Journal Article

Assessing health system preparedness from trends and time delays in the management of myocardial infarctions during the COVID-19 pandemic in India: a multicentre retrospective cohort study

Cherian, Jerin Jose, V, Vanajakshamma, BS, Arun, S, Harikrishnan, Govindan, Unni, Joseph, Johny, Menon, Jaideep C, Mohan, Bishav, Punnoose, Eapen P, Devasia, Tom, Pedada, Chakradhar, Menon, Geetha R, G, Vijayaraghavan, Hegde, Anupama V, Malviya, Amit, Vijan, Vikrant, Abraham, Mathew, Mantri, Raja Ram, John, Denny, Thachathodiyl, Rajesh, CD, Ramakrishna, Thomas, Paul, Abhaichand, Rajpal K, MS, Aravind, Pisharody, Sunil, Sebastian, Placid, Negi, Prakash Chand, Janakiram, Chandrashekar, James, Anju, Arora, Nitesh, Sreedevi, Aswathy, John, John F

2025

Overview

ObjectivesThis study aimed to analyse the number of myocardial infarction (MI) admissions during the COVID-19 lockdown periods of 2020 and 2021 (March 15th to June 15th) and compare them with corresponding pre-pandemic period in 2019. The study also evaluated changes in critical treatment intervals: onset to door (O2D), door to balloon (D2B) and door to needle (D2N) and assessed 30-day clinical outcomes. This study examined MI care trends in India during the COVID-19 lockdown period, irrespective of patients’ COVID-19 infection status.DesignMulticentre retrospective cohort studySettingTwenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities.ParticipantsAll adults (>18 years) admitted with acute myocardial infarction between March 15 and June 15 in 2019 (pre-pandemic), 2020 (first lockdown) and 2021 (second lockdown). A total of 3614 cases were analysed after excluding duplicates and incomplete data.Primary outcomesNumber of MI admissions, median O2D, D2B and D2N times.Secondary outcomes30-day outcomes including death, reinfarction and revascularisation.ResultsMI admissions dropped from 4470 in year 2019 to 2131 (2020) and 1483 (2021). The median O2D increased from 200 min (IQR 115–428) pre-COVID-19 to 390 min (IQR 165–796) in 2020 and 304 min (IQR 135–780) in 2021. The median D2B time reduced from 225 min (IQR 120–420) in 2019 to 100 min (IQR 53–510) in 2020 and 130 min (IQR 60–704) in 2021. Similarly, D2N time decreased from 240 min (IQR 120–840) to 35 min (IQR 25–69) and 45 min (IQR 24–75), respectively. The 30-day outcome of death, reinfarction and revascularisation was 4.25% in 2020 and 5.1% in 2021, comparable to 5.8% reported in the Acute Coronary Syndrome Quality Improvement in Kerala study.ConclusionDespite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Acute coronary syndromes / Adult / Aged / Cardiology / Cardiovascular Disease / Cardiovascular medicine / Cohort analysis / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / Data collection / Data entry / Ethics / Female / Health Services Accessibility / Heart attacks / Hospitals / Humans / India - epidemiology / Male / Medical records / Middle Aged / Myocardial infarction / Myocardial Infarction - epidemiology / Myocardial Infarction - therapy / Pandemics / Patient admissions / Retrospective Studies / SARS-CoV-2 / Shelter in place / Time-to-Treatment - statistics & numerical data / Time-to-Treatment - trends / Trends / Variables