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

Health equity analysis of awareness of GetCheckedOnline in communities outside Vancouver, British Columbia

The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Electrochemical characterization and electrocatalytic application of gold nanoparticles synthesized with different stabilizing agents

Gold nanoparticles (AuNPs) have unique properties, making them attractive for electronic and energy-conversion devices and as (electro)catalysts for electrochemical sensors. In addition to the size and shape of AuNPs, the electrocatalytic properties of AuNP-sensors are also determined by the stabilizing agent used in their synthesis. Here, AuNPs were synthesized with citrate, alginate and quercetin, obtaining spherical and negatively charged nanoparticles. The AuNPs were used to modify glassy carbon electrodes (AuNPs/GCE), which were characterized by scanning electron microscopy and electrochemical techniques. The AuNPs/GCE showed aggregates of different sizes and degrees of dispersion on the electrode surface depending on the stabilizing agent. The AuNP's aggregates affect the homogeneity of the film, the reproducibility of the electrodes and their response in buffer solution. Finally, to evaluate the electrocatalytic ability of the AuNPs/GCE, we studied the oxidation of two analytes with opposite charges: (1) sunset yellow (negative) and (2) hydrazine (positive). Compared with GCE, the AuNPs/GCE showed good electrocatalytic properties for hydrazine, increasing the current up to 50% and shifting the potential by almost 400mV, depending on the AuNP used. For the negatively charged analyte, the current decreased up to 50% and no shift in potential was observed. Thus, the electrocatalytic properties of the AuNPs showed to be highly dependent on the nature of the analyte.FONDECYT 3140533 3150515 FONDAP 1513001

Factores asociados al tiempo de atención de pacientes con diagnóstico de iamcest sometidos a terapia de reperfusión en dos clínicas en Ibagué

Cardiovascular diseases are the leading cause of death worldwide and their management implies an early diagnosis and early coronary reperfusion. In Colombia, the department of Tolima registers the highest death rate from this cause, therefore the objective of the study is to analyze the factors associated with the care time of patients with STEMI undergoing reperfusion therapy in two IPS in the city. This study was conducted in Ibagué between 2016 and 2017, longitudinal, analytical, retrospective from time to event. A review of medical records was carried out and ofthe total of 2755 catheterizations performed during this period, 126 were selected with STEMI, analyzing sociodemographic and clinical conditions of each of the patients. For the analysis of care times, 49 patients who were admitted to the institution from the emergency service were studied. As results, it was found that the average age was 63 years, 71.4% were men. The most prevalent comorbidities were hypertension, dyslipidemia and DM-2. No patient received prehospital medical care. Median gate time - EKG was 27 minutes, gate-needle 75 minutes, and gate - balloon 26 hours. It is concluded that it is necessary to carry out similar studies to know the Latin American statistics since most of the interventions carried out are not within the optimal times established in the international guidelines. Gate time - EKG less than 10 minutes was achieved in 35% of cases. 80% ofthe patients consulted the window forthrombolysis and only 39% received fibrinolysis in less than 60 minutes; 6.1% were taken to ICCP in less than 90 minutes. With the availability of the hemodynamic unit, a reduction in attention times was achieved compared to the consultation during hours without its availability (p value: 0.033).Las enfermedades cardiovasculares son la principal causa de muerte a nivel mundial y su manejo implica un diagnóstico precoz y reperfusión coronaria temprana. En Colombia, el departamento del Tolima registra la mayor tasa de defunciones por esta causa, por ello el objetivo del estudio es analizar los factores asociados al tiempo de atención de pacientes con IAMCEST sometidos a terapia de reperfusión en dos IPS en la ciudad. Este estudio fue realizado en Ibagué entre 2016 a 2017 de corte longitudinal, analítico, retrospectivo de tiempo al evento. Se realizó revisión de historias clínicas y del total de 2755 cateterismos realizados durante este periodo, fueron seleccionados 126 con IAMCEST, analizando condiciones sociodemográficas y clínicas de cada uno de los pacientes. Para el análisis de los tiempos de atención se estudiaron 49 pacientes que ingresaron a la institución desde el servicio de urgencias. Como resultados se encontró que la edad promedio fue 63 años, el 71,4% fueron hombres. Las comorbilidades más prevalentes fueron HTA, dislipidemia y DM-2. Ningún paciente recibió atención médica prehospitalaria. Mediana de tiempo puerta – EKG fue 27 minutos, puerta – aguja 75 minutos y puerta – balón 26 horas. Se concluye que es necesaria la realización de estudios similares para conocer las estadísticas Latinoamericanas puesto que la mayoría de las intervenciones realizadas no se encuentran dentro de los tiempos óptimos establecidos en las guías internacionales. El tiempo puerta – EKG menor a 10 minutos se logró en 35% de casos. El 80% de los pacientes consultó en ventana para trombolisis y solo 39% recibieron fibrinólisis en menos de 60 minutos; 6,1% fue llevado a ICCP en menos de 90 minutos. Con disponibilidad de unidad de hemodinamia se logró reducción en tiempos de atención en comparación con la consulta en horario sin disponibilidad de la misma (Valor p: 0,033)

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

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

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