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1. Is the routine health information system ready to support the planned national health insurance scheme in South Africa?

Author

Wisdom Basera, Lyn A. Hanmer, Edward Nicol, Debbie Bradshaw, Andiswa Zitho, and Ferdinand C. Mukumbang

Subjects
National Health Programs, Health informatics, South Africa, Health Information Systems, Obstetrics and gynaecology, medicine, Information system, data quality, Humans, AcademicSubjects/MED00860, Medical diagnosis, Child, Reimbursement, discharge summaries, Hospitals, Public, business.industry, Health Policy, Public sector, routine health information system (RHIS), medicine.disease, insurance claims, Confidence interval, Cross-Sectional Studies, Data quality, Original Article, National Health Insurance (NHI), Medical emergency, morbidity data, business, clinical coding
Abstract

Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements and resource management. We assessed the quality of inpatient health records, the availability of standard discharge summaries and coded clinical data and the congruence between inpatient health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional health-records review from 45 representative public hospitals consisting of seven tertiary, 10 regional and 28 district hospitals in 10 NHI pilot districts representing all nine provinces. Data were abstracted from a randomly selected sample of 5795 inpatient health records from the surgical, medical, obstetrics and gynaecology, paediatrics and psychiatry departments. Quality was assessed for 10 pre-defined data elements relevant to NHI reimbursements, by comparing information in source registers, patient folders and discharge summaries for patients admitted in March and July 2015. Cohen's/Fleiss’ kappa coefficients (κ) were used to measure agreements between the sources. While 3768 (65%) of the 5795 inpatient-level records contained a discharge summary, less than 835 (15%) of diagnoses were coded using ICD-10 codes. Despite most of the records having correct patient identifiers [κ: 0.92; 95% confidence interval (CI) 0.91–0.93], significant inconsistencies were observed between the registers, patient folders and discharge summaries for some data elements: attending physician’s signature (κ: 0.71; 95% CI 0.67–0.75); results of the investigation (κ: 0.71; 95% CI 0.69–0.74); patient’s age (κ: 0.72; 95% CI 0.70–0.74); and discharge diagnosis (κ: 0.92; 95% CI 0.90–0.94). The strength of agreement for all elements was statistically significant (P-value ≤ 0.001). The absence of coded inpatient diagnoses and identified data inaccuracies indicates that existing routine health information systems in public-sector hospitals in the NHI pilot districts are not yet able to sufficiently support reimbursements and resource management. Institutional capacity is needed to undertake diagnostic coding, improve data quality and ensure that a standard discharge summary is completed for every inpatient.

Published
2021
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2. International Impact of COVID-19 on the Diagnosis of Heart Disease

