Impact of COVID-19 pandemic on pediatric cardiac services in India

Abstract

Background : COVID-19 pandemic has disrupted pediatric cardiac services across the globe. Limited data are available on the impact of COVID.19 on pediatric cardiac care in India. Aims : The aims are to study the impact of COVID-19 pandemic on the care of children with heart disease in India in terms of number of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries. Settings and Design : This is a retrospective, multicentric, observational study. Methods : We collected monthly data on the number and characteristics of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries and major hospital statistics, over a period of 5 months (April to August 2020), which coincided with the first wave of COVID-19 pandemic in India and compared it with data from the corresponding months in 2019. Results : The outpatient visits across the 24 participating pediatric cardiac centers decreased by 74.5% in 2020 (n = 13,878) as compared to the corresponding period in 2019 (n = 54,213). The reduction in the number of hospitalizations, cardiac surgeries, and catheterization procedures was 66.8%, 73.0%, and 74.3%, respectively. The reduction in hospitalization was relatively less pronounced among neonates as compared to infants/children (47.6% vs. 70.1% reduction) and for emergency surgeries as compared to elective indications (27.8% vs. 79.2%). The overall in-hospital mortality was higher in 2020 (8.1%) as compared to 2019 (4.8%), with a higher postoperative mortality (9.1% vs. 4.3%). Conclusions : The current COVID-19 pandemic significantly impacted the delivery of pediatric cardiac care across India with two-third reduction in hospitalizations and cardiac surgeries. In an already resource-constrained environment, the impact of such a massive reduction in the number of surgeries could be significant over the coming years. These findings may prove useful in formulating strategy to manage subsequent waves of ongoing COVID-19 pandemic.

Annals of Pediatric Cardiology: A new look and a new outlook

“…Some good quality multicentric Indian data are also published. [ 25 - 30 ] Almost all the editorials in the last few years were India-centric. We tried to address some of the pertinent Indian problems, including the impact of COVID-19 on Indian pediatric cardiology,[ 31 ] minimum requirements for pediatric cardiac interventions,[ 32 ] fetal cardiology in India,[ 33 ] interventional cardiology,[ 34 ] research and key publications from India,[ 35 ] and Indian pediatric cardiology conference.…”

Pediatric cardiology: In search for evidence

“…[ 25 31 ] During the COVID-19 pandemic, the Pediatric Cardiac Society of India organized and reported a few retrospective multicenter studies. [ 32 33 ] It is the time for us to plan futuristic RCTs.…”

COVID-19 and heart disease in children: What have we learned?

“…A large, multicentric, retrospective study by Choubey et al . [ 3 ] reported outpatient footfalls, admission statistics, and procedural numbers during the first wave from 24 pediatric cardiac centers across the country and compared it with the corresponding period in 2019. The study documented 68%–75% reductions in outpatient visits (from 54,213 to 13,878), hospitalizations, cardiac surgeries, and catheterization procedures.…”

“…On the positive side, emergency procedures including arterial switch surgery, total anomalous venous connection repair, and balloon atrial septostomy showed the least decline during this period. Government-funded tertiary care centers reported a greater reduction[ 3 9 ] for obvious reasons and took a long time to normalize services. Data are needed on how these missed opportunities affect the natural history of CHD.…”