Abstract 10414: Audit of Percutaneous Coronary Intervention Use in St-Elevation Myocardial Infarction Under the Indian National Health Insurance Program Ayushman Bharat

Abstract

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.