Author

Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Gerd Hinterleitner, Paez D., Yao, Lu, Olga, Morozova, Zhuoran, Xu, Juan, Lopez-Mattei, Purvi, Parwani, Mohammad Nawaz Nasery, Artan, Goda, Ervina, Shirka, Rabie, Benlabgaa, Salah, Bouyoucef, Abdelkader, Medjahedi, Qais, Nailli, Mariela, Agolti, Roberto Nicolas Aguero, Maria Del Carmen Alak, Lucia Graciela Alberguina, Guillermo, Arroñada, Andrea, Astesiano, Alfredo, Astesiano, Carolina Bas Norton, Pablo, Benteo, Juan, Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul, Cabrejas, Jorge, Cachero, Alejandro, Canderoli, Silvia, Carames, Patrícia, Carrascosa, Ricardo, Castro, Oscar, Cendoya, Luciano Martin Cognigni, Carlos, Collaud, Claudia, Cortes, Javier, Courtis, Daniel, Cragnolino, Mariana, Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando, Dettori, Alejandro, Deviggiano, Laura, Dragonetti, Mario, Embon, Ruben Emilio Enriquez, Jorge, Ensinas, Fernando, Faccio, Adolfo, Facello, Diego, Garofalo, Ricardo, Geronazzo, Natalia, Gonza, Lucas, Gutierrez, Miguel Angel Guzzo, Victor, Hasbani, Melina, Huerin, Victor, Jäger, Julio Manuel Lewkowicz, Maria Nieves, A López De Munaín, Jose Maria Lotti, Alejandra, Marquez, Osvaldo, Masoli, Edgardo, Mastrovito, Matias, Mayoraz, Graciela Eva Melado, Anibal, Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana, Molteni, Marcos, Montecinos, Eduardo, Noguera, Carlos, Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo, Pollono, Maria Paula Pujol, Alejandro, Radzinschi, Gustavo, Raimondi, Marcela, Redruello, Marina, Rodríguez, Matías, Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico, Rovaletti, Lucas San Miguel, Lucrecia, Solari, Bruno, Strada, Sonia, Traverso, Sonia Simona Traverzo, Maria Del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan, Wolcan, Susana, Zeffiro, Mari, Sakanyan, Scott, Beuzeville, Raef, Boktor, Patrick, Butler, Jennifer, Calcott, Loretta, Carr, Virgil, Chan, Charles, Chao, Woon, Chong, Mark, Dobson, D'Arne, Downie, Girish, Dwivedi, Barry, Elison, Jean, Engela, Roslyn, Francis, Anand, Gaikwad, Ashok Gangasandra Basavaraj, Bruce, Goodwin, Robert, Greenough, Christian, Hamilton-Craig, Victar, Hsieh, Subodh, Joshi, Karin, Lederer, Kenneth, Lee, Joseph, Lee, John, Magnussen, Nghi, Mai, Gordon, Mander, Fiona, Murton, Dee, Nandurkar, Johanne, Neill, Edward, O'Rourke, Patricia, O'Sullivan, George, Pandos, Kunthi, Pathmaraj, Alexander, Pitman, Rohan, Poulter, Manuja, Premaratne, David, Prior, Lloyd, Ridley, Natalie, Rutherford, Hamid, Salehi, Connor, Saunders, Luke, Scarlett, Sujith, Seneviratne, Deepa, Shetty, Ganesh, Shrestha, Jonathan, Shulman, Vijay, Solanki, Tony, Stanton, Murch, Stuart, Michael, Stubbs, Ian, Swainson, Kim, Taubman, Andrew, Taylor, Paul, Thomas, Steven, Unger, Anthony, Upton, Shankar, Vamadevan, William Van Gaal, Johan, Verjans, Demetrius, Voutnis, Victor, Wayne, Peter, Wilson, David, Wong, Kirby, Wong, John, Younger, Gudrun, Feuchtner, Siroos, Mirzaei, Konrad, Weiss, Natallia, Maroz-Vadalazhskaya, Olivier, Gheysens, Filip, Homans, Rodrigo, Moreno-Reyes, Agnès, Pasquet, Veronique, Roelants, Caroline, M Van De Heyning, Raúl Araujo Ríos, Valentina, Soldat-Stankovic, Sinisa, Stankovic, Maria Helena Albernaz Siqueira, Augusto, Almeida, Paulo Henrique Alves Togni, Jose Henrique Andrade, Luciana, Andrade, Carlos, Anselmi, Roberta, Araújo, Guilherme, Azevedo, Sabbrina, Bezerra, Rodrigo, Biancardi, Gabriel Blacher Grossman, Simone, Brandão, Diego Bromfman Pianta, Lara, Carreira, Bruno, Castro, Tien, Chang, Fernando Cunali Jr, Roberto, Cury, Roberto, Dantas, Fernando de Amorim Fernandes, Andrea De Lorenzo, Robson De Macedo Filho, Fernanda, Erthal, Fabio, Fernandes, Juliano, Fernandes, Thiago Ferreira De Souza, Wilson Furlan Alves, Bruno, Ghini, Luiz, Goncalves, Ilan, Gottlieb, Marcelo, Hadlich, Vinícius, Kameoka, Ronaldo, Lima, Adna, Lima, Rafael Willain Lopes, Ricardo Machado, E Silva, Tiago, Magalhães, Fábio Martins Silva, Luiz Eduardo Mastrocola, Fábio, Medeiros, José Claudio Meneghetti, Vania, Naue, Danilo, Naves, Roberto, Nolasco, Cesar, Nomura, Joao Bruno Oliveira, Eduardo, Paixao, Filipe Penna De Carvalho, Ibraim, Pinto, Priscila, Possetti, Mayra, Quinta, Rodrigo Rizzo Nogueira Ramos, Ricardo, Rocha, Alfredo, Rodrigues, Carlos, Rodrigues, Leila, Romantini, Adelina, Sanches, Sara, Santana, Leonardo Sara da Silva, Paulo, Schvartzman, Cristina Sebastião Matushita, Tiago, Senra, Afonso, Shiozaki, Maria Eduarda Menezes de Siqueira, Cristiano, Siqueira, Paola, Smanio, Carlos Eduardo Soares, José Soares Junior, Marcio Sommer Bittencourt, Bernardo, Spiro, Cláudio Tinoco Mesquita, Jorge, Torreao, Rafael, Torres, Marly, Uellendahl, Guilherme Urpia Monte, Otávia, Veríssimo, Estevan Vieira Cabeda, Felipe Villela Pedras, Roberto, Waltrick, Marcello, Zapparoli, Hamid, Naseer, Marina, Garcheva-Tsacheva, Irena, Kostadinova, Youdaline, Theng, Gad, Abikhzer, Rene, Barette, Benjamin, Chow, Dominique, Dabreo, Matthias, Friedrich, Ria, Garg, Mohammed Nassoh Hafez, Chris, Johnson, Marla, Kiess, Jonathon, Leipsic, Eugene, Leung, Robert, Miller, Anastasia, Oikonomou, Stephan, Probst, Idan, Roifman, Gary, Small, Vikas, Tandon, Adwait, Trivedi, James, White, Katherine, Zukotynski, Jose, Canessa, Gabriel Castro Muñoz, Carmen, Concha, Pablo, Hidalgo, Cesar, Lovera, Teresa, Massardo, Luis Salazar Vargas, Pedro, Abad, Harold, Arturo, Sandra, Ayala, Luis, Benitez, Alberto, Cadena, Carlos, Caicedo, Antonio Calderón Moncayo, Sharon, Gomez, Claudia, T Gutierrez Villamil, Claudia, Jaimes, Juan Luis Londoño Blair, Luz, Pabon, Mauricio, Pineda, Juan Carlos Rojas, Diego, Ruiz, Manuel Valencia Escobar, Andres, Vasquez, Damiana, Vergel, Alejandro, Zuluaga, Isabel Berrocal Gamboa, Gabriel, Castro, Ulises, González, Ana, Baric, Tonci, Batinic, Maja, Franceschi, Maja Hrabak Paar, Mladen, Jukic, Petar, Medakovic, Viktor, Persic, Marina, Prpic, Ante, Punda, Juan Felipe Batista, Juan Manuel Gómez Lauchy, Yamile Marcos Gutierrez, Rayner, Menéndez, Amalia, Peix, Luis, Rochela, Christoforos, Panagidis, Ioannis, Petrou, Vaclav, Engelmann, Milan, Kaminek, Vladimír, Kincl, Otto, Lang, Milan, Simanek, Jawdat, Abdulla, Morten, Bøttcher, Mette, Christensen, Lars Christian Gormsen, Philip, Hasbak, Søren, Hess, Paw, Holdgaard, Allan, Johansen, Kasper, Kyhl, Kristian Altern Øvrehus, Niels Peter Rønnow Sand, Rolf, Steffensen, Anders, Thomassen, Zerahn, Bo, Alfredo, Perez, Giovanni Alejandro Escorza Velez, Mayra Sanchez Velez, Islam Shawky Abdel Aziz, Mahasen, Abougabal, Taghreed, Ahmed, Ahmed, Asfour, Mona, Hassan, Alia, Hassan, Ahmed, Ibrahim, Sameh, Kaffas, Ahmed, Kandeel, Mohamed Mandour Ali, Ahmad, Mansy, Hany, Maurice, Sherif, Nabil, Mahmoud, Shaaban, Ana Camila Flores, Anne, Poksi, Juhani, Knuuti, Velipekka, Kokkonen, Martti, Larikka, Valtteri, Uusitalo, Matthieu, Bailly, Samuel, Burg, Jean-François, Deux, Vincent, Habouzit, Fabien, Hyafil, Olivier, Lairez, Franck, Proffit, Hamza, Regaieg, Laure, Sarda-Mantel, Vania, Tacher, Roman, P Schneider, Harold, Ayetey, George, Angelidis, Aikaterini, Archontaki, Sofia, Chatziioannou, Ioannis, Datseris, Christina, Fragkaki, Panagiotis, Georgoulias, Sophia, Koukouraki, Maria, Koutelou, Eleni, Kyrozi, Evangelos, Repasos, Petros, Stavrou, Pipitsa, Valsamaki, Carla, Gonzalez, Goleat, Gutierrez, Alejandro, Maldonado, Klara, Buga, Ildiko, Garai, Erzsébet, Schmidt, Balint, Szilveszter, Edit, Várady, Nilesh, Banthia, Jinendra Kumar Bhagat, Rishi, Bhargava, Vivek, Bhat, Partha, Choudhury, Vijay Sai Chowdekar, Aparna, Irodi, Shashank, Jain, Elizabeth, Joseph, Sukriti, Kumar, Girijanandan, Mahapatra, Deepanjan, Mitra, Bhagwant Rai Mittal, Ahmad, Ozair, Chetan, Patel, Tapan, Patel, Ravi, Patel, Shivani, Patel, Sudhir, Saxena, Shantanu, Sengupta, Santosh, Singh, Bhanupriya, Singh, Ashwani, Sood, Atul, Verma, Erwin, Affandi, Padma Savenadia Alam, Edison, Edison, Gani, Gunawan, Habusari, Hapkido, Basuki, Hidayat, Aulia, Huda, Anggoro Praja Mukti, Djoko, Prawiro, Erwin Affandi Soeriadi, Hilman, Syawaluddin, Amjed, Albadr, Majid, Assadi, Farshad, Emami, Golnaz, Houshmand, Majid, Maleki, Maryam Tajik Rostami, Seyed Rasoul Zakavi, Eed Abu Zaid, Svetlana, Agranovich, Yoav, Arnson, Rachel, Bar-Shalom, Alex, Frenkel, Galit, Knafo, Rachel, Lugassi, Israel Shlomo Maor Moalem, Maya, Mor, Noam, Muskal, Sara, Ranser, Aryeh, Shalev, Domenico, Albano, Pierpaolo, Alongi, Gaspare, Arnone, Elisa, Bagatin, Sergio, Baldari, Matteo, Bauckneht, Paolo, Bertelli, Francesco, Bianco, Rachele, Bonfiglioli, Roberto, Boni, Andrea, Bruno, Isabella, Bruno, Elena, Busnardo, Elena, Califaretti, Luca, Camoni, Aldo, Carnevale, Roberta, Casoni, Armando Ugo Cavallo, Giorgio, Cavenaghi, Franca, Chierichetti, Marcello, Chiocchi, Corrado, Cittanti, Mauro, Colletta, Umberto, Conti, Alberto, Cossu, Alberto, Cuocolo, Marco, Cuzzocrea, Maria Luisa De Rimini, Giuseppe De Vincentis, Eleonora Del Giudice, Alberico Del Torto, DELLA TOMMASINA, Veronica, Rexhep, Durmo, Erba, PAOLA ANNA, Laura, Evangelista, Riccardo, Faletti, Evelina, Faragasso, Mohsen, Farsad, Paola, Ferro, Luigia, Florimonte, Viviana, Frantellizzi, Fabio Massimo Fringuelli, Marco, Gatti, Angela, Gaudiano, Alessia, Gimelli, Raffaele, Giubbini, Francesca, Giuffrida, Salvatore, Ialuna, Riccardo, Laudicella, Lucia, Leccisotti, Lucia, Leva, Liga, Riccardo, Carlo, Liguori, Giampiero, Longo, Margherita, Maffione, Maria Elisabetta Mancini, Claudio, Marcassa, Barbara, Nardi, Sara, Pacella, Giovanna, Pepe, Gianluca, Pontone, Sabina, Pulizzi, Natale, Quartuccio, Lucia, Rampin, Fabrizio, Ricci, Pierluigi, Rossini, Giuseppe, Rubini, Vincenzo, Russo, Gian Mauro Sacchetti, Gianmario, Sambuceti, Massimo, Scarano, Roberto, Sciagrà, Massimiliano, Sperandio, Antonella, Stefanelli, Guido, Ventroni, Stefania, Zoboli, Dainia, Baugh, Duane, Chambers, Ernest, Madu, Felix, Nunura, Hiroshi, Asano, Chimura Misato Chimura, Shinichiro, Fujimoto, Koichiro, Fujisue, Tomohisa, Fukunaga, Yoshimitsu, Fukushima, Kae, Fukuyama, Jun, Hashimoto, Yasutaka, Ichikawa, Nobuo, Iguchi, Masamichi, Imai, Anri, Inaki, Hayato, Ishimura, Satoshi, Isobe, Toshiaki, Kadokami, Takao, Kato, Shinichiro, Kumita, Hirotaka, Maruno, Hiroyuki, Mataki, Masao, Miyagawa, Ryota, Morimoto, Masao, Moroi, Shigeki, Nagamachi, Kenichi, Nakajima, Tomoaki, Nakata, Ryo, Nakazato, Mamoru, Nanasato, Masanao, Naya, Takashi, Norikane, Yasutoshi, Ohta, Satoshi, Okayama, Atsutaka, Okizaki, Yoichi, Otomi, Hideki, Otsuka, Masaki, Saito, Sakata Yasushi Sakata, Masayoshi, Sarai, Daisuke, Sato, Shinya, Shiraishi, Yoshinobu, Suwa, Kentaro, Takanami, Kazuya, Takehana, Junichi, Taki, Nagara, Tamaki, Yasuyo, Taniguchi, Hiroki, Teragawa, Nobuo, Tomizawa, Kenichi, Tsujita, Kyoko, Umeji, Yasushi, Wakabayashi, Shinichiro, Yamada, Shinya, Yamazaki, Tatsuya, Yoneyama, Mohammad, Rawashdeh, Daultai, Batyrkhanov, Tairkhan, Dautov, Khalid, Makhdomi, Kevin, Ombati, Faridah, Alkandari, Masoud, Garashi, Tchoyoson Lim Coie, Sonexay, Rajvong, Artem, Kalinin, Marika, Kalnina, Mohamad, Haidar, Renata, Komiagiene, Giedre, Kviecinskiene, Mindaugas, Mataciunas, Donatas, Vajauskas, Christian, Picard, Noor Khairiah, A Karim, Luise, Reichmuth, Anthony, Samuel, Mohammad Aaftaab Allarakha, Ambedhkar Shantaram Naojee, Erick, Alexanderson-Rosas, Erika, Barragan, Alejandro Becerril González-Montecinos, Manuel, Cabada, Daniel Calderon Rodriguez, Isabel, Carvajal-Juarez, Violeta, Cortés, Filiberto, Cortés, Erasmo De La Peña, Manlio, Gama-Moreno, Luis, González, Nelsy Gonzalez Ramírez, Moisés, Jiménez-Santos, Luis, Matos, Edgar, Monroy, Martha, Morelos, Mario, Ornelas, Jose Alberto Ortga Ramirez, Andrés, Preciado-Anaya, Óscar Ulises Preciado-Gutiérrez, Adriana Puente Barragan, Sandra Graciela Rosales Uvera, Sigelinda, Sandoval, Miguel Santaularia Tomas, Lilia, M Sierra-Galan, Silvia, Siu, Enrique, Vallejo, Mario, Valles, Marc, Faraggi, Erdenechimeg, Sereegotov, Srdja, Ilic, Nozha, Ben-Rais, Nadia Ismaili Alaoui, Sara, Taleb, Khin Pa Pa Myo, Phyo Si Thu, Ram Kumar Ghimire, Bijoy, Rajbanshi, Peter, Barneveld, Andor, Glaudemans, Jesse, Habets, Klaas Pieter Koopmans, Jeroen, Manders, Stefan, Pool, Arthur, Scholte, Asbjørn, Scholtens, Riemer, Slart, Paul, Thimister, Erik-Jan Van Asperen, Niels, Veltman, Derk, Verschure, Nils, Wagenaar, John, Edmond, Chris, Ellis, Kerryanne, Johnson, Ross, Keenan, Shaw Hua Anthony Kueh, Christopher, Occleshaw, Alexander, Sasse, Andrew, To, Niels Van Pelt, Calum, Young, Teresa, Cuadra, Hector Bladimir Roque Vanegas, Idrissa Adamou Soli, Djibrillou Moussa Issoufou, Tolulope, Ayodele, Chibuzo, Madu, Yetunde, Onimode, Elen, Efros-Monsen, Signe Helene Forsdahl, Jenni-Mari Hildre Dimmen, Arve, Jørgensen, Isabel, Krohn, Pål, Løvhaugen, Anders Tjellaug Bråten, Humoud Al Dhuhli, Faiza Al Kindi, Naeema, Al-Bulushi, Zabah, Jawa, Naima, Tag, Muhammad Shehzad Afzal, Shazia, Fatima, Muhammad Numair Younis, Musab, Riaz, Mohammad, Saadullah, Yariela, Herrera, Dora, Lenturut-Katal, Manuel Castillo Vázquez, José, Ortellado, Afroza, Akhter, Dianbo, Cao, Stephen, Cheung, Dai, Xu, Lianggeng, Gong, Dan, Han, Yang, Hou, Caiying, Li, Tao, Li, Dong, Li, Sijin, Li, Jinkang, Liu, Hui, Liu, Ming Yen Ng, Kai, Sun, Gongshun, Tang, Jian, Wang, Ximing, Wang, Zhao-Qian, Wang, Yining, Wang, Yifan, Wang, Jiang, Wu, Zhifang, Wu, Liming, Xia, Jiangxi, Xiao, Lei, Xu, Youyou, Yang, Yin, Wu, Jianqun, Yu, Yuan, Li, Tong, Zhang, Longjiang, Zhang, Yong-Gao, Zhang, Xiaoli, Zhang, Zhu, Li, Ana, Alfaro, Paz, Abrihan, Asela, Barroso, Eric, Cruz, Marie Rhiamar Gomez, Vincent Peter Magboo, John Michael Medina, Jerry, Obaldo, Davidson, Pastrana, Christian Michael Pawhay, Alvin, Quinon, Jeanelle Margareth Tang, Bettina, Tecson, Kristine Joy Uson, Mila, Uy, Magdalena, Kostkiewicz, Jolanta, Kunikowska, Nuno, Bettencourt, Guilhermina, Cantinho, Antonio, Ferreira, Ghulam, Syed, Samer, Arnous, Said, Atyani, Angela, Byrne, Tadhg, Gleeson, David, Kerins, Conor, Meehan, David, Murphy, Mark, Murphy, John, Murray, Julie, O'Brien, Ji-In, Bang, Henry, Bom, Sang-Geon, Cho, Chae Moon Hong, Su Jin Jang, Yong Hyu Jeong, Won Jun Kang, Ji-Young, Kim, Jaetae, Lee, Chang Kyeong Namgung, Young, So, Kyoung Sook Won, Venjamin, Majstorov, Marija, Vavlukis, Barbara Gužic Salobir, Monika, Štalc, Theodora, Benedek, Imre, Benedek, Raluca, Mititelu, Claudiu Adrian Stan, Alexey, Ansheles, Olga, Dariy, Olga, Drozdova, Nina, Gagarina, Vsevolod Milyevich Gulyaev, Irina, Itskovich, Anatoly, Karalkin, Alexander, Kokov, Ekaterina, Migunova, Viktor, Pospelov, Daria, Ryzhkova, Guzaliya, Saifullina, Svetlana, Sazonova, Irina, Shurupova, Tatjana, Trifonova, Wladimir Yurievich Ussov, Margarita, Vakhromeeva, Nailya, Valiullina, Konstantin, Zavadovsky, Kirill, Zhuravlev, Mirvat, Alasnag, Subhani, Okarvi, Dragana Sobic Saranovic, Felix, Keng, Jia Hao Jason See, Ramkumar, Sekar, Min Sen Yew, Andrej, Vondrak, Shereen, Bejai, George, Bennie, Ria, Bester, Gerrit, Engelbrecht, Osayande, Evbuomwan, Harlem, Gongxeka, Magritha Jv Vuuren, Mitchell, Kaplan, Purbhoo, Khushica, Hoosen, Lakhi, Nico, Malan, 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Premprabha, Tanyaluck, Thientunyakit, Ali, Sellem, Kemal Metin Kir, Haluk, Sayman, Mugisha Julius Sebikali, Zerida, Muyinda, Yaroslav, Kmetyuk, Pavlo, Korol, Olena, Mykhalchenko, Volodymyr, Pliatsek, Maryna, Satyr, Batool, Albalooshi, Mohamed Ismail Ahmed Hassan, Jill, Anderson, Punit, Bedi, Thomas, Biggans, Anda, Bularga, Russell, Bull, Rajesh, Burgul, John-Paul, Carpenter, Duncan, Coles, David, Cusack, Aparna, Deshpande, John, Dougan, Timothy, Fairbairn, Alexia, Farrugia, Deepa, Gopalan, Alistair, Gummow, Prasad Guntur Ramkumar, Mark, Hamilton, Mark, Harbinson, Thomas, Hartley, Benjamin, Hudson, Nikhil, Joshi, Michael, Kay, Andrew, Kelion, Azhar, Khokhar, Jamie, Kitt, Ken, Lee, Chen, Low, Sze Mun Mak, Ntouskou, Marousa, Jon, Martin, Elisa, Mcalindon, Leon, Menezes, Gareth, Morgan-Hughes, Alastair, Moss, Anthony, Murray, Edward, Nicol, Dilip, Patel, Charles, Peebles, Francesca, Pugliese, Jonathan Carl Luis Rodrigues, Christopher, Rofe, Nikant, Sabharwal, Rebecca, Schofield, Thomas, Semple, Naveen, Sharma, Peter, Strouhal, Deepak, Subedi, William, Topping, Katharine, Tweed, Jonathan, Weir-Mccall, Suhny, Abbara, Taimur, Abbasi, Brian, Abbott, Shady, Abohashem, Sandra, Abramson, Tarek, Al-Abboud, Mouaz, Al-Mallah, Omar, Almousalli, Karthikeyan, Ananthasubramaniam, Mohan Ashok Kumar, Jeffrey, Askew, Lea, Attanasio, Mallory, Balmer-Swain, Richard, R Bayer, Adam, Bernheim, Sabha, Bhatti, Erik, Bieging, Ron, Blankstein, Stephen, Bloom, Sean, Blue, David, Bluemke, Andressa, Borges, Kelley, Branch, Paco, Bravo, Jessica, Brothers, Matthew, Budoff, Renée, Bullock-Palmer, Angela, Burandt, Floyd, W Burke, Kelvin, Bush, Candace, Candela, Elizabeth, Capasso, Joao, Cavalcante, Donald, Chang, Saurav, Chatterjee, Yiannis, Chatzizisis, Michael, Cheezum, Tiffany, Chen, Jennifer, Chen, Marcus, Chen, Andrew, Choi, James, Clarcq, Ayreen, Cordero, Matthew, Crim, Sorin, Danciu, Bruce, Decter, Nimish, Dhruva, Neil, Doherty, Rami, Doukky, Anjori, Dunbar, William, Duvall, Rachael, Edwards, Kerry, Esquitin, Husam, Farah, Emilio, Fentanes, Maros, Ferencik, Daniel, Fisher, Daniel, Fitzpatrick, Cameron, Foster, Tony, Fuisz, Michael, Gannon, Lori, Gastner, Myron, Gerson, Brian, Ghoshhajra, Alan, Goldberg, Brian, Goldner, Jorge, Gonzalez, Rosco, Gore, Sandra, Gracia-López, Fadi, Hage, Agha, Haider, Sofia, Haider, Yasmin, Hamirani, Karen, Hassen, Mallory, Hatfield, Carolyn, Hawkins, Katie, Hawthorne, Nicholas, Heath, Robert, Hendel, Phillip, Hernandez, Gregory, Hill, Stephen, Horgan, Jeff, Huffman, Lynne, Hurwitz, Ami, Iskandrian, Rajesh, Janardhanan, Christine, Jellis, Scott, Jerome, Dinesh, Kalra, Summanther, Kaviratne, Fernando, Kay, Faith, Kelly, Omar, Khalique, Mona, Kinkhabwala, George Kinzfogl Iii, Jacqueline, Kircher, Rachael, Kirkbride, Michael, Kontos, Anupama, Kottam, Joseph, Krepp, Jay, Layer, Steven, H Lee, Jeffrey, Leppo, John, Lesser, Steve, Leung, Howard, Lewin, Diana, Litmanovich, Yiyan, Liu, Kathleen, Magurany, Jeremy, Markowitz, Amanda, Marn, Stephen, E Matis, Michael, Mckenna, Tony, Mcrae, Fernando, Mendoza, Michael, Merhige, David, Min, Chanan, Moffitt, Karen, Moncher, Warren, Moore, Shamil, Morayati, Michael, Morris, Mahmud, Mossa-Basha, Zorana, Mrsic, Venkatesh, Murthy, Prashant, Nagpal, Kyle, Napier, Katarina, Nelson, Prabhjot, Nijjar, Medhat, Osman, Edward, Passen, Amit, Patel, Pravin, Patil, Ryan, Paul, Lawrence, Phillips, Venkateshwar, Polsani, Rajaram, Poludasu, Brian, Pomerantz, Thomas, Porter, Ryan, Prentice, Amit, Pursnani, Mark, Rabbat, Suresh, Ramamurti, Florence, Rich, Hiram Rivera Luna, Austin, Robinson, Kim, Robles, Cesar, Rodríguez, Mark, Rorie, John, Rumberger, Raymond, Russell, Philip, Sabra, Diego, Sadler, Mary, Schemmer, U Joseph Schoepf, Samir, Shah, Nishant, Shah, Sujata, Shanbhag, Gaurav, Sharma, Steven, Shayani, Jamshid, Shirani, Pushpa, Shivaram, Steven, Sigman, Mitch, Simon, Ahmad, Slim, David, Smith, Alexandra, Smith, Prem, Soman, Aditya, Sood, Monvadi Barbara Srichai-Parsia, James, Streeter, Albert, T Ahmed Tawakol, Dustin, Thomas, Randall, Thompson, Tara, Torbet, Desiree, Trinidad, Shawn, Ullery, Samuel, Unzek, Seth, Uretsky, Srikanth, Vallurupalli, Vikas, Verma, Alfonso, Waller, Ellen, Wang, Parker, Ward, Gaby, Weissman, George, Wesbey, Kelly, White, David, Winchester, David, Wolinsky, Sandra, Yost, Michael, Zgaljardic, Omar, Alonso, Mario, Beretta, Rodolfo, Ferrando, Miguel, Kapitan, Fernando, Mut, Omoa, Djuraev, Gulnora, Rozikhodjaeva, Ha Le Ngoc, Son Hong Mai, Xuan Canh Nguyen, Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Paez, D., Cuocolo, A., Einstein, A, Shaw, L, Hirschfeld, C, Williams, M, Villines, T, Better, N, Vitola, J, Cerci, R, Dorbala, S, Raggi, P, Choi, A, Lu, B, Sinitsyn, V, Sergienko, V, Kudo, T, Norgaard, B, Maurovich-Horvat, P, Campisi, R, Milan, E, Louw, L, Allam, A, Bhatia, M, Malkovskiy, E, Goebel, B, Cohen, Y, Randazzo, M, Narula, J, Pascual, T, Pynda, Y, Dondi, M, Paez, D, Pacella, S, and Erba, P

