirus treatment created severe disruptions and uncertainties with regard to the delivery of routine chronic care. These disruptions include potential blockages in supplies of essential medicines and technologies, screening and diagnosis procedures, limited access to resource availability including health workers and support services that are critical for ongoing management of NCDs [noncommunicable diseases].”
The need for cardiology assessments and maintaining continuity of care is patent. This is true in the context of COVID-19, where there can be lasting damage to heart health due to the novel coronavirus and where comorbidities such as various heart conditions increase the vulnerability of those who contract COVID-19 to serious illness. It is true also in the broader context of a country where heart disease accounts for more than 28 percent of deaths as of 2016 – and where the burden is sharply rising.