{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:04:26Z","timestamp":1779689066390,"version":"3.53.1"},"reference-count":54,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004411","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100025092","name":"Ontario Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100025092","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100025090","name":"Ministry of Long-Term Care","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100025090","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Reichmann Family Chair in Cardiovascular Research"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,6]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic disrupted healthcare delivery worldwide, beginning in early 2020. While cardiac non-invasive testing (NIT) plays a critical role in the evaluation and management of cardiovascular disease, the population-level association of pandemic-related public health measures on cardiac diagnostics remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the rates and patterns of cardiac NIT before and after the implementation of the first and subsequent provincial COVID-19 lockdown measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>A population-based and registry-based retrospective time series analysis conducted in Ontario, Canada, a single-payer healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All individuals receiving transthoracic echocardiography, stress echocardiography, nuclear imaging, cardiac CT or cardiac MRI between 17 March 2018 and 16 March 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Standardised weekly testing rates compared across pre-pandemic and pandemic intervals using ARIMA (autoregressive integrative moving average) modelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 5\u2009269\u2009897 cardiac tests performed, the cumulative rates decreased from 228.8 (95% CI 228.5 to 229.0) tests per 100\u2009000 person-weeks in the pre-pandemic period to 204.3 (95% CI 204.0 to 204.5) tests per 100\u2009000 person-weeks in the pandemic period (p&lt;0.0001). The first lockdown led to the most significant decrease in cumulative testing rate (105.9 per 100\u2009000 person-weeks, 95% CI 105.4 to 106.4, p&lt;0.0001), with an incomplete recovery over time that varied based partially on NIT modality. Outpatient testing decreased more compared with inpatient testing. The rates of transthoracic echocardiography and nuclear imaging decreased, whereas cardiac MRI remained stable and cardiac CT increased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>During the COVID-19 pandemic in Ontario, cumulative cardiac NIT rates declined significantly and did not fully recover by early 2022. The magnitude and patterns of these declines raise concerns about delayed cardiovascular diagnoses while also signalling a possible shift in diagnostic strategies. Efforts should prioritise preserving access to essential diagnostic testing during future health crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108186","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:40:11Z","timestamp":1779687611000},"page":"e108186","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of COVID-19 public health measures with cardiac non-invasive testing utilisation in Ontario, Canada: a population-based, retrospective time series analysis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0101-7934","authenticated-orcid":false,"given":"Ethan","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of Toronto Department of Medicine, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Mendis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Toronto Department of Medicine, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomi","family":"Odugbemi","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Sivaswamy","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiming","family":"Fang","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-4085","authenticated-orcid":false,"given":"Idan","family":"Roifman","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Toronto Department of Medicine, Toronto, Ontario, Canada"},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada"},{"name":"Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"2026052422400794000_16.5.e108186.1","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1001\/jama.2020.5394","article-title":"Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA"},{"key":"2026052422400794000_16.5.e108186.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0146736(20)30183-5"},{"key":"2026052422400794000_16.5.e108186.3","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1016\/S2468-2667(20)30117-1","article-title":"Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study","volume":"5","author":"Marijon","year":"2020","journal-title":"Lancet Public Health"},{"key":"2026052422400794000_16.5.e108186.4","doi-asserted-by":"crossref","unstructured":"Banerjee A , Chen S , Pasea L , et al . 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