Dataset Information

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

ABSTRACT:

Aim

Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India.

Methods & results

In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. 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. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r² = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r² = 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. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively.

Conclusions

The magnitude of reduction in AMI 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 AMI during the pandemic.

SUBMITTER: Zachariah G

PROVIDER: S-EPMC8424286 | biostudies-literature | 2021 Jul-Aug

REPOSITORIES: biostudies-literature

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Publications

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

Zachariah Geevar G Ramakrishnan Sivasubramanian S Das Mrinal Kanti MK Jabir Abdullakutty A Jayagopal Pathiyil Balagopalan PB Venugopal Krishnannair K Mani Kalaivani K Khan Amal Kumar AK Malviya Amit A Gupta Anshul A Goyal Ashok A Singh B P BP Mohan Bishav B Bharti Bishwa Bhushan BB Majumder Biswajit B Wilson Bivin B Karunadas Chakkalakkal Prabhakaran CP Meena Chandra Bhan CB Manjunath Cholenahally Nanjappa CN Cibu Mathew M Roy Debabrata D Choudhary Dinesh D Das Dipak Ranjan DR Sarma Dipak D Girish Meennahalli Palleda MP Wander Gurpreet Singh GS Wardhan Harsh H Ezhilan Janakiraman J Tummala Karthik K Katyal Virender Kumar VK Goswami Kewal K Subramanyam Kodangala K Goyal Krishna Kishore KK Kumar Kenchappa K Pathak Lekha Adik LA Bansal Manish M Mandal Manoranjan M Gupta Mohit Dayal MD Khanna Narendra Nath NN Hanumanthappa Natesh Bangalore NB Bardoloi Neil N Modi Nitin N Naik Nitish N Hasija Pradeep K PK Kerkar Prafulla P Bhattacharyya Pranab Jyoti PJ Gadkari Pushkraj P Chakraborthy Rabindra Nath RN Patil Rahul Raosaheb RR Gupta Rakesh R Yadav Rakesh R Murty Rambhatla Suryanarayana RS Nath Ranjit Kumar RK Sivakumar Rathinavel R Sethi Rishi R Baruah Rituparna R Tyagi Sanjay S Guha Santanu S Krishnappa Santhosh S Kumar Satish S Routray Satya Narayan SN Tewari Satyendra S Ray Saumitra S Reddy Seemala Saikrishna SS Chandra Sharad S Gupta Shashi Bhushan SB Chatterjee Shashi Shekhar SS Siddiqui K K H KKH Sivabalan Maduramuthu M Yerram Sreekanth S Kumar Sudeep S Nagarajan Swaminathan S Devasia Tom T Jadhav Uday U Narain Varun Shankar VS Garg Vijay Kumar VK Gupta Vitull K VK Prabhakaran Dorairaj D Deb Pradip Kumar PK Mohanan Padinhare Purayil PP

Indian heart journal 20210618 4

<h4>Aim</h4>Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India.<h4>Methods & results</h4>In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2 ...[more]

PMID: 34474751

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Project description:ImportanceThe COVID-19 pandemic disrupted usual care for emergent conditions, such as acute myocardial infarction (AMI). Understanding whether Black and Hispanic individuals experiencing AMI had greater increases in poor outcomes compared with White individuals during the pandemic has important equity implications.ObjectiveTo investigate whether the COVID-19 pandemic was associated with increased disparities in treatment and outcomes among Medicare patients hospitalized with AMI.Design, setting, and participantsThis cross-sectional study used Medicare data for patients hospitalized with AMI between January 2016 and November 2020. Patients were categorized as Hispanic, non-Hispanic Black, and non-Hispanic White. The association between race and ethnicity and outcomes as a function of the proportion of hospitalized patients with COVID-19 was evaluated using interrupted time series. Data were analyzed from October 2022 to June 2023.ExposureThe main exposure was a hospital's proportion of hospitalized patients with COVID-19 on a weekly basis as a proxy for care disruption during the pandemic.Main outcomes and measuresRevascularization, 30-day mortality, 30-day readmission, and nonhome discharges.ResultsA total of 1 319 273 admissions for AMI (579 817 females [44.0%]; 122 972 Black [9.3%], 117 668 Hispanic [8.9%], and 1 078 633 White [81.8%]; mean [SD] age, 77 [8.4] years) were included. For patients with non-ST segment elevation MI (NSTEMI) overall, the adjusted odds of mortality and nonhome discharges increased by 51% (adjusted odds ratio [aOR], 1.51; 95% CI, 1.29-1.76; P < .001) and 32% (aOR, 1.32; 95% CI, 1.15-1.52; P < .001), respectively, and the odds of revascularization decreased by 27% (aOR, 0.73; 95% CI, 0.64-0.83; P < .001) among patients hospitalized during weeks with a high hospital COVID-19 burden (>30%) vs patients hospitalized prior to the pandemic. Black individuals with NSTEMI experienced a clinically insignificant 7% greater increase in the odds of mortality (aOR, 1.07; 95% CI, 1.00-1.15; P = .04) for each 10% increase in the COVID-19 hospital burden but no increases in readmissions or nonhome discharges or reductions in revascularization rates compared with White individuals. There were no differential increases in adverse outcomes among Hispanic compared with White patients with NSTEMI based on hospital COVID-19 burden. Increases in hospital COVID-19 burden were not associated with changes in outcomes or the use of revascularization in STEMI overall or by racial or ethnic group.Conclusions and relevanceThis study found that while hospital COVID-19 burden was associated with worse treatment and outcomes for NSTEMI, race and ethnicity-associated inequities did not increase significantly during the pandemic. These findings suggest the need for additional efforts to mitigate outcomes associated with the COVID-19 pandemic for patients admitted with AMI when the hospital COVID-19 burden is substantially increased.

Dataset Information

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

Aim

Methods & results

Conclusions

Publications

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

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