Abstract
Objectives: Worldwide reduction in emergency procedures has been observed during the current COVID-19 pandemic. The effects of the pandemic and its associated lockdown on arrhythmia related emergency procedures is not known. This study was done to see the effects of the COVID-19 pandemic lockdown on provision of emergency arrhythmia procedures and to identify vulnerable patient groups that may be disproportionately affected during lockdown. Methodology: Data for patients requiring emergency intracardiac devices including temporary and permanent pacemakers was collected from three public sector hospitals of Sindh, Pakistan, for the COVID-19 lockdown period of March to May 2020. This was compared to the data for the same period for 2019. Results: Patients presenting during lockdown decreased by 32.8% (from 250 to 168) compared to the same period without lockdown. The decline was across all emergency procedures considered. There was a more than fivefold reduction in the number of patients in patients from outside the metropolitan area of the hospital (64.3%) compared to those residing within the city (12.5%) (p=0.001). There was a trend showing women to be more effected, with the percentage decline in women being statistically significant in the rural setting (-93.8% vs. -52.9%, p=0.043). All age groups were equally affected (p=0.152). Conclusion: A marked reduction in the number of patients who presented for emergency intra cardiac devices and TPM procedures was seen during COVID-19 lockdown. The patients who presented from outside the city of the hospital and women in rural setting were significantly more effected.
Highlights
Temporary (TPM) and permanent pacemakers (PPM) and implantable cardioverter-defibrillators (ICDs) are potentially life-saving procedures for arrhythmia patients presenting in the emergency department
This study was done to see the effects of the COVID pandemic lockdown on emergency arrhythmia procedures and to identify vulnerable patient groups that may be disproportionately affected by lockdown measures
The decline in emergency presentation of patients was seen across all procedures and numbers were decreased for cardiac resynchronization therapy (CRT), ICDs permanent and temporary pacemakers
Summary
Temporary (TPM) and permanent pacemakers (PPM) and implantable cardioverter-defibrillators (ICDs) are potentially life-saving procedures for arrhythmia patients presenting in the emergency department. A 25-40% decrease of emergency presentation of ST elevation myocardial infarction has been seen all over the world since the start of the COVID-19 pandemic.[14]. Electrophysiology (EP) labs in several cities affected by the pandemic showed that only a minimum number of elective EP procedures were performed.[8] There is no data on patients with cardiac rhythm problems requiring emergency procedures. This study was done to see the effects of the COVID pandemic lockdown on emergency arrhythmia procedures and to identify vulnerable patient groups that may be disproportionately affected by lockdown measures
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