{
  "abstract": "Objectives This 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.Design Multicentre retrospective cohort studySetting Twenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities.Participants All 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 outcomes Number of MI admissions, median O2D, D2B and D2N times.Secondary outcomes 30-day outcomes including death, reinfarction and revascularisation.Results MI 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.Conclusion Despite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.",
  "authors": [
    {
      "affiliations": [
        "Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"
      ],
      "name": "Jaideep C Menon"
    },
    {
      "affiliations": [
        "Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"
      ],
      "name": "Aravind MS"
    },
    {
      "affiliations": [
        "Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India"
      ],
      "name": "Harikrishnan S"
    },
    {
      "affiliations": [
        "Public Health Dentistry, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"
      ],
      "name": "Chandrashekar Janakiram"
    },
    {
      "affiliations": [
        "Public Health Dentistry, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"
      ],
      "name": "Anju James"
    },
    {
      "affiliations": [
        "Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"
      ],
      "name": "Aswathy Sreedevi"
    },
    {
      "affiliations": [
        "Health Technology Assessment India, Department of health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, Delhi, India"
      ],
      "name": "Geetha R Menon"
    },
    {
      "affiliations": [
        "Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bangalore, Karnataka, India"
      ],
      "name": "Denny John"
    },
    {
      "affiliations": [
        "Clinical Studies and Trials Unit, Division of Development Research, Indian Council of Medical Research, New Delhi, Delhi, India",
        "Department of Global Public Health, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Jerin Jose Cherian"
    },
    {
      "affiliations": [
        "Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India"
      ],
      "name": "Vanajakshamma V"
    },
    {
      "affiliations": [
        "Department of Cardiology, GKNM Hospitals, Coimbatore, Tamil Nadu, India"
      ],
      "name": "Rajpal K Abhaichand"
    },
    {
      "affiliations": [
        "Cardiology, Malankara Orthodox Syrian Church Medical College and Hospital, Kolenchery, Kerala, India"
      ],
      "name": "Eapen P Punnoose"
    },
    {
      "affiliations": [
        "Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India"
      ],
      "name": "Arun BS"
    },
    {
      "affiliations": [
        "Cardiology, St. Mary's Hospital, Thodupuzha, Kerala, India"
      ],
      "name": "Mathew Abraham"
    },
    {
      "affiliations": [
        "Cardiology, General Hospital, Kochi, Kerala, India"
      ],
      "name": "Paul Thomas"
    },
    {
      "affiliations": [
        "Cardiology, Apollo Hospital Visakhapatnam, Visakhapatnam, Andhra Pradesh, India"
      ],
      "name": "Chakradhar Pedada"
    },
    {
      "affiliations": [
        "Cardiology, Jubilee Mission Hospital Trust, Thrissur, Kerala, India"
      ],
      "name": "Unni Govindan"
    },
    {
      "affiliations": [
        "Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India"
      ],
      "name": "Bishav Mohan"
    },
    {
      "affiliations": [
        "Cardiology, EMS Memorial Cooperative Hospital and Research Centre Ltd, Malappuram, Kerala, India"
      ],
      "name": "Sunil Pisharody"
    },
    {
      "affiliations": [
        "Kasturba Medical College Manipal, Manipal, Karnataka, India"
      ],
      "name": "Tom Devasia"
    },
    {
      "affiliations": [
        "Aster MIMS Hospital Kannur, Kannur, Kerala, India"
      ],
      "name": "Placid Sebastian"
    },
    {
      "affiliations": [
        "Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"
      ],
      "name": "Rajesh Thachathodiyl"
    },
    {
      "affiliations": [
        "KIMS, Trivandrum, Kerala, India"
      ],
      "name": "Vijayaraghavan G"
    },
    {
      "affiliations": [
        "Gandhi Medical College Bhopal, Bhopal, Madhya Pradesh, India"
      ],
      "name": "Nitesh Arora"
    },
    {
      "affiliations": [
        "MS Ramaiah Medical College, Bangalore, Karnataka, India"
      ],
      "name": "Anupama V Hegde"
    },
    {
      "affiliations": [
        "Caritas Hospital, Kottayam, Kerala, India"
      ],
      "name": "Johny Joseph"
    },
    {
      "affiliations": [
        "Baby Memorial Hospital, Calicut, Kerala, India"
      ],
      "name": "John F John"
    },
    {
      "affiliations": [
        "Indira Gandhi Medical College, Nagpur, Maharashtra, India"
      ],
      "name": "Prakash Chand Negi"
    },
    {
      "affiliations": [
        "Sir Ganga Ram Hospital, New Delhi, Delhi, India"
      ],
      "name": "Raja Ram Mantri"
    },
    {
      "affiliations": [
        "NEIGRIHMS, Shillong, Meghalaya, India"
      ],
      "name": "Amit Malviya"
    },
    {
      "affiliations": [
        "Pariyaram Medical College, Kannur, Kerala, India"
      ],
      "name": "Ramakrishna CD"
    },
    {
      "affiliations": [
        "Vijan Hospital and Research Centre, Nashik, Maharashtra, India"
      ],
      "name": "Vikrant Vijan"
    }
  ],
  "title": "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",
  "uid": "0504ac67-0d4c-5e0d-9b96-cc14507fd4fa"
}