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


1 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pediatric Cardiology, Narayana Hrudalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
4 Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
5 Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
6 Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
7 Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
8 Department of Pediatric Cardiology, Max Super Speciality Hospital, New Delhi, India
9 Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
10 Department of Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, New Delhi, India
11 Department of Pediatric Cardiology, Apollo Hospital, Chennai, Tamil Nadu, India
12 Department of Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, Kolkata, West Bengal, India
13 Department of Pediatric Cardiology, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
14 Department of Pediatrics, Division of Pediatric cardiology and Grown up Congenital Heart Diseases, Army Hospital (R and R), New Delhi, India
15 Department of Pediatric Cardiology, Mission Hospital, Durgapur, West Bengal, India
16 Department of Pediatric Cardiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
17 Department of Pediatric Cardiology, GKNM hospital, Coimbatore, Tamil Nadu, India
18 Department of Pediatric Cardiology, Apollo Hospital, New Delhi, India
19 Department of Pediatric Cardiology, Healthworld Hospitals, Durgapur, West Bengal, India
20 Department of Pediatric Cardiology, Narayana Hrudalaya, Jaipur, Rajasthan, India
21 Department of Pediatric Cardiology, Soorya Hospital, Chennai, Tamil Nadu, India
22 Department of Pediatric Cardiology, MIOT Centre for Children's Cardiac Care, MIOT Hospitals, Chennai, Tamil Nadu, India
23 Department of Pediatric Cardiology, Aster Hospital, Calicut, Kerala, India
24 Department of Pediatrics, Division of Pediatric Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
25 Department of Cardio-thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
26 Department of Pediatric Cardiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
27 Department of Pediatric and Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
28 Department of Pediatric Cardiac Surgery, Indraprastha Apollo Hospitals, New Delhi, India
29 Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Sivasubramanian Ramakrishnan
Department of Cardiology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.apc_133_21

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Year : 2021  |  Volume : 14  |  Issue : 3  |  Page : 260-268

 

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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.






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1 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pediatric Cardiology, Narayana Hrudalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
4 Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
5 Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
6 Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
7 Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
8 Department of Pediatric Cardiology, Max Super Speciality Hospital, New Delhi, India
9 Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
10 Department of Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, New Delhi, India
11 Department of Pediatric Cardiology, Apollo Hospital, Chennai, Tamil Nadu, India
12 Department of Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, Kolkata, West Bengal, India
13 Department of Pediatric Cardiology, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
14 Department of Pediatrics, Division of Pediatric cardiology and Grown up Congenital Heart Diseases, Army Hospital (R and R), New Delhi, India
15 Department of Pediatric Cardiology, Mission Hospital, Durgapur, West Bengal, India
16 Department of Pediatric Cardiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
17 Department of Pediatric Cardiology, GKNM hospital, Coimbatore, Tamil Nadu, India
18 Department of Pediatric Cardiology, Apollo Hospital, New Delhi, India
19 Department of Pediatric Cardiology, Healthworld Hospitals, Durgapur, West Bengal, India
20 Department of Pediatric Cardiology, Narayana Hrudalaya, Jaipur, Rajasthan, India
21 Department of Pediatric Cardiology, Soorya Hospital, Chennai, Tamil Nadu, India
22 Department of Pediatric Cardiology, MIOT Centre for Children's Cardiac Care, MIOT Hospitals, Chennai, Tamil Nadu, India
23 Department of Pediatric Cardiology, Aster Hospital, Calicut, Kerala, India
24 Department of Pediatrics, Division of Pediatric Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
25 Department of Cardio-thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
26 Department of Pediatric Cardiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
27 Department of Pediatric and Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, India
28 Department of Pediatric Cardiac Surgery, Indraprastha Apollo Hospitals, New Delhi, India
29 Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Sivasubramanian Ramakrishnan
Department of Cardiology, All India Institute of Medical Sciences, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.apc_133_21

Rights and Permissions

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.






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