Subjects
INCAPS COVID Investigators Group, Heart disease, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Diagnostic Techniques, Cardiovascular, coronavirus, global health, IAEA, Disease, Telehealth, Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, 0302 clinical medicine, cardiovascular disease, cardiac testing, COVID-19, diagnostic techniques, cardiovascular, health care surveys, heart diseases, humans, international agencies, Pandemic, Global health, 030212 general & internal medicine, COVID-19 Heart Disease, Cause of death, STATEMENT, Heart Disease, International Agencie, Public Health and Health Services, Biomedical Imaging, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Heart Diseases, 03 medical and health sciences, Clinical Research, medicine, Humans, Personal protective equipment, Heart Disease - Coronary Heart Disease, business.industry, International Agencies, medicine.disease, the, coronaviru, Diagnostic Techniques, Good Health and Well Being, Clinical research, Cardiovascular System & Hematology, Health Care Survey, Health Care Surveys, Emergency medicine, Global Health, business
Abstract

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. Transthoradc echocardiography decreased by 59%, transesophageat 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). hi 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 teteheatth. 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. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Published
2021
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3. National Trends in Coronary Artery Disease Imagingassociations with Health Care Outcomes and Costs

Author

Jonathan R. Weir-McCall, Edward Nicol, Anoop S V Shah, Michelle C. Williams, Giles Roditi, David E. Newby, and James H. F. Rudd

Subjects
History, medicine.medical_specialty, education.field_of_study, Polymers and Plastics, medicine.diagnostic_test, business.industry, Population, Disease, medicine.disease, Chest pain, Industrial and Manufacturing Engineering, Confidence interval, Coronary artery disease, Myocardial perfusion imaging, Internal medicine, medicine, Cardiology, Myocardial infarction, Business and International Management, medicine.symptom, education, business, Computed tomography angiography
Abstract

Background: We sought to determine the impact of temporal trends and the 2016 updated National Institute for Health and Care Excellence chest pain guidelines (CG95) on imaging investigations and outcomes for coronary artery disease. Methods: Investigations for coronary artery disease from 2012-2018 were extracted from the English national database of imaging procedures and linked to national hospital admission and mortality registries. Growth rates were calculated, adjusted for population size, and linked with trends in cardiovascular hospital admissions and mortality compared across tertiles of imaging growth. The impact of CG95 was assessed using an interrupted time-series analysis. Findings: From 2012-2018, 1,909,314 investigations for coronary artery disease were performed, with an annualised per capita growth rate of 4·8%. At a national level, CG95 was associated with a rise in coronary computed tomography angiography (CTA) (exp(β) 1·10 [95% confidence interval 1·03 to 1·18], p=0·006), with no change in myocardial perfusion imaging and a potential modest fall in invasive coronary angiography (exp(β) 0·997 [0·993 to 1·00], p=0·06). At a regional level, greater CTA growth was associated with reduced hospitalisations for myocardial infarction (-0·7 [-0·8 to 1·7] admissions/100,000 population/year) whereas lower growth was associated with increased hospitalisations for myocardial infarction (1·8 [0·9 to 2·7] admissions/100,000 population/year). Cardiovascular and coronary artery disease deaths fell by -2·95 [-3·11 to -2·72] and -1·66 [-1·79 to -1·51] deaths/100,000/year respectively (p

Published
2021
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4. Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia

