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55% Patients Couldn't Understand Seriousness, Died: AIIMS Study On Heart Attacks

NEW DELHI, May 30: Only a small proportion of patients (10 per cent) with cardiac and stroke emergencies reach health facilities within an hour, which is critical in preventing death, a recent Indian study has shown. The sooner such patients reach a hospital, the better the result of their treatment.

The study, conducted by the All India Institute of Medical Sciences (AIIMS) and published in the top medical journal The Lancet, sought to address the reasons for delays at multiple levels in reaching the facilities.

"We conducted a social audit of people who died due to heart attacks or strokes in the Ballabgarh block of Haryana's Faridabad," Anand Krishnan, Professor, Centre for Community Medicine at AIIMS, said, adding that they wanted to understand if patients reached a hospital in time, what problems they face in accessing urgent care, and what were the reasons for the delay in reaching hospitals.

The study, funded by the Indian Council of Medical Research, was done by three departments of AIIMS -- Cardiology, Neurology, and community medicine.

The study found that around 30 to 40 per cent of people didn't get late because of situations they had control over, Dr Krishnan said, adding that around 55 per cent delayed the hospital visit to understand what had happened -- whether it was a heart attack, stroke, or non-critical pain. They were confused about whether to go to the hospital, he said.

Around 20 to 30 per cent faced issues like a vehicle, or money for treatment, causing the delay. "They wanted to go immediately but faced financial or geographical access issues," Dr Krishnan said.

Approximately 10 per cent of people faced a delay in treatment after reaching the hospital in time, he said, adding that there are issues with emergency response in hospitals.

The study, which included 435 deaths, was conducted over a year. It started before Covid and ended towards the beginning of the pandemic.

"There may be slight changes, but the figures are expected to be similar across the country," Dr Krishnan said.

Similar studies have been conducted in the past, but they were hospital-based, he said. "This is the first study where we went into the community."

"We shouldn't have beginner's suspicion because this is a very deadly disease. All cases of chest pain, especially on the left side, should be immediately examined by a doctor. Not all chest pain is a heart attack, nether all heart attacks begin with chest pain. There's no full-proof way. We should maintain a high degree of suspicion. People at risk, for example, if they have blood pressure issues, should be extra cautious," Dr Krishnan said, and further advised people to rush to only those hospitals that are fully equipped for immediate treatment.

This descriptive study was conducted in two out of three tehsils (Badkhal and Ballabgarh) of the Faridabad district of Haryana with an estimated population of 21 lakh in 2020-21.

The three-delays model was used to qualitatively classify the delays in care seeking -- deciding to seek care, reaching the appropriate health facility (AHF) and initiating definitive treatment.

"We noted level-1 delay in 38.4 per cent (60 per cent due to non-recognition of seriousness); level-2 delay in 20 per cent (40 per cent due to going to inappropriate facility) and level-3 delay in 10.8 per cent (57 per cent due to lack of affordability)," the study stated.

"Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies, including stroke. Delayed presentation leads to delay or failure to provide the most beneficial therapies like thrombolysis for myocardial infarction/ischemic stroke leading to poorer disease outcomes. It is estimated that interventions that reduce delays in care in patients with myocardial infarction (MI) could decrease risk of mortality by 30 per cent," the study said.

Next pandemic could be 'deadlier': WHO chief

GENEVA, May 24: World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus has warned that the world should be ready for the next pandemic, which might be “even deadlier” than the Covid-19 pandemic.

Tedros's statement comes days after the WHO said Covid-19 was no longer a global emergency, marking a symbolic end to the devastating pandemic that has claimed at least 7 million lives worldwide.

Delivering his report to the 76th World Health Assembly, the UN agency’s decision-making body, Tedros said, “The end of COVID-19 as a global health emergency is not the end of COVID-19 as a global health threat.”

“The threat of another variant emerging that causes new surges of disease and death remains, and the threat of another pathogen emerging with even deadlier potential remains,” he said.

Furthermore, in the face of overlapping and converging crises, “pandemics are far from the only threat we face”, the WHO head added, underscoring the need for effective global mechanisms that address and respond to emergencies of all kinds.

He added that when the next pandemic comes knocking – and “it will – we must be ready to answer decisively, collectively, and equitably”. 

Tedros said Covid-19 had significant implications for health-related targets under the Sustainable Development Goals (SDGs), which have a deadline of 2030. The pandemic also affected progress towards the Triple Billion targets, announced at the 2017 World Health Assembly.

Earlier, Tedros said the pandemic had been on a downward trend for more than a year, acknowledging that most countries have already returned to life before Covid-19. He bemoaned the damage that the pandemic had done to the global community, saying the virus had shattered businesses and plunged millions into poverty.

Covid No Longer A Global Health Emergency: WHO

LONDON, May 5: COVID-19 no longer represents a global health emergency, the World Health Organization said on Friday, a major step towards the end of the pandemic that has killed more than 6.9 million people, disrupted the global economy and ravaged communities.

The WHO's Emergency Committee met on Thursday and recommended the UN-agency declare an end to the public health emergency of international concern, which has been in place for over three years.

"It is therefore with great hope that I declare COVID-19 over as a global health emergency," said WHO Director-General Tedros Adhanom Ghebreyesus, adding the end of the emergency did not mean COVID was over as a global health threat.

The WHO's emergency committee first declared that COVID represented its highest level of alert more than three years ago, on Jan. 30 2020. The status helps focus international attention on a health threat, as well as bolstering collaboration on vaccines and treatments.

Lifting it is a sign of the progress the world has made in these areas, but COVID-19 is here to stay, the WHO has said, even if it no longer represents an emergency.

"COVID has changed the world, and it has changed us. And that's the way it should be. If we go back to how things were before COVID-19, we will have failed to learn our lessons, and failed our future generations," said Ghebreyesus.

The death rate has slowed from a peak of more than 100,000 people per week in January 2021 to just over 3,500 in the week to April 24, 2023, according to WHO data.

The WHO does not declare the beginning or end of pandemics, although it did start using the term for COVID in March 2020.

Last year, U.S. President Joe Biden said the pandemic was over. Like a number of other countries, the world's biggest economy has begun dismantling its domestic state of emergency for COVID, meaning it will stop paying for vaccines among other benefits.

Other regions have taken similar steps. The European Union said in April last year the emergency phase of the pandemic was over, and the WHO's African head, Matshidiso Moeti, said in December it was time to move to routine management of COVID across the continent.

Ending the emergency could mean that international collaboration or funding efforts are also brought to an end or shift in focus, although many have already adapted as the pandemic has receded in different regions.



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