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Changing Pattern of Admissions for Acute Myocardial Infarction in India During the COVID-19 Pandemic

33 Pages Posted: 4 Feb 2021

See all articles by Geevar Zachariah

Geevar Zachariah

Mother Heart Care; Mother Hospital, Trissur

Ramakrishnan Sivasubramanian

All India Institute of Medical Sciences (AIIMS)

Mrinal Kanti Das

C K Birla Hospital

Abdullakutty Jabir

Lisie Heart Institute

Jayagopal Pathiyil Balagopalan

Lakshmi Hospital, Palakka

Venugopal Krishnan Nair

Pushpagiri Medical College, Thrivalla

Kalaivani Mani

All India Institute of Medical Sciences (AIIMS) - Department of Biostatistics

Amal Kumar Khan

Burdwan Medical College and Hospital

Amit Malviya

North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong - Department of Cardiology

Anshul Gupta

Manipal Hospitals, Jaipur

Ashok Goyal

Bani Park Hospital, Jaipur

Bateshwar Prasad Singh

Patna Medical College

Bishav Mohan

Dayanand Medical College

Bishwa Bhushan Bharti

Ford Hospital

Biswajit Majumder

R. G. Kar Medical College and Hospital - Department of Cardiology

Bivin Wilson

GKNM Hospital, Coimbatore

Chakkalakkal Prabhakaran Karunadas

Government Medical College, Thrissur

Chandra Bhan Meena

SMS Medical College & Attached Hospitals

Cholenahally Nanjappa Manjunath

Sri Jayadeva Institute of Cardiovascular Sciences & Research

Cibu Mathew

Government Medical College, Thrissur

Debabrata Roy

Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata

Dinesh Choudhary

Sardar Patel Medical College

Dipak Ranjan Das

SCB Medical College, Cuttack

Diapk Sarma

Christian Medical Centre Hospital, Jorhat

Girish Meennahalli Palleda

Govind Ballabh Pant Hospital

Gurpreet Singh Wander

Dayanand Medical College, Ludhiana

Harsh Wardhan

Primus Super Specialty Hospital, New Delhi

Janakiraman Ezhilan

Madras Medical Mission

Karthik Tummala

Help Hospital, Vijayawada

Katyal Virender Kumar

University of Health Sciences - Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS)

Kewal Goswami

All India Institute of Medical Sciences (AIIMS)

Kodangala Subramanyam

K.S Hegde Medical Academy - Department of Cardiology

Krishna Kishore Goyal

Apollo CVHF Hospital, Ahmedabad

Kumar Kenchappa

Sparsh Hospital, Bangalore

Lekha Adik Pathak

Nanavati Super Specialty Hospital, Mumbai

Manish Bansal

Medanta Hospital, New Delhi

Manoranjan Mandal

Nil Ratan Sircar Medical College and Hospital - Department of Cardiology

Mohit Dayal Gupta

Govind Ballabh Pant Hospital

Narendranath Khanna

Apollo Hospitals

Natesh Bangalore Hanumanthappa

Sri Jayadeva Institute of Cardiovascular Sciences & Research

Neil Bardoloi

Excelcare Hospitals, Assam

Nitin Modi

Convenient Hospitals Ltd, Indore

Nitish Naik

All India Institute of Medical Sciences (AIIMS)

Pradeep K. Hasija

Armed Forces Medical College

Prafulla Kerker

KEM Hospital

Pranab Jyoti Bhattacharyya

Gauhati Medical College and Hospital, Guwahati, Assam

Pushkraj Gadkari

Srikrishna Hrudayalaya & Critical Care Centre, Nagpur

Rabindra Nath Chakraborthy

Apollo Gleneagles Heart Institute, Kolkata

Rahul Raosaheb Patil

Independent

Rakesh Gupta

JROP Health Centre, New Delhi

Rakesh Yadav

All India Institute of Medical Sciences (AIIMS)

Rambhatla Suryanarayana Murty

Capital Hospital, Bhuvaneswar, Odissa

Ranjit Kumar Nath

RML Hospital

Rathinavel Sivakumar

Meenakshi Mission Hospital, Madurai

Rishi Sethi

King George's Medical University

Rituparna Baruah

Apollo Hospital, Guwahati

Sanjay Tyagi

GB Pant Hospital - Department of Cardiology

Santanu Guha

Calcutta Medical College & Hospital

Santhosh Krishnappa

Sri Jayadeva Institute of Cardiovascular Sciences & Research

Satish Kumar

Bokaro General Hospital

Satyanarayan Routray

Srirama Chandra Bhanja Medical College

Satyendra Tiwari

Sanjay Gandhi Post Graduate Institute of Medical Sciences

Saumitra Ray

Vivekananda Institute of Medical Sciences

Seemala Saikrishna Reddy

All India Institute of Medical Sciences (AIIMS)

