COVID-19 对心脏病诊断的国际影响。
International Impact of COVID-19 on the Diagnosis of Heart Disease.
机构信息
Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA.
出版信息
J Am Coll Cardiol. 2021 Jan 19;77(2):173-185. doi: 10.1016/j.jacc.2020.10.054.
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 < 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.
背景
2019 年冠状病毒病（COVID-19）大流行对非传染性疾病的诊断和治疗产生了不利影响。其对心血管疾病诊断护理的影响（心血管疾病仍然是全球死亡的主要原因）尚未量化。
目的
本研究旨在评估 COVID-19 对全球心血管诊断程序量和安全实践的影响。
方法
国际原子能机构进行了一项全球调查，评估了 COVID-19 导致的心血管程序量和安全实践的变化。从参与的地点获得了 2020 年 3 月和 4 月的非侵入性和侵入性心脏测试量，并与 2019 年 3 月的测试量进行了比较。确定了个人防护设备的可用性和与大流行相关的测试实践的变化。
结果
共提交了来自 108 个国家的 909 个进行心脏诊断程序的住院和门诊中心的调查。与 2019 年 3 月相比，2020 年 3 月的程序量减少了 42%，与 2019 年 3 月相比，2020 年 4 月的程序量减少了 64%。经胸超声心动图减少了 59%，经食管超声心动图减少了 76%，压力测试减少了 78%，这因压力模式而异。冠状动脉造影（侵入性或计算机断层扫描）减少了 55%（每种程序均<0.001）。在多变量回归中，国内生产总值较低的国家的中心的程序减少幅度更大。在低收入和中低收入国家的地理位置与心脏手术减少 22%和个人防护设备和远程医疗可用性较低有关。
结论
COVID-19 在全球范围内导致心血管诊断测试显着且突然减少，尤其是在经济困难的国家。需要进一步研究心血管结局以及与 COVID-19 相关的护理提供方式的变化。
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