Author

Takashi Kudo, Ryan Lahey, Cole B. Hirschfeld, Michelle C. Williams, Bin Lu, Mirvat Alasnag, Mona Bhatia, Hee-Seung Henry Bom, Tairkhan Dautov, Reza Fazel, Ganesan Karthikeyan, Felix Y.J. Keng, Ronen Rubinshtein, Nathan Better, Rodrigo Julio Cerci, Sharmila Dorbala, Paolo Raggi, Leslee J. Shaw, Todd C. Villines, João V. Vitola, Andrew D. Choi, Eli Malkovskiy, Benjamin Goebel, Yosef A. Cohen, Michael Randazzo, Thomas N.B. Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, Andrew J. Einstein, Rodrigo Cerci, Joao V. Vitola, Gerd Hinterleitner, Yao Lu, Olga Morozova, Zhuoran Xu, Yosef Cohen, Andrew Choi, Juan Lopez-Mattei, Purvi Parwani, Mohammad Nawaz Nasery, Artan Goda, Ervina Shirka, Rabie Benlabgaa, Salah Bouyoucef, Abdelkader Medjahedi, Qais Nailli, Mariela Agolti, Roberto Nicolas Aguero, Maria del Carmen Alak, Lucia Graciela Alberguina, Guillermo Arroñada, Andrea Astesiano, Alfredo Astesiano, Carolina Bas Norton, Pablo Benteo, Juan Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul Cabrejas, Jorge Cachero, Roxana Campisi, Alejandro Canderoli, Silvia Carames, Patrícia Carrascosa, Ricardo Castro, Oscar Cendoya, Luciano Martin Cognigni, Carlos Collaud, Claudia Cortes, Javier Courtis, Daniel Cragnolino, Mariana Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando Dettori, Alejandro Deviggiano, Laura Dragonetti, Mario Embon, Ruben Emilio Enriquez, Jorge Ensinas, Fernando Faccio, Adolfo Facello, Diego Garofalo, Ricardo Geronazzo, Natalia Gonza, Lucas Gutierrez, Miguel Angel Guzzo, Victor Hasbani, Melina Huerin, Victor Jäger, Julio Manuel Lewkowicz, Maria Nieves A. López De Munaín, Jose Maria Lotti, Alejandra Marquez, Osvaldo Masoli, Osvaldo Horacio Masoli, Edgardo Mastrovito, Matias Mayoraz, Graciela Eva Melado, Anibal Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana Molteni, Marcos Montecinos, Eduardo Noguera, Carlos Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo Pollono, Maria Paula Pujol, Alejandro Radzinschi, Gustavo Raimondi, Marcela Redruello, Marina Rodríguez, Matías Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico Rovaletti, Lucas San Miguel, Lucrecia Solari, Bruno Strada, Sonia Traverso, Sonia Simona Traverzo, Maria del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan Wolcan, Susana Zeffiro, Mari Sakanyan, Scott Beuzeville, Raef Boktor, Patrick Butler, Jennifer Calcott, Loretta Carr, Virgil Chan, Charles Chao, Woon Chong, Mark Dobson, D'Arne Downie, Girish Dwivedi, Barry Elison, Jean Engela, Roslyn Francis, Anand Gaikwad, Ashok Gangasandra Basavaraj, Bruce Goodwin, Robert Greenough, Christian Hamilton-Craig, Victar Hsieh, Subodh Joshi, Karin Lederer, Kenneth Lee, Joseph Lee, John Magnussen, Nghi Mai, Gordon Mander, Fiona Murton, Dee Nandurkar, Johanne Neill, Edward O'Rourke, Patricia O'Sullivan, George Pandos, Kunthi Pathmaraj, Alexander Pitman, Rohan Poulter, Manuja Premaratne, David Prior, Lloyd Ridley, Natalie Rutherford, Hamid Salehi, Connor Saunders, Luke Scarlett, Sujith Seneviratne, Deepa Shetty, Ganesh Shrestha, Jonathan Shulman, Vijay Solanki, Tony Stanton, Murch Stuart, Michael Stubbs, Ian Swainson, Kim Taubman, Andrew Taylor, Paul Thomas, Steven Unger, Anthony Upton, Shankar Vamadevan, William Van Gaal, Johan Verjans, Demetrius Voutnis, Victor Wayne, Peter Wilson, David Wong, Kirby Wong, John Younger, Gudrun Feuchtner, Siroos Mirzaei, Konrad Weiss, Natallia Maroz-Vadalazhskaya, Olivier Gheysens, Filip Homans, Rodrigo Moreno-Reyes, Agnès Pasquet, Veronique Roelants, Caroline M. Van De Heyning, Raúl Araujo Ríos, Valentina Soldat-Stankovic, Sinisa Stankovic, Maria Helena Albernaz Siqueira, Augusto Almeida, Paulo Henrique Alves Togni, Jose Henrique Andrade, Luciana Andrade, Carlos Anselmi, Roberta Araújo, Guilherme Azevedo, Sabbrina Bezerra, Rodrigo Biancardi, Gabriel Blacher Grossman, Simone Brandão, Diego Bromfman Pianta, Lara Carreira, Bruno Castro, Tien Chang, Fernando Cunali, Roberto Cury, Roberto Dantas, Fernando de Amorim Fernandes, Andrea De Lorenzo, Robson De Macedo Filho, Fernanda Erthal, Fabio Fernandes, Juliano Fernandes, Thiago Ferreira De Souza, Wilson Furlan Alves, Bruno Ghini, Luiz Goncalves, Ilan Gottlieb, Marcelo Hadlich, Vinícius Kameoka, Ronaldo Lima, Adna Lima, Rafael Willain Lopes, Ricardo Machado e Silva, Tiago Magalhães, Fábio Martins Silva, Luiz Eduardo Mastrocola, Fábio Medeiros, José Claudio Meneghetti, Vania Naue, Danilo Naves, Roberto Nolasco, Cesar Nomura, Joao Bruno Oliveira, Eduardo Paixao, Filipe Penna De Carvalho, Ibraim Pinto, Priscila Possetti, Mayra Quinta, Rodrigo Rizzo Nogueira Ramos, Ricardo Rocha, Alfredo Rodrigues, Carlos Rodrigues, Leila Romantini, Adelina Sanches, Sara Santana, Leonardo Sara da Silva, Paulo Schvartzman, Cristina Sebastião Matushita, Tiago Senra, Afonso Shiozaki, Maria Eduarda Menezes de Siqueira, Cristiano Siqueira, Paola Smanio, Carlos Eduardo Soares, José Soares Junior, Marcio Sommer Bittencourt, Bernardo Spiro, Cláudio Tinoco Mesquita, Jorge Torreao, Rafael Torres, Marly Uellendahl, Guilherme Urpia Monte, Otávia Veríssimo, Estevan Vieira Cabeda, Felipe Villela Pedras, Roberto Waltrick, Marcello Zapparoli, Hamid Naseer, Marina Garcheva-Tsacheva, Irena Kostadinova, Youdaline Theng, Gad Abikhzer, Rene Barette, Benjamin Chow, Dominique Dabreo, Matthias Friedrich, Ria Garg, Mohammed Nassoh Hafez, Chris Johnson, Marla Kiess, Jonathon Leipsic, Eugene Leung, Robert Miller, Anastasia Oikonomou, Stephan Probst, Idan Roifman, Gary Small, Vikas Tandon, Adwait Trivedi, James White, Katherine Zukotynski, Jose Canessa, Gabriel Castro Muñoz, Carmen Concha, Pablo Hidalgo, Cesar Lovera, Teresa Massardo, Luis Salazar Vargas, Pedro Abad, Harold Arturo, Sandra Ayala, Luis Benitez, Alberto Cadena, Carlos Caicedo, Antonio Calderón Moncayo, Sharon Gomez, Claudia T. Gutierrez Villamil, Claudia Jaimes, Juan Londoño, Juan Luis Londoño Blair, Luz Pabon, Mauricio Pineda, Juan Carlos Rojas, Diego Ruiz, Manuel Valencia Escobar, Andres Vasquez, Damiana Vergel, Alejandro Zuluaga, Isabel Berrocal Gamboa, Gabriel Castro, Ulises González, Ana Baric, Tonci Batinic, Maja Franceschi, Maja Hrabak Paar, Mladen Jukic, Petar Medakovic, Viktor Persic, Marina Prpic, Ante Punda, Juan Felipe Batista, Juan Manuel Gómez Lauchy, Yamile Marcos Gutierrez, Rayner Menéndez, Amalia Peix, Luis Rochela, Christoforos Panagidis, Ioannis Petrou, Vaclav Engelmann, Milan Kaminek, Vladimír Kincl, Otto Lang, Milan Simanek, Jawdat Abdulla, Morten Bøttcher, Mette Christensen, Lars Christian Gormsen, Philip Hasbak, Søren Hess, Paw Holdgaard, Allan Johansen, Kasper Kyhl, Bjarne Linde Norgaard, Kristian Altern Øvrehus, Niels Peter Rønnow Sand, Rolf Steffensen, Anders Thomassen, Bo Zerahn, Alfredo Perez, Giovanni Alejandro Escorza Velez, Mayra Sanchez Velez, Islam Shawky Abdel Aziz, Mahasen Abougabal, Taghreed Ahmed, Adel Allam, Ahmed Asfour, Mona Hassan, Alia Hassan, Ahmed Ibrahim, Sameh Kaffas, Ahmed Kandeel, Mohamed Mandour Ali, Ahmad Mansy, Hany Maurice, Sherif Nabil, Mahmoud Shaaban, Ana Camila Flores, Anne Poksi, Juhani Knuuti, Velipekka Kokkonen, Martti Larikka, Valtteri Uusitalo, Matthieu Bailly, Samuel Burg, Jean-François Deux, Vincent Habouzit, Fabien Hyafil, Olivier Lairez, Franck Proffit, Hamza Regaieg, Laure Sarda-Mantel, Vania Tacher, Roman P. Schneider, Harold Ayetey, George Angelidis, Aikaterini Archontaki, Sofia Chatziioannou, Ioannis Datseris, Christina Fragkaki, Panagiotis Georgoulias, Sophia Koukouraki, Maria Koutelou, Eleni Kyrozi, Evangelos Repasos, Petros Stavrou, Pipitsa Valsamaki, Carla Gonzalez, Goleat Gutierrez, Alejandro Maldonado, Klara Buga, Ildiko Garai, Pál Maurovich-Horvat, Erzsébet Schmidt, Balint Szilveszter, Edit Várady, Nilesh Banthia, Jinendra Kumar Bhagat, Rishi Bhargava, Vivek Bhat, Partha Choudhury, Vijay Sai Chowdekar, Aparna Irodi, Shashank Jain, Elizabeth Joseph, Sukriti Kumar, Prof Dr Girijanandan Mahapatra, Deepanjan Mitra, Bhagwant Rai Mittal, Ahmad Ozair, Chetan Patel, Tapan Patel, Ravi Patel, Shivani Patel, Sudhir Saxena, Shantanu Sengupta, Santosh Singh, Bhanupriya Singh, Ashwani Sood, Atul Verma, Erwin Affandi, Padma Savenadia Alam, Edison Edison, Gani Gunawan, Habusari Hapkido, Basuki Hidayat, Aulia Huda, Anggoro Praja Mukti, Djoko Prawiro, Erwin Affandi Soeriadi, Hilman Syawaluddin, Amjed Albadr, Majid Assadi, Farshad Emami, Golnaz Houshmand, Majid Maleki, Maryam Tajik Rostami, Seyed Rasoul Zakavi, Eed Abu Zaid, Svetlana Agranovich, Yoav Arnson, Rachel Bar-Shalom, Alex Frenkel, Galit Knafo, Rachel Lugassi, Israel Shlomo Maor Moalem, Maya Mor, Noam Muskal, Sara Ranser, Aryeh Shalev, Domenico Albano, Pierpaolo Alongi, Gaspare Arnone, Elisa Bagatin, Sergio Baldari, Matteo Bauckneht, Paolo Bertelli, Francesco Bianco, Rachele Bonfiglioli, Roberto Boni, Andrea Bruno, Isabella Bruno, Elena Busnardo, Elena Califaretti, Luca Camoni, Aldo Carnevale, Roberta Casoni, Armando Ugo Cavallo, Giorgio Cavenaghi, Franca Chierichetti, Marcello Chiocchi, Corrado Cittanti, Mauro Colletta, Umberto Conti, Alberto Cossu, Alberto Cuocolo, Marco Cuzzocrea, Maria Luisa De Rimini, Giuseppe De Vincentis, Eleonora Del Giudice, Alberico Del Torto, Veronica Della Tommasina, Rexhep Durmo, Paola Anna Erba, Laura Evangelista, Riccardo Faletti, Evelina Faragasso, Mohsen Farsad, Paola Ferro, Luigia Florimonte, Viviana Frantellizzi, Fabio Massimo Fringuelli, Marco Gatti, Angela Gaudiano, Alessia Gimelli, Raffaele Giubbini, Francesca Giuffrida, Salvatore Ialuna, Riccardo Laudicella, Lucia Leccisotti, Lucia Leva, Riccardo Liga, Carlo Liguori, Giampiero Longo, Margherita Maffione, Maria Elisabetta Mancini, Claudio Marcassa, Elisa Milan, Barbara Nardi, Sara Pacella, Giovanna Pepe, Gianluca Pontone, Sabina Pulizzi, Natale Quartuccio, Lucia Rampin, Fabrizio Ricci, Pierluigi Rossini, Giuseppe Rubini, Vincenzo Russo, Gian Mauro Sacchetti, Gianmario Sambuceti, Massimo Scarano, Roberto Sciagrà, Massimiliano Sperandio, Antonella Stefanelli, Guido Ventroni, Stefania Zoboli, Dainia Baugh, Duane Chambers, Ernest Madu, Felix Nunura, Hiroshi Asano, Chimura Misato Chimura, Shinichiro Fujimoto, Koichiro Fujisue, Tomohisa Fukunaga, Yoshimitsu Fukushima, Kae Fukuyama, Jun Hashimoto, Yasutaka Ichikawa, Nobuo Iguchi, Masamichi Imai, Anri Inaki, Hayato Ishimura, Satoshi Isobe, Toshiaki Kadokami, Takao Kato, Shinichiro Kumita, Hirotaka Maruno, Hiroyuki Mataki, Masao Miyagawa, Ryota Morimoto, Masao Moroi, Shigeki Nagamachi, Kenichi Nakajima, Tomoaki Nakata, Ryo Nakazato, Mamoru Nanasato, Masanao Naya, Takashi Norikane, Yasutoshi Ohta, Satoshi Okayama, Atsutaka Okizaki, Yoichi Otomi, Hideki Otsuka, Masaki Saito, Sakata Yasushi Sakata, Masayoshi Sarai, Daisuke Sato, Shinya Shiraishi, Yoshinobu Suwa, Kentaro Takanami, Kazuya Takehana, Junichi Taki, Nagara Tamaki, Yasuyo Taniguchi, Hiroki Teragawa, Nobuo Tomizawa, Kenichi Tsujita, Kyoko Umeji, Yasushi Wakabayashi, Shinichiro Yamada, Shinya Yamazaki, Tatsuya Yoneyama, Mohammad Rawashdeh, Daultai Batyrkhanov, Khalid Makhdomi, Kevin Ombati, Faridah Alkandari, Masoud Garashi, Tchoyoson Lim Coie, Sonexay Rajvong, Artem Kalinin, Marika Kalnina, Mohamad Haidar, Renata Komiagiene, Giedre Kviecinskiene, Mindaugas Mataciunas, Donatas Vajauskas, Christian Picard, Noor Khairiah A. Karim, Luise Reichmuth, Anthony Samuel, Mohammad Aaftaab Allarakha, Ambedhkar Shantaram Naojee, Erick Alexanderson-Rosas, Erika Barragan, Alejandro Becerril González-Montecinos, Manuel Cabada, Daniel Calderon Rodriguez, Isabel Carvajal-Juarez, Violeta Cortés, Filiberto Cortés, Erasmo De La Peña, Manlio Gama-Moreno, Luis González, Nelsy Gonzalez Ramírez, Moisés Jiménez-Santos, Luis Matos, Edgar Monroy, Martha Morelos, Mario Ornelas, Jose Alberto Ortga Ramirez, Andrés Preciado-Anaya, Óscar Ulises Preciado-Gutiérrez, Adriana Puente Barragan, Sandra Graciela Rosales Uvera, Sigelinda Sandoval, Miguel Santaularia Tomas, Lilia M. 