Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Development of an Updated Global Land In Situ‐Based Data Set of Temperature and Precipitation Extremes: HadEX3

We present the second update to a data set of gridded land‐based temperature and precipitation extremes indices: HadEX3. This consists of 17 temperature and 12 precipitation indices derived from daily, in situ observations and recommended by the World Meteorological Organization (WMO) Expert Team on Climate Change Detection and Indices (ETCCDI). These indices have been calculated at around 7,000 locations for temperature and 17,000 for precipitation. The annual (and monthly) indices have been interpolated on a 1.875°×1.25° longitude‐latitude grid, covering 1901–2018. We show changes in these indices by examining ”global”‐average time series in comparison with previous observational data sets and also estimating the uncertainty resulting from the nonuniform distribution of meteorological stations. Both the short and long time scale behavior of HadEX3 agrees well with existing products. Changes in the temperature indices are widespread and consistent with global‐scale warming. The extremes related to daily minimum temperatures are changing faster than the maximum. Spatial changes in the linear trends of precipitation indices over 1950–2018 are less spatially coherent than those for temperature indices. Globally, there are more heavy precipitation events that are also more intense and contribute a greater fraction to the total. Some of the indices use a reference period for calculating exceedance thresholds. We present a comparison between using 1961–1990 and 1981–2010. The differences between the time series of the temperature indices observed over longer time scales are shown to be the result of the interaction of the reference period with a warming climate. The gridded netCDF files and, where possible, underlying station indices are available from www.metoffice.gov.uk/hadobs/hadex3 and www.climdex.org.Robert Dunn was supported by the Met Office Hadley Centre Climate Programme funded by BEIS and Defra (GA01101) and thanks Nick Rayner and Lizzie Good for helpful comments on the manuscript. Lisa Alexander is supported by the Australian Research Council (ARC) Grants DP160103439 and CE170100023. Markus Donat acknowledges funding by the Spanish Ministry for the Economy, Industry and Competitiveness Ramón y Cajal 2017 Grant Reference RYC‐2017‐22964. Mohd Noor'Arifin Bin Hj Yussof and Muhammad Khairul Izzat Bin Ibrahim thank the Brunei Darussalam Meteorological Department (BDMD). Ying Sun was supported by China funding agencies 2018YFA0605604 and 2018YFC1507702. Fatemeh Rahimzadeh and Mahbobeh Khoshkam thank I.R. of Iranian Meteorological Organization (IRIMO) and the Atmospheric Science and Meteorological Organization Research Center (ASMERC) for Data and also sharing their experiences, especially Abbas Rangbar. Jose Marengo was supported by the National Institute of Science and Technology for Climate Change Phase 2 under CNPq Grant 465501/2014‐1, FAPESP Grants 2014/50848‐9 and 2015/03804‐9, and the National Coordination for High Level Education and Training (CAPES) Grant 88887.136402‐00INCT. The team that worked on the data in West Africa received funding from the UK's National Environment Research Council (NERC)/Department for International Development DFID) Future Climate For Africa programme, under the AMMA‐2050 project (Grants NE/M020428/1 and NE/M019969/1). Data from Southeast Asia (excl. Indonesia) was supported by work on using ClimPACT2 during the Second Workshop on ASEAN Regional Climate Data, Analysis and Projections (ARCDAP‐2), 25–29 March 2019, Singapore, jointly funded by Meteorological Service Singapore and WMO through the Canada‐Climate Risk and Early Warning Systems (CREWS) initiative. This research was supported by Thai Meteorological Department (TMD) and Thailand Science Research and Innovation (TSRI) under Grant RDG6030003. Daily data for Mexico were provided by the Servicio Meteorológico Nacional (SMN) of Comisión Nacional del Agua (CONAGUA). We acknowledge the data providers in the ECA&D project (https://www.ecad.eu), the SACA&D project (https://saca-bmkg.knmi.nl), and the LACA&D project (https://ciifen.knmi.nl). We thank the three anonymous reviewers for their detailed comments which improved the manuscript.Peer ReviewedPostprint (published version

