International Impact of COVID-19 on the Diagnosis of Heart Disease

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

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Kosten der Bürokratie – Reformen dringend geboten

Oliver Falck, Yuchen Mo Guo und Christian Pfaffl, ifo Institut, berechnen die wirtschaftlichen Nachteile der hohen Bürokratie in Deutschland: Die Kosten durch entgangene Wirtschaftsleistung liegen bei 146 Mrd. Euro pro Jahr. Ein umfassender Bürokratieabbau, kombiniert mit Digitalisierung, könnte die Wettbewerbsfähigkeit steigern und das Bruttoinlandsprodukt pro Kopf signifikant erhöhen. Zur Umsetzung sei jedoch ein langfristiger politischer Wille nötig, da die positiven Effekte solcher Reformen oft erst mit Verzögerung sichtbar werden. Klaus M. Schmidt, LMU München, erklärt das Phänomen der wachsenden Bürokratie. Hauptursachen seien die demokratische Reaktionsfalle, bürokratische Machtausübung durch Interessengruppen und eine überforderte Verwaltung. Bürokratie müsse kooperativer gestaltet werden, z.B. durch die Einführung von Praxischecks und One-Stop-Shops. Das Ziel einer schlanken und ergebnisorientierten Bürokratie müsse auf allen Ebenen der Gesetzgebung und Verwaltung verankert werden. Christoph Knill, LMU München, Markus Hinterleitner, Universität Lausanne, und Yves Steinebach, Universität Oslo, untersuchen die bürokratische Überlastung in Demokratien durch die zunehmende Anhäufung politischer Maßnahmen, die sogenannte Politikakkumulation. Diese führe zu einer schleichenden Überlastung der Verwaltung, da Kapazitäten oft nicht mitwachsen, was die Effektivität der Umsetzung beeinträchtigt. Eine Verbesserung der vertikalen Kopplung von Politikproduktion und Implementation hätte großes Potenzial, dauerhaft die angemessene Balance von steigenden Implementationslasten und vorhandenen administrativen Kapazitäten zu gewährleisten. Die Kosten der Bürokratie in Deutschland stellen auch aus Sicht von Sabine Kuhlmann und Florian Gerls, Normenkontrollrat, zunehmend eine Belastung für Unternehmen dar, was die Notwendigkeit für effektiven Bürokratieabbau verdeutlicht. Der Bürokratiekostenindex und die "One in one out"-Regel sollten dabei die Belastungen kontrollieren, erfassen jedoch nicht alle Kostenarten und haben somit nur begrenzte Wirksamkeit. Empfohlene Maßnahmen zur spürbaren Entlastung seien eine stärkere Digitalisierung und Vereinfachung administrativer Prozesse sowie eine effektivere Integration europäischer Regulierungen in die nationale Bürokratiepolitik. Aus Sicht von Tanja Gönner, Bundesverband der Deutschen Industrie – BDI, stellt die Bürokratie in Deutschland eine erhebliche Belastung für Unternehmen dar und behindert das wirtschaftliche Wachstum sowie die Innovationskraft, besonders im Mittelstand. Trotz politischer Maßnahmen zur Bürokratieentlastung sei die tatsächliche Wirkung in der Praxis gering, und es bestehe weiterhin ein enormer Handlungsbedarf, um Verwaltungsprozesse zu modernisieren, die Digitalisierung voranzutreiben und die Wettbewerbsfähigkeit des Standorts Deutschland zu sichern. Ein kultureller Wandel hin zu mehr Vertrauen und Ermöglichung anstelle von Misstrauen könnte die Bürokratiekosten senken und die Effizienz verbessern. Thomas Licht, Annette von Maltzan und Klaus Wohlrabe, ifo Institut, stellen die Ergebnisse einer Umfrage unter deutschen Familienunternehmen vor. Über 90 % der deutschen Unternehmen verspüren eine steigende Bürokratiebelastung, die auch ihre Investitionsbereitschaft negativ beeinflusse. Besonders hinderlich seien langsame Genehmigungsverfahren und die komplexe Steuergesetzgebung. Auch das Lieferkettengesetz wird als besonders belastend empfunden. Mit einer umfassenden Digitalisierung von Verwaltungsprozessen könne der bürokratische Aufwand reduziert und die Effizienz gesteigert werden. Daniel Weinberger, Yannik Hahn und Alexandra Heimisch-Röcker, IHK für München und Oberbayern stellen eine Umfrage unter bayerischen Unternehmen zur Bürokratie vor: Über 90% der Unternehmen fühlen sich durch diese in ihrem Geschäftsbetrieb eingeschränkt, wobei fast die Hälfte von erheblicher Beeinträchtigung berichtet. Besonders belastend seien Nachweispflichten, häufige Gesetzesänderungen und langsame Genehmigungsverfahren, was kleinere Unternehmen verhältnismäßig stärker trifft als größere. Florian Englmaier, LMU München, Gerd Mühlheußer und Niklas Wallmeier, beide Universität Hamburg, und Andreas Roider, Universität Regensburg, untersuchen den Einsatz moderner Managementmethoden in deutschen Kommunen und deren Einfluss auf die Leistungsfähigkeit. Die Ergebnisse zeigen eine große Varianz in der Anwendung dieser Methoden, unabhängig von Faktoren wie Bundesland oder Gemeindegröße. Kommunen, die systematisches Management praktizieren, erzielen bessere Resultate in Bereichen wie Lebensqualität, Standortattraktivität und Verwaltungseffizienz. Angesichts der Herausforderungen der Digitalisierung wird empfohlen, den zielgerichteten Einsatz strukturierter Managementmethoden in Kommunen weiter auszubauen. Gabriele C. Klug, Wirtschaftsvereinigung der Grünen, und Fabian Dittrich beschreiben die erheblichen direkten Bürokratiekosten in Deutschland, die jährlich rund 65 Mrd. Euro betragen und vor allem kleine und mittelständische Unternehmen belasten. Der Abbau bürokratischer Hürden und die Digitalisierung der Verwaltung seien entscheidend für eine schnellere Dekarbonisierung und eine nachhaltige Transformation der Wirtschaft. Es bedürfe eines Maximums an Agilität in der Arbeitsweise, eines steten Werbens um eine veränderte Verwaltungskultur sowie des Muts zur Innovation – wie zum Einsatz von KI in Verwaltungsprozessen. Sebastian Blesse, Universität Leipzig, Leon Högner und Sarah Necker, beide ifo Institut, betrachten die Finanzierung der Kommunen über Fördermittel. Oft würden diese nicht abgerufen, aufgrund von hohen administrativen Hürden und dem damit verbundenen Personalaufwand. Eine Lösung wäre, die Fördermittel in Pauschaltransfers umzuwandeln und an die Kommunen zu verteilen. Alternativ sollte die Komplexität des Fördermittelprozesses verbessert werden, beispielsweise indem Prozesse vereinheitlicht und entbürokratisiert werden und Informationen an zentraler Stelle transparent zur Verfügung gestellt werden

