Abstract
Background
In 2005, 80% of cardiovascular disease (CVD) deaths occurred in low- to middle-income countries (i.e., developing nations). Cardiovascular imaging, such as myocardial perfusion SPECT, is one method that may be applied to detect and foster improved detection of at-risk patients. This document will review the availability and utilization for nuclear cardiology procedures worldwide and propose strategies to devise regional centers of excellence to achieve quality imaging around the world.
Methods
As a means to establish the current state of nuclear cardiology, International Atomic Energy Agency member and non-member states were queried as to annual utilization of nuclear cardiology procedures. Other sources for imaging statistics included data from medical societies (American Society of Nuclear Cardiology, European Society of Cardiology, and the European Association of Nuclear Medicine) and nuclear cardiology working groups within several nations. Utilization was calculated by dividing annual procedural volume by 2007 population statistics (/100,000) and categorized as high (>1,000/100,000), moderate-high (250-999/100,000), moderate (100-249/100,000), low-moderate (50-99/100,000) and low (<50/100,000).
Results
High nuclear cardiology utilization was reported in the United States, Canada, and Israel. Most Western European countries, Australia, and Japan reported moderate-high utilization. With the exception of Argentina, Brazil, Colombia and Uruguay, South America had low usage. This was also noted across Eastern Europe, Russia, and Asia. Utilization patterns generally mirrored each country’s gross domestic product. However, nuclear cardiology utilization was higher for developing countries neighboring moderate-high “user” countries (e.g., Algeria and Egypt); perhaps the result of accessible high-quality training programs.
Conclusions
Worldwide utilization patterns for nuclear cardiology vary substantially and may be influenced by physician access to training and education programs. Development of regional training centers of excellence can guide utilization of nuclear cardiology through the application of guideline- and appropriateness-driven testing, training, continuing education, and quality assurance programs aiding developing nations to confront the epidemics of CVD.
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Acknowledgments
In addition to data provided by IAEA member states and members of the technical panel, we would like to thank the following physicians for contributing data to this report (in alphabetical order of countries): (1) Argentina: Angel Sandrin; (2) Bangladesh: Luftun Nisa; (3) Bolivia: Raul Araujo; (4) Colombia: Sonia Merlano; (5) Costa Rica: Ulises Gonzalez; (6) Ecuador: Sandra Moreno; (7) Europe and Russian Federation: Ignasio Carrio, Richard Underwood; (8) Israel: Chaim Golan, Arie Wolak; (9) Japan: Naoya Matsumoto; (10) Lebanon: Habib Dakik; (11) Macedonia: Irena Peovska; (12) Saudi Arabia: Khalid El Nemr, Khaled El Saban.
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International Atomic Energy Agency (IAEA) Technical Meeting, Work Group on Nuclear Cardiology, Vienna, Austria, 2008.
See related editorial, doi:10.1007/s12350-009-9122-9.
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Vitola, J.V., Shaw, L.J., Allam, A.H. et al. Assessing the need for nuclear cardiology and other advanced cardiac imaging modalities in the developing world. J. Nucl. Cardiol. 16, 956–961 (2009). https://doi.org/10.1007/s12350-009-9104-y
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DOI: https://doi.org/10.1007/s12350-009-9104-y