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Bayer, Adam Bernheim, Sabha Bhatti, Erik Bieging, Ron Blankstein, Stephen Bloom, Sean Blue, David Bluemke, Andressa Borges, Kelley Branch, Paco Bravo, Jessica Brothers, Matthew Budoff, Renée Bullock-Palmer, Angela Burandt, Floyd W. Burke, Kelvin Bush, Candace Candela, Elizabeth Capasso, Joao Cavalcante, Donald Chang, Saurav Chatterjee, Yiannis Chatzizisis, Michael Cheezum, Tiffany Chen, Jennifer Chen, Marcus Chen, James Clarcq, Ayreen Cordero, Matthew Crim, Sorin Danciu, Bruce Decter, Nimish Dhruva, Neil Doherty, Rami Doukky, Anjori Dunbar, William Duvall, Rachael Edwards, Kerry Esquitin, Husam Farah, Emilio Fentanes, Maros Ferencik, Daniel Fisher, Daniel Fitzpatrick, Cameron Foster, Tony Fuisz, Michael Gannon, Lori Gastner, Myron Gerson, Brian Ghoshhajra, Alan Goldberg, Brian Goldner, Jorge Gonzalez, Rosco Gore, Sandra Gracia-López, Fadi Hage, Agha Haider, Sofia Haider, Yasmin Hamirani, Karen Hassen, Mallory Hatfield, Carolyn Hawkins, Katie Hawthorne, Nicholas Heath, Robert Hendel, Phillip Hernandez, Gregory Hill, Stephen Horgan, Jeff Huffman, Lynne Hurwitz, Ami Iskandrian, Rajesh Janardhanan, Christine Jellis, Scott Jerome, Dinesh Kalra, Summanther Kaviratne, Fernando Kay, Faith Kelly, Omar Khalique, Mona Kinkhabwala, George Kinzfogl Iii, Jacqueline Kircher, Rachael Kirkbride, Michael Kontos, Anupama Kottam, Joseph Krepp, Jay Layer, Steven H. Lee, Jeffrey Leppo, John Lesser, Steve Leung, Howard Lewin, Diana Litmanovich, Yiyan Liu, Kathleen Magurany, Jeremy Markowitz, Amanda Marn, Stephen E. Matis, Michael Mckenna, Tony Mcrae, Fernando Mendoza, Michael Merhige, David Min, Chanan Moffitt, Karen Moncher, Warren Moore, Shamil Morayati, Michael Morris, Mahmud Mossa-Basha, Zorana Mrsic, Venkatesh Murthy, Prashant Nagpal, Kyle Napier, Katarina Nelson, Prabhjot Nijjar, Medhat Osman, Edward Passen, Amit Patel, Pravin Patil, Ryan Paul, Lawrence Phillips, Venkateshwar Polsani, Rajaram Poludasu, Brian Pomerantz, Thomas Porter, Ryan Prentice, Amit Pursnani, Mark Rabbat, Suresh Ramamurti, Florence Rich, Hiram Rivera Luna, Austin Robinson, Kim Robles, Cesar Rodríguez, Mark Rorie, John Rumberger, Raymond Russell, Philip Sabra, Diego Sadler, Mary Schemmer, U. Joseph Schoepf, Samir Shah, Nishant Shah, Sujata Shanbhag, Gaurav Sharma, Steven Shayani, Jamshid Shirani, Pushpa Shivaram, Steven Sigman, Mitch Simon, Ahmad Slim, David Smith, Alexandra Smith, Prem Soman, Aditya Sood, Monvadi Barbara Srichai-Parsia, James Streeter, Albert T, Ahmed Tawakol, Dustin Thomas, Randall Thompson, Tara Torbet, Desiree Trinidad, Shawn Ullery, Samuel Unzek, Seth Uretsky, Srikanth Vallurupalli, Vikas Verma, Alfonso Waller, Ellen Wang, Parker Ward, Gaby Weissman, George Wesbey, Kelly White, David Winchester, David Wolinsky, Sandra Yost, Michael Zgaljardic, Omar Alonso, Mario Beretta, Rodolfo Ferrando, Miguel Kapitan, Fernando Mut, Omoa Djuraev, Gulnora Rozikhodjaeva, Ha Le Ngoc, Son Hong Mai, Xuan Canh Nguyen, Kudo, T, Lahey, R, Hirschfeld, C, Williams, M, Lu, B, Alasnag, M, Bhatia, M, Henry Bom, H, Dautov, T, Fazel, R, Karthikeyan, G, Keng, F, Rubinshtein, R, Better, N, Cerci, R, Dorbala, S, Raggi, P, Shaw, L, Villines, T, Vitola, J, Choi, A, Malkovskiy, E, 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Schmidt, E, Szilveszter, B, Várady, E, Banthia, N, Bhagat, J, Bhargava, R, Bhat, V, Choudhury, P, Chowdekar, V, Irodi, A, Jain, S, Joseph, E, Kumar, S, Girijanandan Mahapatra, P, Mitra, D, Mittal, B, Ozair, A, Patel, C, Patel, T, Patel, R, Patel, S, Saxena, S, Sengupta, S, Singh, S, Singh, B, Sood, A, Verma, A, Affandi, E, Alam, P, Edison, E, Gunawan, G, Hapkido, H, Hidayat, B, Huda, A, Mukti, A, Prawiro, D, Soeriadi, E, Syawaluddin, H, Albadr, A, Assadi, M, Emami, F, Houshmand, G, Maleki, M, Rostami, M, Zakavi, S, Zaid, E, Agranovich, S, Arnson, Y, Bar-Shalom, R, Frenkel, A, Knafo, G, Lugassi, R, Maor Moalem, I, Mor, M, Muskal, N, Ranser, S, Shalev, A, Albano, D, Alongi, P, Arnone, G, Bagatin, E, Baldari, S, Bauckneht, M, Bertelli, P, Bianco, F, Bonfiglioli, R, Boni, R, Bruno, A, Bruno, I, Busnardo, E, Califaretti, E, Camoni, L, Carnevale, A, Casoni, R, Cavallo, A, Cavenaghi, G, Chierichetti, F, Chiocchi, M, Cittanti, C, Colletta, M, Conti, U, Cossu, A, Cuocolo, A, Cuzzocrea, M, De Rimini, M, De Vincentis, G, Del Giudice, E, Del Torto, A, Della Tommasina, V, Durmo, R, Erba, P, Evangelista, L, Faletti, R, Faragasso, E, Farsad, M, Ferro, P, Florimonte, L, Frantellizzi, V, Fringuelli, F, Gatti, M, Gaudiano, A, Gimelli, A, Giubbini, R, Giuffrida, F, Ialuna, S, Laudicella, R, Leccisotti, L, Leva, L, Liga, R, Liguori, C, Longo, G, Maffione, M, Mancini, M, Marcassa, C, Milan, E, Nardi, B, Pacella, S, Pepe, G, Pontone, G, Pulizzi, S, Quartuccio, N, Rampin, L, Ricci, F, Rossini, P, Rubini, G, Russo, V, Sacchetti, G, Sambuceti, G, Scarano, M, Sciagrà, R, Sperandio, M, Stefanelli, A, Ventroni, G, Zoboli, S, Baugh, D, Chambers, D, Madu, E, Nunura, F, Asano, H, Chimura, C, Fujimoto, S, Fujisue, K, Fukunaga, T, Fukushima, Y, Fukuyama, K, Hashimoto, J, Ichikawa, Y, Iguchi, N, Imai, M, Inaki, A, Ishimura, H, Isobe, S, Kadokami, T, Kato, T, Kumita, S, Maruno, H, Mataki, H, Miyagawa, M, Morimoto, R, Moroi, M, Nagamachi, S, Nakajima, K, Nakata, T, Nakazato, R, Nanasato, M, Naya, M, Norikane, T, Ohta, Y, Okayama, S, Okizaki, A, Otomi, Y, Otsuka, H, Saito, M, Sakata, S, Sarai, M, Sato, D, Shiraishi, S, Suwa, Y, Takanami, K, Takehana, K, Taki, J, Tamaki, N, Taniguchi, Y, Teragawa, H, Tomizawa, N, Tsujita, K, Umeji, K, Wakabayashi, Y, Yamada, S, Yamazaki, S, Yoneyama, T, Rawashdeh, M, Batyrkhanov, D, Makhdomi, K, Ombati, K, Alkandari, F, Garashi, M, Coie, T, Rajvong, S, Kalinin, A, Kalnina, M, Haidar, M, Komiagiene, R, Kviecinskiene, G, Mataciunas, M, Vajauskas, D, Picard, C, Karim, N, Reichmuth, L, Samuel, A, Allarakha, M, Naojee, A, Alexanderson-Rosas, E, Barragan, E, González-Montecinos, A, Cabada, M, Rodriguez, D, Carvajal-Juarez, I, Cortés, V, Cortés, F, De La Peña, E, Gama-Moreno, M, González, L, Ramírez, N, Jiménez-Santos, M, Matos, L, Monroy, E, Morelos, M, Ornelas, M, Ortga Ramirez, J, Preciado-Anaya, A, Preciado-Gutiérrez, Ó, Barragan, A, Rosales Uvera, S, Sandoval, S, Tomas, M, Sierra-Galan, L, Siu, S, Vallejo, E, Valles, M, Faraggi, M, Sereegotov, E, Ilic, S, Ben-Rais, N, Alaoui, N, Taleb, S, Pa Myo, K, Thu, P, Ghimire, R, Rajbanshi, B, Barneveld, P, Glaudemans, A, Habets, J, Koopmans, K, Manders, J, Pool, S, Scholte, A, Scholtens, A, Slart, R, Thimister, P, Van Asperen, E, Veltman, N, Verschure, D, Wagenaar, N, Edmond, J, Ellis, C, Johnson, K, Keenan, R, Kueh, S, Occleshaw, C, Sasse, A, To, A, Van Pelt, N, Young, C, Cuadra, T, Roque Vanegas, H, Soli, I, Issoufou, D, Ayodele, T, Madu, C, Onimode, Y, Efros-Monsen, E, Forsdahl, S, Hildre Dimmen, J, Jørgensen, A, Krohn, I, Løvhaugen, P, Bråten, A, Al Dhuhli, H, Al Kindi, F, Al-Bulushi, N, Jawa, Z, Tag, N, Afzal, M, Fatima, S, Younis, M, Riaz, M, Saadullah, M, Herrera, Y, Lenturut-Katal, D, Vázquez, M, Ortellado, J, Akhter, A, Cao, D, Cheung, S, Dai, X, Gong, L, Han, D, Hou, Y, Li, C, Li, T, Li, D, Li, S, Liu, J, Liu, H, Ng, M, Sun, K, Tang, G, Wang, J, Wang, X, Wang, Z, Wang, Y, Wu, J, Wu, Z, Xia, L, Xiao, J, Xu, L, Yang, Y, Yin, W, Yu, J, Yuan, L, Zhang, T, Zhang, L, Zhang, Y, Zhang, X, Zhu, L, Alfaro, A, Abrihan, P, Barroso, A, Cruz, E, Gomez, M, Magboo, V, Medina, J, Obaldo, J, Pastrana, D, Pawhay, C, Quinon, A, Tang, J, Tecson, B, Uson, K, Uy, M, Kostkiewicz, M, Kunikowska, J, Bettencourt, N, Cantinho, G, Ferreira, A, Syed, G, Arnous, S, Atyani, S, Byrne, A, Gleeson, T, Kerins, D, Meehan, C, Murphy, D, Murphy, M, Murray, J, O'Brien, J, Bang, J, Bom, H, Cho, S, Hong, C, Jang, S, Jeong, Y, Kang, W, Kim, J, Namgung, C, So, Y, Won, K, Majstorov, V, Vavlukis, M, Salobir, B, Štalc, M, Benedek, T, Benedek, I, Mititelu, R, Stan, C, Ansheles, A, Dariy, O, Drozdova, O, Gagarina, N, Gulyaev, V, Itskovich, I, Karalkin, A, Kokov, A, Migunova, E, Pospelov, V, Ryzhkova, D, Saifullina, G, Sazonova, S, Sergienko, V, Shurupova, I, Trifonova, T, Ussov, W, Vakhromeeva, M, Valiullina, N, Zavadovsky, K, Zhuravlev, K, Okarvi, S, Saranovic, D, Jason See, J, Sekar, R, Yew, M, Vondrak, A, Bejai, S, Bennie, G, Bester, R, Engelbrecht, G, Evbuomwan, O, Gongxeka, H, Vuuren, M, Kaplan, M, Khushica, P, Lakhi, H, Louw, L, Malan, N, Milos, K, Modiselle, M, More, S, Naidoo, M, Scholtz, L, Vangu, M, Aguadé-Bruix, S, Blanco, I, Cabrera, A, Camarero, A, Casáns-Tormo, I, Cuellar-Calabria, H, Flotats, A, Fuentes Cañamero, M, García, M, Jimenez-Heffernan, A, Leta, R, Diaz, J, Lumbreras, L, Marquez-Cabeza, J, Martin, F, Martinez de Alegria, A, Medina, F, Canal, M, Peiro, V, Pubul-Nuñez, V, Rayo Madrid, J, Rey, C, Perez, R, Ruiz, J, Hernández, G, Sevilla, A, Zeidán, N, Nanayakkara, D, Udugama, C, Simonsson, M, Alkadhi, H, Buechel, R, Burger, P, Ceriani, L, De Boeck, B, Gräni, C, Juillet de Saint Lager Lucas, A, Kamani, C, Kawel-Boehm, N, Manka, R, Prior, J, Rominger, A, Vallée, J, Khiewvan, B, Premprabha, T, Thientunyakit, T, Sellem, A, Kir, K, Sayman, H, Sebikali, M, Muyinda, Z, Kmetyuk, Y, Korol, P, Mykhalchenko, O, Pliatsek, V, Satyr, M, Albalooshi, B, Ahmed Hassan, M, Anderson, J, Bedi, P, Biggans, T, Bularga, A, Bull, R, Burgul, R, Carpenter, J, Coles, D, Cusack, D, Deshpande, A, Dougan, J, Fairbairn, T, Farrugia, A, Gopalan, D, Gummow, A, Ramkumar, P, Hamilton, M, Harbinson, M, Hartley, T, Hudson, B, Joshi, N, Kay, M, Kelion, A, Khokhar, A, Kitt, J, Low, C, Mak, S, Marousa, N, Martin, J, Mcalindon, E, Menezes, L, Morgan-Hughes, G, Moss, A, Murray, A, Nicol, E, Patel, D, Peebles, C, Pugliese, F, Luis Rodrigues, J, Rofe, C, Sabharwal, N, Schofield, R, Semple, T, Sharma, N, Strouhal, P, Subedi, D, Topping, W, Tweed, K, Weir-Mccall, J, Abbara, S, Abbasi, T, Abbott, B, Abohashem, S, Abramson, S, Al-Abboud, T, Al-Mallah, M, Almousalli, O, Ananthasubramaniam, K, Kumar, M, Askew, J, Attanasio, L, Balmer-Swain, M, Bayer, R, Bernheim, A, Bhatti, S, Bieging, E, Blankstein, R, Bloom, S, Blue, S, Bluemke, D, Borges, A, Branch, K, Bravo, P, Brothers, J, Budoff, M, Bullock-Palmer, R, Burandt, A, Burke, F, Bush, K, Candela, C, Capasso, E, Cavalcante, J, Chang, D, Chatterjee, S, Chatzizisis, Y, Cheezum, M, Chen, T, Chen, J, Chen, M, Clarcq, J, Cordero, A, Crim, M, Danciu, S, Decter, B, Dhruva, N, Doherty, N, Doukky, R, Dunbar, A, Duvall, W, Edwards, R, Esquitin, K, Farah, H, Fentanes, E, Ferencik, M, Fisher, D, Fitzpatrick, D, Foster, C, Fuisz, T, Gannon, M, Gastner, L, Gerson, M, Ghoshhajra, B, Goldberg, A, Goldner, B, Gonzalez, J, Gore, R, Gracia-López, S, Hage, F, Haider, A, Haider, S, Hamirani, Y, Hassen, K, Hatfield, M, Hawkins, C, Hawthorne, K, Heath, N, Hendel, R, Hernandez, P, Hill, G, Horgan, S, Huffman, J, Hurwitz, L, Iskandrian, A, Janardhanan, R, Jellis, C, Jerome, S, Kalra, D, Kaviratne, S, Kay, F, Kelly, F, Khalique, O, Kinkhabwala, M, Iii, G, Kircher, J, Kirkbride, R, Kontos, M, Kottam, A, Krepp, J, Layer, J, Lee, S, Leppo, J, Lesser, J, Leung, S, Lewin, H, Litmanovich, D, Liu, Y, Magurany, K, Markowitz, J, Marn, A, Matis, S, Mckenna, M, Mcrae, T, Mendoza, F, Merhige, M, Min, D, Moffitt, C, Moncher, K, Moore, W, Morayati, S, Morris, M, Mossa-Basha, M, Mrsic, Z, Murthy, V, Nagpal, P, Napier, K, Nelson, K, Nijjar, P, Osman, M, Passen, E, Patel, A, Patil, P, Paul, R, Phillips, L, Polsani, V, Poludasu, R, Pomerantz, B, Porter, T, Prentice, R, Pursnani, A, Rabbat, M, Ramamurti, S, Rich, F, Luna, H, Robinson, A, Robles, K, Rodríguez, C, Rorie, M, Rumberger, J, Russell, R, Sabra, P, Sadler, D, Schemmer, M, Schoepf, U, Shah, S, Shah, N, Shanbhag, S, Sharma, G, Shayani, S, Shirani, J, Shivaram, P, Sigman, S, Simon, M, Slim, A, Smith, D, Smith, A, Soman, P, Srichai-Parsia, M, Streeter, J, T, A, Tawakol, A, Thomas, D, Thompson, R, Torbet, T, Trinidad, D, Ullery, S, Unzek, S, Uretsky, S, Vallurupalli, S, Verma, V, Waller, A, Wang, E, Ward, P, Weissman, G, Wesbey, G, White, K, Winchester, D, Wolinsky, D, Yost, S, Zgaljardic, M, Alonso, O, Beretta, M, Ferrando, R, Kapitan, M, Mut, F, Djuraev, O, Rozikhodjaeva, G, Le Ngoc, H, Mai, S, and Nguyen, X

