Recovery of cardiovascular testing in Asia during the COVID-19 pandemic: findings from the INCAPS COVID 2 study

BACKGROUND: Understanding pandemic-related reductions and subsequent recovery of cardiovascular testing in Asia is important for guiding regional public health efforts. OBJECTIVES: This study sought to evaluate the recovery of cardiovascular testing in Asia 1 year into the COVID-19 pandemic. METHODS: In this subanalysis of a worldwide survey on the impact of COVID-19 on cardiovascular diagnostic care in April 2020 and April 2021, recovery of testing volume in Asia was compared among subregions, World Bank income groups and imaging modalities. RESULTS: Of 669 sites worldwide, 164 sites were in 33 Asian countries. Cardiovascular testing volumes in Asia decreased by 53% from March 2019 to April 2020, then recovered 96% of this decrease by April 2021, compared with 98% recovery in the rest of the world. Eastern Asia and Western and Central Asia reported recovery rates of 123% and 110%, compared with 50% and 80% recovery in Southern and South-eastern Asia. Testing volumes among high-income and upper-middle-income Asian countries recovered to 117% and 121% but remained depressed at 49% and 14% recovery in lower-middle and low-income countries, respectively. Stress ECG, stress echo and stress positron emission tomography studies experienced median reductions of 48%, 35% and 57% in testing volume between March 2019 and April 2021, while volumes of coronary artery calcium, coronary CT angiography and cardiac MR remained stable during this period. CONCLUSIONS: The recovery of cardiovascular testing in Asia 1 year into the COVID-19 pandemic lagged in the Southern and South-eastern subregions, as well as in lower-income countries. Recovery favoured advanced cardiac imaging modalities over standard stress testing modalities.

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