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

A Review of the Health Act, 2017 from an Access, Quality and Cost Paradigm

The Health Act 2017 was recently enacted to establish a unified health system, to coordinate the interrelationship between the national government and the county government health systems, to provide for regulation of health care service, and health care service providers, health products and health technologies and for connected purposes. The enactment of this Act comes against the backdrop of a health care system that is riddled with structural barriers inhibiting access to health care services with resultant grave consequences. The enactment of the Act is therefore, timely given the constitutional context of the right to the highest attainable standards of health care. However, the key question remains whether the Act sufficiently addresses some of the concerns prevalent in the Kenyan health care system. This paper examines the Act using the lens of access, cost, and quality which are the chief concerns of any health care system. The paper examines the salient issues in the Act under these three broad limbs while examining whether the Act contain provisions that improve access to, reduce costs and improves quality of health care provided in Kenya. The analysis adopted in this paper flows from the understanding of health care as a right with concomitant obligations on the State and its agencies and also within the context of devolved governance adopted by the Constitution in 2010 while also appreciating international best practices and norms