Impact on Interventional Cardiology Services during the COVID-19 Pandemic in Public / Private sector : Analysis of Data from a Nationwide Health Insurance Scheme in India

Abstract

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.