Development of an updated global land in situ‐based data set of temperature and precipitation extremes: HadEX3

We present the second update to a data set of gridded land‐based temperature and precipitation extremes indices: HadEX3. This consists of 17 temperature and 12 precipitation indices derived from daily, in situ observations and recommended by the World Meteorological Organization (WMO) Expert Team on Climate Change Detection and Indices (ETCCDI). These indices have been calculated at around 7,000 locations for temperature and 17,000 for precipitation. The annual (and monthly) indices have been interpolated on a 1.875°×1.25° longitude‐latitude grid, covering 1901–2018. We show changes in these indices by examining ”global”‐average time series in comparison with previous observational data sets and also estimating the uncertainty resulting from the nonuniform distribution of meteorological stations. Both the short and long time scale behavior of HadEX3 agrees well with existing products. Changes in the temperature indices are widespread and consistent with global‐scale warming. The extremes related to daily minimum temperatures are changing faster than the maximum. Spatial changes in the linear trends of precipitation indices over 1950–2018 are less spatially coherent than those for temperature indices. Globally, there are more heavy precipitation events that are also more intense and contribute a greater fraction to the total. Some of the indices use a reference period for calculating exceedance thresholds. We present a comparison between using 1961–1990 and 1981–2010. The differences between the time series of the temperature indices observed over longer time scales are shown to be the result of the interaction of the reference period with a warming climate. The gridded netCDF files and, where possible, underlying station indices are available from www.metoffice.gov.uk/hadobs/hadex3 and www.climdex.org.Robert Dunn was supported by the Met Office Hadley Centre Climate Programme funded by BEIS and Defra (GA01101) and thanks Nick Rayner and Lizzie Good for helpful comments on the manuscript. Lisa Alexander is supported by the Australian Research Council (ARC) Grants DP160103439 and CE170100023. Markus Donat acknowledges funding by the Spanish Ministry for the Economy, Industry and Competitiveness Ramón y Cajal 2017 Grant Reference RYC‐2017‐22964. Mohd Noor'Arifin Bin Hj Yussof and Muhammad Khairul Izzat Bin Ibrahim thank the Brunei Darussalam Meteorological Department (BDMD). Ying Sun was supported by China funding agencies 2018YFA0605604 and 2018YFC1507702. Fatemeh Rahimzadeh and Mahbobeh Khoshkam thank I.R. of Iranian Meteorological Organization (IRIMO) and the Atmospheric Science and Meteorological Organization Research Center (ASMERC) for Data and also sharing their experiences, especially Abbas Rangbar. Jose Marengo was supported by the National Institute of Science and Technology for Climate Change Phase 2 under CNPq Grant 465501/2014‐1, FAPESP Grants 2014/50848‐9 and 2015/03804‐9, and the National Coordination for High Level Education and Training (CAPES) Grant 88887.136402‐00INCT. The team that worked on the data in West Africa received funding from the UK's National Environment Research Council (NERC)/Department for International Development DFID) Future Climate For Africa programme, under the AMMA‐2050 project (Grants NE/M020428/1 and NE/M019969/1). Data from Southeast Asia (excl. Indonesia) was supported by work on using ClimPACT2 during the Second Workshop on ASEAN Regional Climate Data, Analysis and Projections (ARCDAP‐2), 25–29 March 2019, Singapore, jointly funded by Meteorological Service Singapore and WMO through the Canada‐Climate Risk and Early Warning Systems (CREWS) initiative. This research was supported by Thai Meteorological Department (TMD) and Thailand Science Research and Innovation (TSRI) under Grant RDG6030003. Daily data for Mexico were provided by the Servicio Meteorológico Nacional (SMN) of Comisión Nacional del Agua (CONAGUA). We acknowledge the data providers in the ECA&D project (https://www.ecad.eu), the SACA&D project (https://saca-bmkg.knmi.nl), and the LACA&D project (https://ciifen.knmi.nl). We thank the three anonymous reviewers for their detailed comments which improved the manuscript.Peer ReviewedPostprint (published version

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, 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% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: 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

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology