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Changing Pattern of Admissions for Acute Myocardial Infarction in India During the COVID-19 Pandemic
Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited.
Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes.
Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ.
Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic.
Funding Statement: The study is funded by cardiological society of India.
Declaration of Interests: Nothing to declare for all the authors.
Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.
Zachariah, Geevar and Sivasubramanian, Ramakrishnan and Das, Mrinal Kanti and Jabir, Abdullakutty and Balagopalan, Jayagopal Pathiyil and Nair, Venugopal Krishnan and Mani, Kalaivani and Khan, Amal Kumar and Malviya, Amit and Gupta, Anshul and Goyal, Ashok and Singh, Bateshwar Prasad and Mohan, Bishav and Bharti, Bishwa Bhushan and Majumder, Biswajit and Wilson, Bivin and Karunadas, Chakkalakkal Prabhakaran and Meena, Chandra Bhan and Manjunath, Cholenahally Nanjappa and Mathew, Cibu and Roy, Debabrata and Choudhary, Dinesh and Das, Dipak Ranjan and Sarma, Diapk and Palleda, Girish Meennahalli and Wander, Gurpreet Singh and Wardhan, Harsh and Ezhilan, Janakiraman and Tummala, Karthik and Kumar, Katyal Virender and Goswami, Kewal and Subramanyam, Kodangala and Goyal, Krishna Kishore and Kenchappa, Kumar and Pathak, Lekha Adik and Bansal, Manish and Mandal, Manoranjan and Gupta, Mohit Dayal and Khanna, Narendranath and Hanumanthappa, Natesh Bangalore and Bardoloi, Neil and Modi, Nitin and Naik, Nitish and Hasija, Pradeep K. and Kerker, Prafulla and Bhattacharyya, Pranab Jyoti and Gadkari, Pushkraj and Chakraborthy, Rabindra Nath and Patil, Rahul Raosaheb and Gupta, Rakesh and Yadav, Rakesh and Murty, Rambhatla Suryanarayana and Nath, Ranjit Kumar and Sivakumar, Rathinavel and Sethi, Rishi and Baruah, Rituparna and Tyagi, Sanjay and Guha, Santanu and Krishnappa, Santhosh and Kumar, Satish and Routray, Satyanarayan and Tiwari, Satyendra and Ray, Saumitra and Reddy, Seemala Saikrishna and Chandra, Sharad and Gupta, Shashi Bhushan and Chatterjee, Shashi Shekhar and KKH, Siddiqui and Maduramuthu, Sivabalan and Yerram, Sreekanth and Kumar, Sudeep and Nagarajan, Swaminathan and Devasia, Tom and Jadhav, Uday and Narain, Varun Shankar and Garg, Vijay Kumar and Gupta, Vitull K. and Prabhakaran, Dorairaj and Deb, Pradip Kumar and Mohanan, Padinhare Purayil, Changing Pattern of Admissions for Acute Myocardial Infarction in India During the COVID-19 Pandemic. Available at SSRN: https://ssrn.com/abstract=3763781 or http://dx.doi.org/10.2139/ssrn.3763781
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