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Heart disease, business.industry, cardiac testing, coronavirus, COVID-19, global health, Disease, medicine.disease_cause, medicine.disease, coronaviru, cardiovascular disease, RC666-701, Emergency medicine, Pandemic, medicine, Global health, Diseases of the circulatory (Cardiovascular) system, business, Coronavirus
Abstract

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Published
2021

5. M5 Reporting incidental coronary and cardiac calcification on thoracic CT– BSCI/BSCCT survey of radiologist opinions

Author

James Stirrup, Michelle C. Williams, Aparna Deshpande, James Shambrook, Alastair J Moss, Bobby Agrawal, Ben Holloway, Giles Roditi, Deepa Gopalan, Gareth Morgan Hughes, Matthias Schmitt, Russell Bull, J. Weir-McCall, and Edward Nicol

Subjects
Aortic valve, Aorta, medicine.medical_specialty, Thoracic aorta calcification, business.industry, medicine.disease, Coronary arteries, medicine.anatomical_structure, medicine.artery, Coronary artery calcification, Mitral valve, medicine, Thoracic ct, Radiology, business, Calcification
Abstract

Introduction Coronary and cardiac calcifications are common incidental findings on thoracic CT which are frequently not reported. This survey sought the opinions of UK radiologists regarding reporting of incidental calcification. Methods Using an online survey form UK radiologists were invited to answer questions regarding reporting of coronary, aortic valve, mitral and thoracic aorta calcification on routine non-cardiac/vascular thoracic CT. Results 210 radiologists completed the survey including 24 (11%) trainees and 186 (89%) consultants. 30% were not sub-specialists in cardiac, thoracic or vascular imaging. Calcification was not reported by 11% for the coronary arteries, 21% for the aortic valve, 25% for the mitral valve and 38% for the aorta. Age and indication for imaging were the most frequent factors influencing the reporting of calcification. For coronary calcification a per patient visual assessment was the most frequently used (66%), followed by per vessel visual assessment (14%), semi-quantitative scoring (5%) and Agatston scoring (2%). Several comments suggested that guidelines for reporting incidental coronary and cardiac calcification would be useful. Conclusion Reporting of incidental coronary and cardiac calcification varies widely and guidelines are required.

