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

Towards a Meta Cost-Benefit Analysis: The Case of Brexit

Doubtless Brexit is one of the most important regulatory challenges for an entire country since the beginning of the twenty-first century. Equally important are the implications, in terms of costs and benefits, of this democratic decision for the UK’s economy and for its regulatory environment. So far, some cost-benefit analyses have attempted to measure the post-Brexit situation. Few studies have proposed a ‘meta cost-benefit analysis’, which would encompass current studies into one aggregated study. No study has provided for a meta cost-benefit analysis as the Brexit negotiations unfold and which provides for a comprehensive discussion of the regulatory issues at stake. This article intends to fill this gap. The originality of this article lies in both its content and its timing. The content is original because it discusses the scientific possibility of a meta cost-benefit analysis of Brexit together with the inherent limits associated with such an endeavour. The timing is appropriate as we are in the critical halfway point of the two-year negotiation period (2017-2019) during which the EU and the UK must secure the relevant deals to ensure a smooth and frictionless Brexit for both sides of the Channel