Sharad Chandra

King George's Medical University

Shashi Bhushan Gupta

C Rly HQ Hospital, Mumbai

Shashi Shekhar Chatterjee

Ruby General Hospital

Siddiqui KKH

Calcutta Medical Research Institute, Kolkata

Sivabalan Maduramuthu

Hindusthan Hospital, Coimbatore

Sreekanth Yerram

Nizam's Institute of Medical Science, Hyderabad

Sudeep Kumar

Sanjay Gandhi Post Graduate Institute of Medical Sciences

Swaminathan Nagarajan

SGPGI, Lucknow

Tom Devasia

Kasturba Medical College

Uday Jadhav

MGM New Bombay Hospital

Varun Shankar Narain

King George's Medical University

Vijay Kumar Garg

Independent

Vitull K. Gupta

Kishori Ram Hospital, Bathinda

Dorairaj Prabhakaran

Public Health Foundation of India

Pradip Kumar Deb

Eastern Clinic, Kolkata

Padinhare Purayil Mohanan

West Fort Hi-Tech Hospital, Thrissur

More...

Abstract

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.

Suggested Citation

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

Geevar Zachariah

Mother Heart Care ( email )

Thrissur
India

Mother Hospital, Trissur ( email )

Ramakrishnan Sivasubramanian (Contact Author)

All India Institute of Medical Sciences (AIIMS) ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India
(91) (11) 26593860 (Phone)
(91) (11) 26588663 (Fax)

Mrinal Kanti Das

C K Birla Hospital ( email )

Kolkata
India

Abdullakutty Jabir

Lisie Heart Institute ( email )

Jayagopal Pathiyil Balagopalan

Lakshmi Hospital, Palakka ( email )

Kerala
India

Venugopal Krishnan Nair

Pushpagiri Medical College, Thrivalla ( email )

Kerala
India

Kalaivani Mani

All India Institute of Medical Sciences (AIIMS) - Department of Biostatistics ( email )

New Delhi
India

Amal Kumar Khan

Burdwan Medical College and Hospital ( email )

Aftab Road
Burdwan, 713104
India

Amit Malviya

North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong - Department of Cardiology ( email )

Meghalaya
India

Anshul Gupta

Manipal Hospitals, Jaipur

India

Ashok Goyal

Bani Park Hospital, Jaipur ( email )

India

Bateshwar Prasad Singh

Patna Medical College ( email )

Patna
India

Bishav Mohan

Dayanand Medical College ( email )

Ludhiana
India

Bishwa Bhushan Bharti

Ford Hospital ( email )

Patna
India

Biswajit Majumder

R. G. Kar Medical College and Hospital - Department of Cardiology ( email )

1, Kshudiram Bose Sarani
Kolkata
West Bengal, 700002
India

Bivin Wilson

GKNM Hospital, Coimbatore ( email )

India

Chakkalakkal Prabhakaran Karunadas

Government Medical College, Thrissur ( email )

India

Chandra Bhan Meena

SMS Medical College & Attached Hospitals ( email )

Jaipur
India

Cholenahally Nanjappa Manjunath

Sri Jayadeva Institute of Cardiovascular Sciences & Research ( email )

Bannerghatta Main Road, Phase 3
Jayanagara 9th Block
Bengaluru, Karnataka 560069
India

Cibu Mathew

Government Medical College, Thrissur ( email )

India

Debabrata Roy

Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata ( email )

India

Dinesh Choudhary

Sardar Patel Medical College ( email )

India

Dipak Ranjan Das

SCB Medical College, Cuttack ( email )

India

Diapk Sarma

Christian Medical Centre Hospital, Jorhat ( email )

India

Girish Meennahalli Palleda

Govind Ballabh Pant Hospital ( email )

New Delhi
India

Gurpreet Singh Wander

Dayanand Medical College, Ludhiana ( email )

India

Harsh Wardhan

Primus Super Specialty Hospital, New Delhi ( email )

India

Janakiraman Ezhilan

Madras Medical Mission ( email )

Chennai
India

Karthik Tummala

Help Hospital, Vijayawada ( email )

India

Katyal Virender Kumar

University of Health Sciences - Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS) ( email )

Haryana, 124001
India

Kewal Goswami

All India Institute of Medical Sciences (AIIMS) ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Kodangala Subramanyam

K.S Hegde Medical Academy - Department of Cardiology ( email )

Mangalore Karnataka
India

Krishna Kishore Goyal

Apollo CVHF Hospital, Ahmedabad ( email )

India

Kumar Kenchappa

Sparsh Hospital, Bangalore ( email )

