Impact of COVID-19 pandemic induced lockdown on management of myocardial infarction: An Indian survey report from the experiences by 1083 cardiologists

Abstract

Background: COVID-19 has induced a change in the management of myocardial infarction (MI). Methods: We developed a customized technological virtual response system for mapping exercise, during August 14–28, 2020, to understand the management of MI. Prior telephonic consent was obtained, and the weblink of the questionnaire was provided on individual WhatsApp. Anonymized data were statistically analyzed by GraphPad software version 8.4.3. Results: The mean year of experience in active clinical practice was 12 years (standard deviation 10, 95% confidence interval 12–13). There were 41% (n = 445) participants who reported reduction by 25%–29% of MI patients, reporting to hospital, followed by 27.8% (n = 302) participants, reporting that <25% patients with MI approached the hospital. Sixty percent reported as the most important reason for a decrease in cases of MI patient's fear of contracting COVID-19 (n = 648), followed by limited transportation by 20.49% (n = 222) participants. There were health-care-driven reasons for a decrease in MI primary percutaneous coronary intervention activations. These included cardiologist's reluctance to do primary percutaneous cardiovascular interventions (PCI) due to COVID-19 and patients presenting late beyond the optimal window for PCI/thrombolysis by 34.71% (n = 376) and 31% (n = 341) of participants, respectively. There were 68.5% (n = 742) of respondents that were of opinion that the time component of MI care that has increased most was time between symptom onset to first medical contact, followed by time between medical contact to catheterization laboratory arrival, as opined by 20% (n = 217) of the participants. It was reported that patients undergoing no reperfusion due to delayed treatment were increased to less than 25%, as reported by 43.4% (n = 471), respondents. This was followed by 32.5% (n = 352), respondents reporting that there was 26%–50% increase in the number of patients undergoing no reperfusion due to delayed treatment. Immediate thrombolysis was preferred by 28% (n = 304) of participants from the teaching institutions. There were 75.1% (n = 814) of the participants, that tested patients for COVID-19 before shifting to the catheterization laboratory. Conclusion: This is one of the largest perception mapping exercises, limited with the absence of actual patient data, which is a cohesive reflection in line with global evidence for a remarkable decrease in cases and interventions for the management of MI. The lessons from the experiences entail that there is a need to encourage patients with symptoms suspected of MI to promptly contact emergency services to enable timely diagnosis and enable reperfusion therapy. Impact on the MI management appears to be substantial, which calls for action for change in infrastructure and policy framework to improvise MI care.