Published
2020
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6. Management of established coronary artery disease in aircrew with previous myocardial infarction or revascularisation

Author

Norbert Guettler, Eddie D Davenport, Joanna d’Arcy, Dennis Bron, Olivier Manen, Rienk Rienks, Edward Nicol, Gary Gray, and Thomas Syburra

Subjects
Standards, medicine.medical_specialty, Myocardial Infarction, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, aviation medicine, 0302 clinical medicine, medicine, Humans, Plaque morphology, 030212 general & internal medicine, Myocardial infarction, Cardiac risk, business.industry, Disease Management, medicine.disease, Stenosis, cardiology, Practice Guidelines as Topic, Emergency medicine, Aerospace Medicine, Aircrew, Aviation medicine, Cardiology and Cardiovascular Medicine, business
Abstract

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease (CAD) without myocardial infarction (MI) or revascularisation (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology.Aircrew may present with MI (both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI)) as the initial presenting symptom of obstructive CAD requiring revascularisation. Management of these individuals should be conducted according to published guidelines, ideally with consultation between the cardiologist, surgeon and aviation medical examiner. Return to restricted flight duties is possible in the majority of aircrew; however, they must have normal cardiac function, acceptable residual disease burden and no residual ischaemia. They must also be treated with aggressive cardiac risk factor modification. Aircrew should be restricted to dual pilot operations in non-high-performance aircraft, with return to flying no sooner than 6 months after the event. At minimum, annual follow-up with routine non-invasive cardiac evaluation is recommended.

Published
2018
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7. Heart muscle disease management in aircrew

Author

Joanna d’Arcy, Dennis Bron, Olivier Manen, Norbert Guettler, Rienk Rienks, Gary Gray, Eddie D Davenport, Edward Nicol, and Thomas Syburra

Subjects
health care delivery, Standards, myocardial disease, medicine.medical_specialty, Myocarditis, Heart disease, Cardiomyopathy, heart disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, Pericarditis, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, business.industry, Disease Management, medicine.disease, Family member, Military Personnel, Muscle disease, Aerospace Medicine, Electrocardiography, Ambulatory, Aircrew, Aviation medicine, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business
Abstract

This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with suspected or confirmed heart muscle disease (both pilots and non-pilot aviation professionals). ECG abnormalities on aircrew periodic medical examination or presentation of a family member with a confirmed cardiomyopathy are the most common reason for investigation of heart muscle disease in aircrew. Holter monitoring and imaging, including cardiac MRI is recommended to confirm or exclude the presence of heart muscle disease and, if confirmed, management should be led by a subspecialist. Confirmed heart muscle disease often requires restriction toflying duties due to concerns regarding arrhythmia. Pericarditis and myocarditis usually require temporary restriction and return to flying duties is usually dependent on a lack of recurrent symptoms and acceptable imaging and electrophysiological investigations.

Published
2018
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8. Contemporaneous management of valvular heart disease and aortopathy in aircrew

Author

Dennis Bron, Olivier Manen, Joanna d’Arcy, Rienk Rienks, Thomas Syburra, Edward Nicol, Eddie D Davenport, Norbert Guettler, and Gary Gray

Subjects
health care delivery, Standards, medicine.medical_specialty, Cardiac output, Population, Aortic Diseases, Cardiology, Heart Valve Diseases, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Bicuspid aortic valve, Risk Factors, Internal medicine, medicine.artery, medicine, Humans, 030212 general & internal medicine, education, Cardiac imaging, education.field_of_study, Aorta, business.industry, valvular heart disease, Disease Management, medicine.disease, Military Personnel, aortic and arterial disease, Aerospace Medicine, cardiovascular system, Aircrew, Cardiology and Cardiovascular Medicine, business
Abstract

Valvular heart disease (VHD) is highly relevant in the aircrew population as it may limit appropriate augmentation of cardiac output in high-performance flying and predispose to arrhythmia. Aircrew with VHD require careful long-term follow-up to ensure that they can fly if it is safe and appropriate for them to do so. Anything greater than mild stenotic valve disease and/or moderate or greater regurgitation is usually associated with flight restrictions. Associated features of arrhythmia, systolic dysfunction, thromboembolism and chamber dilatation indicate additional risk and will usually require more stringent restrictions. The use of appropriate cardiac imaging, along with routine ambulatory cardiac monitoring, is mandatory in aircrew with VHD.Aortopathy in aircrew may be found in isolation or, more commonly, associated with bicuspid aortic valve disease. Progression rates are unpredictable, but as the diameter of the vessel increases, the associated risk of dissection also increases. Restrictions on aircrew duties, particularly in the context of high-performance or solo flying, are usually required in those with progressive dilation of the aorta.

Published
2018
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9. Congenital heart disease in aircrew

Author

Olivier Manen, Thomas Syburra, Norbert Guettler, Rienk Rienks, Dennis Bron, Gary Gray, Edward Nicol, Joanna d’Arcy, and Eddie D Davenport

Subjects
Heart Defects, Congenital, health care delivery, Standards, medicine.medical_specialty, Consensus, Heart disease, Aviation, Cardiology, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, North Atlantic Treaty, business.industry, Disease Management, Expert consensus, Civil aviation, medicine.disease, congenital heart disease, Military aviation, Military Personnel, Aerospace Medicine, Aircrew, Medical emergency, Aviation medicine, Cardiology and Cardiovascular Medicine, business
Abstract

This article focuses i on the broad aviation medicine considerations that are required to optimally manage aircrew ii with suspected or confirmed congenital heart disease (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology. This expert opinion was born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of cardiovascular disease in aircrew (HFM-251) many of whom also work with and advise civil aviation authorities.

Published
2018
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10. Child mortality trends and causes of death in South Africa, 1997 - 2012, and the importance of a national burden of disease study

Author

Rob E. Dorrington, V Pillay-van Wyk, P Groenewald, Debbie Bradshaw, Nadine Nannan, Edward Nicol, and William Msemburi

Subjects
Burden of disease, Diarrhea, medicine.medical_specialty, HIV Infections, Infant, Premature, Diseases, 03 medical and health sciences, South Africa, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), 030225 pediatrics, Cause of Death, Epidemiology, Medicine, Humans, Tuberculosis, 030212 general & internal medicine, Child, Asphyxia, Asphyxia Neonatorum, Transmission (medicine), business.industry, Mortality rate, Infant, Newborn, Infant, General Medicine, Pneumonia, medicine.disease, Health Surveys, Child mortality, Child, Preschool, Population Surveillance, Child Mortality, Wounds and Injuries, Neonatal death, medicine.symptom, business, Demography
Abstract

Background. The Rapid Mortality Surveillance System has reported reductions in child mortality rates in recent years in South Africa (SA). In this article, we present information about levels of mortality and causes of death from the second SA National Burden of Disease Study (SA NBD) to inform the response required to reduce child mortality further. Objectives. To estimate trends in and causes of childhood mortality at national and provincial levels for the period 1997 - 2012, to highlight the importance of the SA NBD. Methods. Numbers of registered child deaths were adjusted for under-reporting. Adjustments were made for the misclassification of AIDS deaths and the proportion of ill-defined natural causes. Non-natural causes were estimated using results from the National Injury Mortality Surveillance System for 2000 and the National Injury Mortality Survey for 2009. Six neonatal conditions and 11 other causes were consolidated from the SA NBD and the Child Health Epidemiological Reference Group lists of causes of death for the analysis. The NBD cause-fractions were compared with those from Statistics South Africa, the United Nations Children’s Fund (UNICEF) and the Institute for Health Metrics and Evaluation (IHME). Results. Under-5 mortality per 1 000 live births increased from 65 in 1997 to 79 in 2004 as a result of HIV/AIDS, before dropping to 40 by 2012. The neonatal mortality rate declined from 1997 to 2001, followed by small variations. The death rate from diarrhoeal diseases began to decrease in 2008 and the death rate from pneumonia from 2010. By 2012, neonatal deaths accounted for 27% of child deaths, with conditions associated with prematurity, birth asphyxia and severe infections being the main contributors. In 1997, KwaZulu-Natal, Free State, Mpumalanga and Eastern Cape provinces had the highest under-5 mortality, close to 80 per 1 000 live births. Mortality rates in North West were in the mid-range and then increased, placing this province in the highest group in the later years. The Western Cape had the lowest mortality rate, declining throughout the period apart from a slight increase in the early 2000s. Conclusions. The SA NBD identified the causes driving the trends, making it clear that prevention of mother-to-child transmission of HIV, the Expanded Programme on Immunisation and programmes aimed at preventing neonatal deaths need to be equitably implemented throughout the country to address persistent provincial inequalities in child deaths. The rapid reduction of childhood mortality since 2005 suggests that the 2030 Sustainable Development Goal target of 25 per 1 000 for under-5 mortality is achievable for SA. Comparison with alternative estimates highlights the need for cause-of-death data from civil registration to be adjusted using a burden-of-disease approach.

Published
2019

11. Medication in aircrew

Author

Nicholas Green, Steven Gaydos, Hutchison Ewan, and Edward Nicol

Subjects
business.industry, Medicine, Aircrew, Medical emergency, business, medicine.disease
Published
2019
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12. Congenital heart disease

Author

Steven Gaydos, Nicholas Green, Edward Nicol, and Hutchison Ewan

Subjects
medicine.medical_specialty, Heart disease, business.industry, Internal medicine, medicine, Cardiology, business, medicine.disease
Published
2019
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13. Valvular heart disease

Author

Hutchison Ewan, Edward Nicol, Steven Gaydos, and Nicholas Green

Subjects
medicine.medical_specialty, business.industry, Internal medicine, valvular heart disease, Cardiology, Medicine, business, medicine.disease
Published
2019
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14. Sub-atmospheric decompression illness

Author

Edward Nicol, Nicholas Green, Steven Gaydos, and Hutchison Ewan

Subjects
medicine.medical_specialty, business.industry, Medicine, Decompression illness, business, medicine.disease, Intensive care medicine
Published
2019
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16. Cardiac MRI improves cardiovascular risk stratification in hazardous occupations

Author

Edward Nicol, Joseph Britton, Rebecca Chamley, Stefan Neubauer, Joanna d’Arcy, Iain Parsons, David Holdsworth, Arun J Baksi, and Christopher W. Pavitt

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Health Status, Cardiomyopathy, 030218 nuclear medicine & medical imaging, Workflow, Electrocardiography, 0302 clinical medicine, Return to Work, Risk Factors, Radiological and Ultrasound Technology, medicine.diagnostic_test, Middle Aged, musculoskeletal system, Magnetic Resonance Imaging, Occupational, Military Personnel, Cardiovascular Diseases, Risk stratification, Cardiology, cardiovascular system, Aviation medicine, Female, Medical assessment, Cardiology and Cardiovascular Medicine, circulatory and respiratory physiology, Adult, Risk, medicine.medical_specialty, Occupational risk, Risk Assessment, 03 medical and health sciences, Young Adult, Predictive Value of Tests, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Occupational Health, Angiology, Retrospective Studies, business.industry, Research, Reproducibility of Results, Magnetic resonance imaging, medicine.disease, Pilots, lcsh:RC666-701, Ectopy, Aircrew, business
Abstract

