Global testing rates for world’s greatest killer fall 64% during the pandemic

Associate Professor Nathan Better has witnessed the effects of delayed cardiac testing firsthand.
 
The cardiologist and deputy director of nuclear medicine at Royal Melbourne Hospital, and expert lecturer at the International Atomic Energy Agency (IAEA), told newsGP the patient in question – a man in his 50s who he has been seeing annually for a heart valve problem – came dangerously close to severe heart failure.
 
‘[The patient] was given strict instructions that should he develop any symptoms, he should make an earlier appointment and have an earlier echocardiogram done and an earlier review,’ he said.
 
Yet, despite the advice, it was another 10 months before he presented to Associate Professor Better again.
 
‘And the patient confessed that he’d been getting short of breath for about four months and had decided to ignore it,’ he said.
 
‘I could see clinically he was in heart failure at that stage; the echo showed that the heart valve had deteriorated markedly, he developed quite severe mitral regurgitation and his cardiac function had deteriorated quite markedly with significant heart failure present.’
 
As a result, the patient had to be rushed for urgent cardiac surgery in the peak of the COVID era.
 
‘Fortunately, he came through it, but obviously his peri-operative risk was much higher,’ Associate Professor better said. ‘If he’d waited another month, the outcome could have been worse still.’
 
Perhaps the most concerning part of this story, Associate Professor Better says, is that it is not an anomaly.
 
‘If you speak to every single cardiologist, they’ve got stories like this, or patients who had chest pain who did not go to see their GP, did not see their specialist, did not turn up for their appropriate cardiac test, were missed, and then presented late with a heart attack,’ he said.
 
‘And what we’ll be looking to see in the future is how that translates to cardiac events and whether there are direct consequences of this, and [whether] the cardiac event rate will increase as well.
 
‘My suspicion is that that will be the case.’
 
New research he co-authored with his colleagues at IAEA, published in the Journal of the American College of Cardiology on 19 January, which explored the global effect of the pandemic on cardiac testing rates, would also appear to back that up.
 
‘What we found confirmed all our suspicions,’ Associate Professor Better said. ‘There was a dramatic reduction in all cardiac testing.
 
‘Obviously, the big “flavour of the month” in 2020 was COVID, and in the past 12 months there have been approximately two million deaths worldwide because of COVID-19.
 
‘But during that exact period, there were more than 17 million cardiac deaths.
 
‘[Now] that patients are not even going to their cardiac testing we’re very concerned that this will result in increased cardiac morbidity and mortality over the next one to five years.’
 
Associate Professor Nathan Better says it is imperative patients do not ignore cardiac symptoms, even in the era of COVID.

For the study, researchers looked at 909 centres in 108 countries.
 
‘We wanted to see the changing cardiac procedures rate between March 2019 to March 2020 and April 2020,’ Associate Professor Better said.
 
‘And we found that between March 2019 and 2020 there was a 42% drop in all cardiac testing right across the world.
 
‘We looked at it a month later – so, to April 2020 – and we found a further 50% drop. So the number in total fell by 64% from March 2019 to April 2020.’
 
But while there was a reduction in testing rates around the world, not every country was affected to the same extent.
 
‘Obviously we found a lot of disparity across the world,’ Associate Professor Better said.
 
‘Latin America had an even higher impact than it did in places like Australia or the US, but one of the major findings was that the places in the world that got hit the hardest were those in low and low middle income countries.
 
‘The developing world got hit the hardest – they had a 22% extra decrease in cardiac testing compared to the rest of the world.’
 
Associate Professor Better says the reduction in cardiac testing in such countries may have significant future health implications.
 
‘We’re very concerned places that can’t afford it and the poorest are probably going to be the hardest hit with future cardiac events,’ he said.
 
‘Our spike was a little bit less but it was still around about the 50% mark for Oceania as a group.’
 
According to Associate Professor Better, there were two main reasons for the dramatic drop in testing; government directives, and nervous patients cancelling the tests themselves due to COVID fears at hospitals and outpatient facilities.
 
But regardless of the reason, Associate Professor Better says the worry now is what effect this decline will have on future cardiac health.
 
‘The main concern is, will this lead to more cardiac events in the long term?’ he said.
 
‘We’re very concerned as a group that if this does come to fruition, and the cardiac event rate increases, then people need to be aware of it.’
 
GPs play a key role in helping patients avoid preventable health issues, such as cardiovascular disease, by continuing to counsel them about the importance of testing and procedures, and taking appropriate action for symptoms.
 
‘However, our biggest number one take home message is for patients: that if they develop any symptoms that are concerning, do not ignore them,’ Associate Professor Better said.
 
‘Tell your GP about it and if appropriate, they can organise referral for a cardiac specialist and/or for appropriate cardiac testing.’
 
Associate Professor Better hopes clinicians and patients alike will heed the message about the importance of investigating and treating cardiac concerns appropriately.
 
‘Cardiac disease still gazumps the incidence of COVID-related deaths and obviously tests that need to be done for the heart should not be ignored,’ he said.
 
‘In 2021 and beyond, we need to remember the importance of cardiac testing – even in the face of a pandemic.’
 
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