The patients with heart disease coming for hospital admissions can be largely divided into two categories: routine and urgent.
Routine admissions are mainly for routine procedures or surgeries for an underlying disease so as to avoid the disease related complications in the future. These patients may not be very symptomatic and are well managed with medications. Example of these patients are : asymptomatic multi vessel disease waiting for bypass surgery, surgical or device closure of atrial septal defect etc. Admissions in these patients can be delayed for a few months because of ongoing corona pandemic. The reasons for delaying the procedure or surgery are as follows:
1. These patients are stable at present and are relatively asymptomatic on medications. They should continue to stay on drugs. There is a risk of contracting covid-19 infection in the hospital. As most of the hospitals are also required to admit covid patients and treat them, there is always a risk of cross infection to non covid patients. If covid infection happens to patients with heart disease, there is a high risk of morbidity and mortality. So considering the risk-benefit ratio of going for routine procedure, it makes more sense to delay the procedure for a few more months.
2. The hospitals have to look after both covid and non-covid patients. As most of the hospitals are saturated with covid patients, there is a need for more manpower towards covid patients. As such the covid is a very contagious disease, so some of the hospital staffs also get infected at most places. That leaves the hospital very much short staffed towards the non covid patients. So the non covid regular patients may not get adequate attention.
Urgent admissions have to be taken as they require immediate attention or else it may be life threatening. Such cases are: myocardial infarction (heart attack), unstable angina, heart failure, heart blockages needing pacemaker implantation, survivors of cardiac arrest, pulmonary thromboembolism etc. Management of urgent cases also have been modified to some extent due to corona pandemic.
As these patients may also be having covid disease, they are usually shifted to an ICU where they are managed till their covid report is available.
To avoid covid cross infection, the management protocol has been modified to less touch technique. Immediate invasive or surgical procedures like angiography/ angioplasty/open heart surgeries are avoided to prevent cross infection to hospital staffs as well as considering the fact that it leads to high mortality rate to the patients ( if covid positive) during the perioperative period. So, thrombolytic drug therapy is preferred over primary angioplasty to a patient coming with acute myocardial infarction (heart attack). Once the patient turns out to be covid negative, then the usual treatment plan is undertaken as during the pre covid era. Sometimes multiple swab tests are done to patients to make sure covid negative status due to the possibility of false negative results with a single test ( as high as 30 to 40%). Some patients however may need immediate procedure such as pacemaker implantation or angioplasty in failed thrombolytic cases etc. In these patients even if they turn out to be covid positive, required procedures are done after taking due precautions by all staffs involved.
(Disclaimer: The author Dr Santosh Kumar Dora is senior cardiologist, Asian Heart Institute, Mumbai. Views expressed are a personal opinion.)