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.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.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.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.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.