Background The COVID-19 pandemic changed the priority of different healthcare services. Specifically, the stringent lockdowns to control its spread impacted the provision of most elective non-covid healthcare services across the world, including India. We aimed to assess the impact of COVID-19 on interventional cardiology procedures covered by the nationwide health insurance scheme, Pradhan Mantri Jan Arogya Yojna (PMJAY) in India. Methods Data from 28,025 cardiac patients receiving PTCA were screened retrospectively for inclusion into the analysis. We compared outcomes across three 2-months phases of COVID-19 pandemic i.e. “before lockdown” phase (22nd January to 21st March 2020), “lockdown” phase (22nd March 2020 to 20th May 2020), and “after lockdown” was lifted (21st May to 19th July 2020). Results A total of 14,928 PTCA cases from 22nd January-19th July 2020 (median age: 58 years, IQR= 51-66; females= 25.1%) were included in the study. Compared with before lockdown, the number of PTCA procedures declined by 62% during the lockdown and remained lower by 29.4% after lockdown was lifted. The decline was greater in public health (77.4%) than private health facilities (47.9%). PTCA procedure claims as a proportion of overall cardiac procedures’ claims increased from 58.1% before lockdown to 71.4% during lockdown, as elective procedures like cardiac catheterizations, balloon valvuloplasty, devices for structural heart disorders and renal artery stenting declined. Compared with before lockdown, in-hospital mortality for patients receiving PTCA increased by 84% during lockdown (OR: 1.84, 95% confidence interval (1.32-2.55) and remained higher after lockdown was lifted (OR: 1.56 (1.17-2.08)) Conclusion Decline in PTCA procedures and increase in mortality of patients receiving PTCA procedures highlights importance of maintaining essential non-covid emergency services to prevent delays in life-saving procedures and also provide patient education/helpline to seek timely intervention during a pandemic. It also highlights an important role played by the private sector in providing non-COVID care as the public health care system was overwhelmed by a pandemic.

Background The prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for low-income patients, the high cost of post-PCI treatment, especially Dual Antiplatelet Therapy (DAPT), still caused many patients to prematurely discontinue the secondary prevention. Our study aimed to investigate the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence in India. Method We collected clinical data of 4,595 patients undergoing PCI in 110 participating medical centers in Maharashtra, India from 2012 to 2015 by electronic medical records. We surveyed 2527 adult patients who were under the insurance scheme by telephone interview, usually between 6 to 12 months after their revascularization. Patients reporting DAPT continuation in the telephone survey were categorized as DAPT adherence. The outcome of the interest was all-cause mortality within 1 year after the index procedure. Multivariate Cox proportional hazard (PH) model with adjustment of potential confounders and standardization were used to explore the effects of DAPT adherence on all-cause mortality. We further used a multivariate logistic model to investigate the potential determinants of DAPT adherence. Results Out of the 2527 patients interviewed, 2064 patients were included in the analysis, of whom 470 (22.8%) discontinued DAPT prematurely within a year. After adjustment for baseline confounders, DAPT adherence was associated with lower one-year all-cause mortality compared to premature discontinuation (less than 6-month), with an adjusted hazard ratio (HR) of 0.52 (95% Confidence Interval (CI) = (0.36, 0.67)). We also found younger patients (OR per year was 0.99 (0.97, 1.00)) and male (vs. female, OR of 1.30 (0.99, 1.70)) had higher adherence to DAPT at one year as did patients taking antihypertensive medications (vs. non medication, OR of 1.57 (1.25, 1.95)). Conclusion These findings suggest the protective effects of DAPT adherence on 1-year mortality among post-PCI patients in a low-income setting and indicate younger age, male sex and use of other preventive treatments were predictors of higher DAPT adherence.

Introduction: National health insurance programs like Ayushman Bharat (AB) have increased access to treatments like PCI to poor patients in low-to-middle income countries (LMICs). Evaluating such systems for STEMI care through electronic health records (e-HR) data can provide a unique opportunity to assess quality of PCI. Methods: We evaluated PCI cases within AB across 5 Indian states, selecting 4 hospitals from each state (2 public & 2 private facilities). Each week from January to May 2020, we selected 5 random cases from each hospital for detailed review. We accessed e-HR data of these patients. To ensure data quality, data was double abstracted at two different time points. We report descriptive statistics focused on the timing of PCI relative to their symptom onset and first medical contact (FMC). Results: Of 300 PCIs reviewed within AB, 196 patients were managed for STEMI. A total of 47 from Uttar Pradesh, 53 from Chhattisgarh, 43 from Maharashtra, 28 from Madhya Pradesh, and 25 from Haryana. Of these, 59.7% (117/196) patients reached FMC within 3 hours of symptom onset; 17.9% (35/196) within 3-12 hours, 5.1% (10/196) within 12-48 hours, 3.1% (6/196) within 48-72 hours, and 12.8% (25/196) after 72 hours. From FMC, PCI was done in only 4.6 % (9/196) patients within 3 hours and 8.7 % (17/196) within 12 hours. Over half (107/196 or 54.6%) received PCI after 72 hours (Figure). Of these, only 3/107 (2.8%) received fibrinolytic therapy and 35/107 (32.7%) had complete occlusion of the culprit vessel, nullifying the benefit of PCI based on randomized trial evidence. Conclusion: Many poor Indian patients undergoing PCI for STEMI under AB are receiving PCI after long delays with underuse of fibrinolytic therapy. Opportunities to improve reperfusion therapy in India exist for socioeconomically disadvantaged patients.