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Short report
Management of cardiovascular emergencies during the COVID-19 pandemic
  1. Rahul Choudhary1,
  2. Dinesh Gautam2,
  3. Rohit Mathur3,
  4. Dinesh Choudhary4
  1. 1 Department of Cardiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
  2. 2 Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
  3. 3 Dr SN Medical College, Jodhpur, Rajasthan, India
  4. 4 SP Medical College, Bikaner, Rajasthan, India
  1. Correspondence to Dr Rahul Choudhary, Department of Cardiology, All India Institute of Medical Sciences Jodphur, Jodhpur 342005, India; drrahulchoudhary{at}yahoo.com

Abstract

Background It has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic.

Methods This was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown.

Results 25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block.

Conclusion The COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.

  • acute coronary syndrome
  • heart failure
  • thrombolysis

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/emermed-2020-210231

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    Footnotes

    • Handling editor Edward Carlton

    • Contributors RC conceived the study. RC, DG, RM and DC initiated the study design and collected the data. RC analysed the data and drafted the article. All authors approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (RC) upon reasonable request.