Disruption of standard patient care due to the COVID-19 pandemic has been long postulated, and is now supported by a study reported in the Journal of the American College of Cardiology reporting delays in the delivery of essential diagnostic services, particularly for cardiovascular conditions, affecting health outcomes.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185.

The International Atomic Energy Agency (IAEA) conducted a worldwide survey of its members assessing the changes in cardiovascular procedure volumes and safety practices during the COVID-19 pandemic.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. A survey questionnaire for each site was devised, including descriptors of participating health care facility and health care professionals, use of personal protective equipment (PPE), and changes in procedural volume for a range of cardiovascular diagnostic procedures, including transthoracic echocardiography, stress testing, position emission tomography (PET), and invasive coronary angiography.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. The data for each participating site was obtained for March and April 2020, and compared with March 2019, which served as a baseline.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185.

Data was obtained from 909 inpatient and outpatient centres in 108 countries.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. A total of 1.3 million cardiac diagnostic procedures were performed during the three months considered.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. Cardiac diagnostic procedure volumes worldwide experienced a 42% decrease from March 2019 to March 2020, and a 64% decrease from March 2019 to April 2020.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. The greatest regional decreases were observed in Middle East and Latin America.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. The decreases varied between specific procedure types, with transthoracic echocardiography decreasing by 59%, transoesophageal echocardiography by 76%, and stress tests by 78%. Coronary angiography procedures decreased by 55%.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185.

Selected outpatient activities were cancelled in 83% of centres that performed cardiac diagnostic testing, and all outpatient activities were cancelled at some point in 45% of centres.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185. Although some centres extended hours and added weekend hours, most centres had to increase time per study for cleaning and disinfection, suggesting challenges in catching up to postponed cardiac diagnostic procedures during the pandemic.¹Einstein AJ et al. J Am Coll Cardiol. 2021;77(2):173-185.