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.
Subject(s)
COVID-19 , Coronary AneurysmABSTRACT
Background: COVID-19 pandemic has resulted in nearly 55,000 deaths in India and over 800,000 deaths worldwide. Despite several clinical trials there is no effective proven treatment currently available for this condition and the mainstay of management is only supportive.Methods: Data from consecutive patients presenting to a telemedicine clinic between May and August 2020 with severe COVID 19 and receiving domiciliary treatment with oral cotrimoxazole in addition to standard therapy was collected and retrospectively analyzed. Results: 14 patients received cotrimoxazole in addition to standard therapy. Following start of the treatment regimen, all of the patients showed marked improvement in their clinical parameters including fever and oxygen requirements. In addition we observed that all the patients receiving cotrimoxazole in addition to standard therapy made complete recovery. Only one patient required hospital admission for a transient period.Conclusion: This observation warrants an urgent clinical trial. If the above results are replicated in future trials it may change the way in which we manage patients with this potentially life-threatening condition.