The Covid-19 pandemic and decrease in acute coronary syndrome presentations in Western Rajasthan: A single centre retrospective observational study

s Indian Heart Journal 72 (2020) S1eS51 E-mail address: jakshat01@gmail.com (A.A. Jain). Background: Corona virus disease 2019 (Covid-19 or SARS-Cov-2) pandemic has affected several aspects of health care system and community apart from economy. Healthcare system is overburdened. The effects of pandemic amongst the individuals and families in form of economic loss, discomfort, stress, fear and behavioural alteration cannot be undermined. It is a single centre observational study in a high volume tertiary care centre in Mumbai Metropolitan Region (MMR). Our objective was to find if there has been any significant difference between patient profile with regard to diagnosis, symptoms, hospital course, outcome and prognosis between two specified time periods. Methods: Single centre, observational, retrospective analysis through information obtained frommedical record of the patient(s). Patients admitted between 1st of February 2020 to 31st of July 2020 (6months) were included in the covid group; and those who were admitted from 1 st August 2019 to 31st January 2020 were included in Pre-covid group. Information was tabulated, compared and inferred with appropriate statistical analysis. Results: Total of 328 patients of ACS admitted in pre covid period and 140 patients admitted during covid period. Covid positive patients and patients with excluded from the study. There was 57.3% decrease in ACS admission in covid group. Mean age of presentation in pre covid group was 55.6 years and in covid group was 57.6 years. No significant sex difference was noted. Proportion of referred cases decreased from 26.8% to 11.4%. Chest pain was most common presenting complaint in both the groups. Breathlessness was more common in covid group (80% against 67.1%). Mean BP at presentation was similar. However, patients presenting in Killips’ III/IV stage (42.8% against 25.7%), cardiogenic shock (14.3% against 6.1%), and those requiring ventilatory support (28.6% against 14.6%) was more common in covid group. Proportion of patients presenting with NSTEMI declined from 22% to 5.7% in covid group. Also higher proportion of patients in covid group had ejection fraction less than 40% i.e. 71.4% against 58.6%. Patients in the covid-19 group had higher mortality rates (17.1% against 7.3%) in spite of patient being managed in both the groups with pharmacoinvasive approach. Conclusion: There was obvious trend of decreased admission and referrals, increased severity of presenting cases and high mortality. Similar findings in different parts of the world suggest that this trend is not due to local factors of illiteracy or poor healthcare infrastructure in developing countries. As the pandemic continues it is crucial to follow this early signal and investigate its causes. It might give insight to the community factors that can help in reducing the incidence of ACS and hence forth help in planning steps for community prevention in long term. It will direct our attention the root cause(s) of under reporting and help us rectify the same so as to provide the advantage of early treatment to maximum population and prevent both mortality and morbidity.