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia The IAEA INCAPS-COVID Study

BackgroundThe 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.ObjectivesThis study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia.MethodsThe 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.ResultsProcedure 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&nbsp;2020.ConclusionsThe 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

Uveitis manifestations in patients of the Swiss Inflammatory Bowel Disease Cohort Study

Background: The knowledge about risk factors for the onset of uveitis manifestations in patients with inflammatory bowel disease (IBD) is still limited. Here, we aimed to provide an overview of the clinical factors associated with the onset of uveitis in the Swiss IBD Cohort Study (SIBDCS). Methods: We included epidemiological and clinical data from 1840 patients with Crohn’s disease (CD) and 1426 patients with ulcerative colitis (UC) followed up in the SIBDCS between 2006 and 2018. Associations between disease characteristics and uveitis were assessed in univariate and multivariate analyses. Results: Overall, we identified 285 patients with uveitis. Uveitis was more frequent in patients with CD (11.1%; 205 of 1635) than UC (5.6%; 80 of 1346; odds ratio 2.11, p &lt; 0.001). The occurrence of uveitis manifestations in patients with UC and CD was significantly associated with the onset of other extraintestinal manifestations, also in multivariate analyses. The onset of uveitis was associated with the hallmark features of severe disease in both CD and UC, including a higher clinical disease activity index and the use of immunomodulators or calcineurin inhibitors. In CD, uveitis was more frequent in females and showed a positive correlation with a positive family history of IBD. Conclusions: Our data demonstrate that uveitis in IBD occurs more often in CD as well as in women and is associated with a more severe disease course. This might guide physicians’ awareness in at-risk patients to the presence of uveitis extraintestinal manifestations and help to improve patient care. </jats:sec

Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics &amp;gt;2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach. </jats:sec

Depressive Symptoms Predict Clinical Recurrence of Inflammatory Bowel Disease

Abstract Background Inflammatory bowel disease (IBD) patients are at high risk for depression, and depression has been shown to affect disease course. We examined interrelations between depression, genetic risk factors for depression, and IBD flares. Method In 1973 patients (1137 Crohn’s disease, 836 ulcerative colitis) of the Swiss IBD Cohort Study (SIBDCS), depressive status (hospital anxiety and depression subscale for depression, HADS-D ≥11) was assessed on a yearly basis. We investigated the impact of depression on IBD-relevant clinical outcomes in Cox proportional hazards models. We used active disease (CDAI ≥150 or MTWAI ≥10) and 2 published composite flare definitions—FNCE (physician-reported flare, nonresponse to therapy, new complication, or extraintestinal manifestation) and AFFSST (active disease, physician-reported flare, fistula, stenosis, and new systemic therapy)—as clinical end points. Additionally, 62 preselected single nucleotide polymorphisms (SNPs) were screened for cross-sectional associations with depression, and if present, their predictive value for future depression and clinical deterioration was assessed. Results Depression was a strong risk factor for disease-related end points, including active disease (adjusted hazard ratio [aHR], 3.55; P &amp;lt; 0.001), AFFSST (aHR, 1.62; P &amp;lt; 0.001), and FNCE (aHR, 1.35; P = 0.019). The SNP rs2522833 was significantly associated with depression at enrollment (q = 0.059). The TC allele of rs588765 was negatively associated with the presence of depression at enrollment (q = 0.050) and after enrollment (aHR, 0.67; P = 0.035) and with fewer active disease states (aHR, 0.72; P = 0.045) during follow-up. Conclusion In IBD, depressive symptoms and inflammatory activity are intimately related. Depressive symptoms were a strong predictor of clinical deterioration, and genetic markers may play a role in this relationship. </jats:sec

Abdominal pain in patients with inflammatory bowel disease: association with single-nucleotide polymorphisms prevalent in irritable bowel syndrome and clinical management

Abstract Background Abdominal pain is a frequent symptom in patients with inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC). Pain can result from ongoing inflammation or functional disorders imitating irritable bowel syndrome (IBS). Several single-nucleotide polymorphisms (SNPs) have been associated with IBS. However, the impact of IBS genetics on the clinical course of IBD, especially pain levels of patients remains unclear. Methods Data of 857 UC and 1206 CD patients from the Swiss IBD Cohort Study were analysed. We tested the association of the maximum of the abdominal pain item of disease activity indices in UC and CD over the study period with 16 IBS-associated SNPs, using multivariate ANOVA models. Results In UC patients, the SNPs rs1042713 (located on the ADRB2 gene) and rs4663866 (close to the HES6 gene) were associated with higher abdominal pain levels (P = 0.044; P = 0.037, respectively). Abdominal pain was not associated with any markers of patient management in a model adjusted for confounders. In CD patients, higher levels of abdominal pain correlated with the number of physician contacts (P &lt; 10–15), examinations (P &lt; 10–12), medical therapies (P = 0.023) and weeks of hospitalisation (P = 0.0013) in a multivariate model. Conclusions We detected an association between maximal abdominal pain in UC patients and two IBS-associated SNPs. Abdominal pain levels had a pronounced impact on diagnostic and therapeutic procedures in CD but not in UC patients. </jats:sec