Background The benefit of cardiovascular magnetic resonance Imaging (CMR) in assessing occupational risk is unknown. Pilots undergo frequent medical assessment for occult disease, which threatens incapacitation or distraction during flight. ECG and examination anomalies often lead to lengthy restriction, pending full investigation. CMR provides a sensitive, specific assessment of cardiac anatomy, tissue characterisation, perfusion defects and myocardial viability. We sought to determine if CMR, when added to standard care, would alter occupational outcome. Methods A retrospective review was conducted of all personnel attending the RAF Aviation Medicine Consultation Service (AMCS) for assessment of a cardiac anomaly, over a 2-year period. Those undergoing standard of care (history, examination, exercise ECG, 24 h-Holter and transthoracic echocardiography), and those undergoing a CMR in addition, were identified. The influence of CMR upon the final decision regarding flying restriction was determined by comparing the diagnosis reached with standard of care plus CMR vs. standard of care alone. Results Of the ~ 8000 UK military aircrew, 558 personnel were seen for cardiovascular assessment. Fifty-two underwent CMR. A normal TTE did not reliably exclude abnormalities subsequently detected by CMR. Addition of CMR resulted in an upgraded occupational status in 62% of those investigated, with 37% returning to unrestricted duties. Only 8% of referrals were undiagnosed following CMR. All these were cases of borderline chamber dilatation and reduction in systolic function in whom diagnostic uncertainty remained between physiological exercise adaptation and early cardiomyopathy. Conclusions CMR increases the likelihood of a definitive diagnosis and of return to flying. This study supports early use of CMR in occupational assessment for high-hazard occupations. Electronic supplementary material The online version of this article (10.1186/s12968-019-0544-5) contains supplementary material, which is available to authorized users.

Published
2019

17. The challenge of asymptomatic coronary artery disease in aircrew; detecting plaque before the accident

Author

Dennis Bron, Norbert Guettler, Edward Nicol, Eddie D Davenport, Joanna d’Arcy, Gary Gray, Rienk Rienks, Olivier Manen, and Thomas Syburra

Subjects
health care delivery, medicine.medical_specialty, Standards, Computed Tomography Angiography, cardiac imaging and diagnostics, Stress testing, Population, Ischemia, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Global Health, Asymptomatic, Risk Assessment, cardiac risk factors and prevention, Coronary artery disease, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, education, education.field_of_study, business.industry, medicine.disease, Plaque, Atherosclerotic, Survival Rate, Younger adults, Emergency medicine, Asymptomatic Diseases, Aerospace Medicine, Exercise Test, Aircrew, medicine.symptom, Morbidity, Cardiology and Cardiovascular Medicine, Risk assessment, business
Abstract

Coronary events remain a major cause of sudden incapacitation, including death, in both the general population and among aviation personnel, and are an ongoing threat to flight safety and operations. The presentation is often unheralded, especially in younger adults, and is often due to rupture of a previously non-obstructive coronary atheromatous plaque. The challenge for aeromedical practitioners is to identify individuals at increased risk for such events. This paper presents the NATO Cardiology Working Group (HFM 251) consensus approach for screening and investigation of aircrew for asymptomatic coronary disease.A three-phased approach to coronary artery disease (CAD) risk assessment is recommended, beginning with initial risk-stratification using a population-appropriate risk calculator and resting ECG. For aircrew identified as being at increased risk, enhanced screening is recommended by means of Coronary Artery Calcium Score alone or combined with a CT coronary angiography investigation. Additional screening may include exercise testing, and vascular ultrasound imaging. Aircrew identified as being at high risk based on enhanced screening require secondary investigations, which may include functional ischaemia, and potentially invasive coronary angiography. Functional stress testing as a stand-alone investigation for significant CAD is not recommended in aircrew. Aircrew identified with coronary disease require further clinical and aeromedical evaluation before being reconsidered for flying status.

Published
2018

18. Epidemiology of lower respiratory infection and pneumonia in South Africa (1997–2015): a systematic review protocol

Author

Victoria Pillay-van Wyk, Ali Dhansay, Pam Groenewald, Jané Joubert, Mweete D Nglazi, Debbie Bradshaw, Rifqah A Roomaney, Oluwatoyin F Awotiwon, and Edward Nicol

Subjects
Research design, south africa, medicine.medical_specialty, Veterinary medicine, 030231 tropical medicine, Subgroup analysis, burden of disease, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Epidemiology, Case fatality rate, medicine, Protocol, Prevalence, Humans, 030212 general & internal medicine, Respiratory Tract Infections, Respiratory tract infections, business.industry, Incidence (epidemiology), Public health, Incidence, General Medicine, Pneumonia, medicine.disease, lower respiratory infection, Research Design, Public Health, business, Systematic Reviews as Topic
Abstract

Introduction Lower respiratory infections (LRIs) and pneumonia are among the leading causes of death worldwide, especially in children aged under 5 years, and these patterns are reflected in the South African population. Local epidemiological data for LRIs and pneumonia are required to inform the Second National Burden of Disease Study underway in South Africa. The aim of this systematic review is to identify published studies reporting the prevalence, incidence, case fatality, duration or severity of LRI and pneumonia in adults and children in South Africa. Methods and analysis Electronic database searches will be conducted to obtain studies reporting on the prevalence, incidence, case fatality, duration and severity of LRI and pneumonia in South Africa between January 1997 and December 2015. Studies that are assessed to have moderate or low risk of bias will be included in a meta-analysis, if appropriate. Where meta-analysis is not possible, the articles will be described narratively. Subgroup analysis (eg, age groups) will also be conducted where enough information is available. Ethics and dissemination This systematic review will only include published data with no linked patient-level information; thus, no ethics approval is required. The findings will be used to calculate the burden of disease attributed to LRI and pneumonia in South Africa and will highlight the type of epidemiological data available in the country. The article will be disseminated in a peer-reviewed publication. PROSPERO registration number CRD42016036520.

Published
2016

19. A 5-year review of atrial fibrillation in military aircrew

Author

Andrew C. Timperley, Edward Nicol, David C. McLoughlin, Alys H. Hunter, and Alastair N. C. Reid

Subjects
Adult, Male, Adolescent, Databases, Factual, Electric Countershock, Work Capacity Evaluation, Context (language use), Young Adult, Atrial Fibrillation, Medicine, Humans, Paroxysmal AF, Fibrillation, business.industry, Public Health, Environmental and Occupational Health, Atrial fibrillation, Middle Aged, medicine.disease, United Kingdom, Military aviation, Search terms, Military Personnel, Practice Guidelines as Topic, Aerospace Medicine, Catheter Ablation, Aircrew, Female, Electronic database, Medical emergency, medicine.symptom, business, Anti-Arrhythmia Agents
Abstract

INTRODUCTION Atrial fibrillation (AF) is a common cause of disqualification from flying in both civilian and military aircrew. We reviewed 5 yr of atrial fibrillation management in the Royal Air Force (RAF) from both a clinical and occupational perspective. METHODS Patients were identified from the RAF Medical Boards (RAFMB) electronic database using search terms "atrial," "fibrillation," and "arrhythmia." Management was compared to current RAF and national clinical guidelines and current civilian and military aviation medicine policy. RESULTS Over the 5-yr period assessed, 23 aircrew were identified with AF. Paroxysmal AF (PAF) was the most common diagnosis. Five aircrew remained fit to fly with no limitations, 12 fit to fly with restrictions, and 6 were graded permanently unfit for flying, with one of these being medically discharged. DISCUSSION The incidence and demographics of aircrew identified with AF in this paper is comparable to previous studies. All aircrew in our study were treated in accordance with current RAF/national guidelines. Emerging treatments such as radiofrequency ablation and the new anticoagulants remain to be assessed for suitability in a military context. CONCLUSION Management of AF in RAF aircrew requires a holistic approach, with an awareness of the arrhythmogenic aviation environment in which RAF aircrew operate. Most RAF aircrew with AF will retain a restricted flying status, but this should be considered on a case-by-case basis.

Published
2014

20. 25 The use of cardiovascular magnetic resonance (CMR) imaging in the assessment of personnel in the UK armed forces

Author

R Chamley, Iain Parsons, Edward Nicol, and Joanna d’Arcy

Subjects
education.field_of_study, medicine.medical_specialty, Bundle branch block, business.industry, Population, Cardiomyopathy, Retrospective cohort study, medicine.disease, Asymptomatic, Surgery, T wave, Emergency medicine, medicine, Aircrew, cardiovascular diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, Risk assessment, education, business
Abstract

Introduction The Armed Forces places considerable occupational demands on its workforce. Cardiovascular disease (CVD) remains a common cause of death and premature discharge. Simple CVD screening is performed periodically throughout the careers of service personnel, particularly in those in high risk roles such as aircrew. Abnormalities commonly require investigation with advanced cardiovascular imaging. Methods A retrospective cohort analysis of all military CMR requests to two military cardiologists was undertaken to determine demographics, reason for referral, results of investigation and occupational outcome. Results Between 2011 and 2015, fifty-six patients (95% male, median age 44 years) were referred for CMR. The commonest indications were abnormal echocardiography (21%), ventricular ectopy (16%), suspicion of cardiomyopathy (13%) and other asymptomatic ECG abnormalities (T wave inversion (11%) and bundle branch block (7%)). Of the CMR scans performed, 25% demonstrated features confirming cardiomyopathy (25% dilated and 12.5% hypertrophic phenotype). CMR features of athletic heart were seen in 11% of scans, and considered potentially suggestive of early cardiomyopathy. A quarter of patients had significant late gadolinium enhancement, in a variety of pathological patterns. Adenosine stress imaging was performed in 21% of patients, a quarter of which demonstrated perfusion abnormalities. Whilst 30% of patients were able to return to unrestricted duties following CMR, 70% required occupational restriction, mostly in aircrew. Of these 18% were unable to fly pending further review, 36% were deemed unfit to fly solo, and 7% had restrictions placed on their ability to deploy on overseas operations. Conclusion CMR is a valuable tool in the investigation of military personnel, and a useful adjunct to determine occupational, as well as clinical, risk. With the recent introduction of more rigorous CVD screening to join the Army, and the importance of comprehensive risk assessment in aircrew, the use of CMR in this population is likely to increase.

Published
2015
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21. Fast atrial fibrillation and caecal volvulus - a case report and evidence based management

Author

Alexander Liu and Edward Nicol

Subjects
medicine.medical_specialty, Abdominal pain, Palliative care, Exacerbation, medicine.medical_treatment, Article, Duodenal Neoplasms, Laparotomy, Atrial Fibrillation, medicine, Palpitations, Cecal Diseases, Humans, Aged, 80 and over, Evidence-Based Medicine, business.industry, Warfarin, Atrial fibrillation, General Medicine, medicine.disease, Surgery, Anesthesia, Vomiting, Female, medicine.symptom, business, Intestinal Volvulus, medicine.drug
Abstract

An 81-year-old Caucasian lady with permanent atrial fibrillation (AF) was admitted with palpitations and fast AF. She took bisoprolol and warfarin with subtherapeutic international normalised ratio. Rate control of AF was successful. Around 36 h later, she developed abdominal pain and vomiting. A caecal volvulus was diagnosed on CT. She underwent emergency laparotomy. Intraoperatively, an obstructing tumour was found in the colonic hepatic flexure. It was deemed inoperable. The caecal volvulus was decompressed and an ileo-transverse colon bypass was performed. She made a good recovery and her fast AF settled postoperatively. She was seen by the oncology team and was discharged with palliative care support with no further exacerbation of AF.

Published
2011
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