India

Lekha Adik Pathak

Nanavati Super Specialty Hospital, Mumbai ( email )

India

Manish Bansal

Medanta Hospital, New Delhi

India

Manoranjan Mandal

Nil Ratan Sircar Medical College and Hospital - Department of Cardiology ( email )

138 A J C Bose Road,
Sealdah
Kolkata, West Bengal 700014
India

Mohit Dayal Gupta

Govind Ballabh Pant Hospital ( email )

New Delhi
India

Narendranath Khanna

Apollo Hospitals ( email )

Jubilee Hills Hyderabad
India

Natesh Bangalore Hanumanthappa

Sri Jayadeva Institute of Cardiovascular Sciences & Research ( email )

Bannerghatta Main Road, Phase 3
Jayanagara 9th Block
Bengaluru, Karnataka 560069
India

Neil Bardoloi

Excelcare Hospitals, Assam ( email )

India

Nitin Modi

Convenient Hospitals Ltd, Indore ( email )

India

Nitish Naik

All India Institute of Medical Sciences (AIIMS) ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Pradeep K. Hasija

Armed Forces Medical College ( email )

Solapur Road
Pune, 411040
India

Prafulla Kerker

KEM Hospital ( email )

Mumbai
India

Pranab Jyoti Bhattacharyya

Gauhati Medical College and Hospital, Guwahati, Assam ( email )

India

Pushkraj Gadkari

Srikrishna Hrudayalaya & Critical Care Centre, Nagpur ( email )

India

Rabindra Nath Chakraborthy

Apollo Gleneagles Heart Institute, Kolkata ( email )

India

Rahul Raosaheb Patil

Independent ( email )

Pune
India

Rakesh Gupta

JROP Health Centre, New Delhi

India

Rakesh Yadav

All India Institute of Medical Sciences (AIIMS)

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Rambhatla Suryanarayana Murty

Capital Hospital, Bhuvaneswar, Odissa ( email )

India

Ranjit Kumar Nath

RML Hospital ( email )

New Delhi
India

Rathinavel Sivakumar

Meenakshi Mission Hospital, Madurai ( email )

India

Rishi Sethi

King George's Medical University ( email )

King George's Medical University
Lucknow
India

Rituparna Baruah

Apollo Hospital, Guwahati ( email )

Jubilee Hills Hyderabad
India

Sanjay Tyagi

GB Pant Hospital - Department of Cardiology

New Delhi
India

Santanu Guha

Calcutta Medical College & Hospital ( email )

Kolkata
India

Santhosh Krishnappa

Sri Jayadeva Institute of Cardiovascular Sciences & Research ( email )

Bannerghatta Main Road, Phase 3
Jayanagara 9th Block
Bengaluru, Karnataka 560069
India

Satish Kumar

Bokaro General Hospital

Jharkhand
India

Satyanarayan Routray

Srirama Chandra Bhanja Medical College ( email )

India

Satyendra Tiwari

Sanjay Gandhi Post Graduate Institute of Medical Sciences ( email )

Lucknow
India

Saumitra Ray

Vivekananda Institute of Medical Sciences ( email )

India

Seemala Saikrishna Reddy

All India Institute of Medical Sciences (AIIMS) ( email )

Aurobindo Marg
Ansari Nagar East
New Delhi, New Delhi 110029
India

Sharad Chandra

King George's Medical University ( email )

King George's Medical University
Lucknow
India

Shashi Bhushan Gupta

C Rly HQ Hospital, Mumbai ( email )

Shashi Shekhar Chatterjee

Ruby General Hospital ( email )

Kolkata
India

Siddiqui KKH

Calcutta Medical Research Institute, Kolkata ( email )

India

Sivabalan Maduramuthu

Hindusthan Hospital, Coimbatore ( email )

India

Sreekanth Yerram

Nizam's Institute of Medical Science, Hyderabad ( email )

India

Sudeep Kumar

Sanjay Gandhi Post Graduate Institute of Medical Sciences

Lucknow
India

Swaminathan Nagarajan

SGPGI, Lucknow ( email )

India

Tom Devasia

Kasturba Medical College ( email )

Udupi District
Manipal, Karnataka
India

Uday Jadhav

MGM New Bombay Hospital ( email )

Mumbai
India

Varun Shankar Narain

King George's Medical University ( email )

King George's Medical University
Lucknow
India

Vijay Kumar Garg

Independent ( email )

India

Vitull K. Gupta

Kishori Ram Hospital, Bathinda ( email )

India

Dorairaj Prabhakaran

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

Pradip Kumar Deb

Eastern Clinic, Kolkata ( email )

India

Padinhare Purayil Mohanan

West Fort Hi-Tech Hospital, Thrissur ( email )