In India, heart diseases and stroke is a leading cause of death. With over three million deaths each year, India is set to be the ‘heart disease capital of the world’ in few years’ time. Experts observe that there is a steep increase in heart attacks among Indians below 45 years. In particular, the occurrence of lesions or blockage in the heart vessels due to deposits of fat, cholesterol, platelets, and calcium has become a common cardiac ailment. CVDs in India afflict the rich as well as the poor. It is estimated that by 2020, CVDs will be the cause of over 40 per cent deaths in India vis-à-vis 24 per cent in 1990. Globally, it already causes 17.3 million deaths annually. “With rapid change in our economic situation over the last two decades there has been phenomenal increase in incidence of CVDs (partly as a result of increased incidence of diabetes, sedentary lifestyles, change in eating habits etc) in India, whilst the rates of CVDs have been on decline in western world”, updates Dr Venkat D Nagarajan, Consultant Cardiologist and Electrophysiologist, Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai. Elaborating on the primary risk factors for CVDs, Dr Mantravadi Rajkumar, Consultant Cardiac Electrophysiologist, Sahyadri Hospitals, Pune informs, “Poor lifestyle choices like smoking, excess alcohol and other stress coping substances, mindless pursuance of diets that are rich in carbohydrates and fats; unbalanced aggressive stressful work ethics cause our bodies to release substances which increase the wear and tear, cause subtle and sustained damages to cardiovascular system and eventually cause immense physical and mental suffering in addition to a foreshortened life”. According to the World Heart Federation, at least 80 per cent of premature deaths from heart disease and stroke could be avoided if these risk factors are controlled.
Increased incidence in women and children
What’s more alarming is the growing incidence of CVDs among women and children in India. According to the World Heart Federation, heart disease is the number one killer of women, causing one in three female deaths (i.e. about one death per minute). Indian women are more vulnerable to CVDs than men. The research reveals nearly two-third of the deaths from heart attacks in women occur among those who have no history of chest pain. Metabolic syndrome — a combination of fat around one’s abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than on men. Also mental stress and depression affect women’s hearts more than men’s. Depression makes it difficult to maintain a healthy lifestyle. Moreover, smoking is also said to be a greater risk factor for heart disease in women. The mounting number of CVD patients reveals the dire need to have a preventive and curative system against these diseases in our country.
Overcoming challenges
Lack of affordability, awareness and appropriate diagnostic facilities are the biggest challenges faced by Indian cardiologists’ face while providing treatment for CVDs. Dr Ramakanta Panda, Founder and Vice-Chairman, Asian Heart Institute, Mumbai points out, “Even the most advanced countries such as US can’t afford advanced treatment options for cardiac patients because of the high costs involved. Creating awareness about prevention of heart disease is hence the need of the hour. The focus should be on various education programmes which create awareness about the risk factors (such as smoking, unhealthy diet, sedentary lifestyle, high BP, etc.,) of heart disease and its prevention
In addition to this, routine medical treatment is available at affordable rates; however catastrophic treatment options such as bypass surgery come at a high cost, making them out of reach for many. Hence government should make available health insurance schemes whereby patients can pay partially for the treatment hence reducing the financial burden”.
World Heart Day
In the quest to reduce the burden of CVDs across the globe, the World Heart Federation designated September 29 as World Heat Day (WHD) in 2000 in a bid to raise awareness around CV risk among patients and healthcare workers. WHD engages millions of people worldwide in diabetes advocacy and awareness. It involves several global diabetes community including IDF member associations, diabetes organisations, NGOs, health departments, civil society, individuals and companies to develop an extensive range of activities, tailored to suit a variety of groups. WHD is celebrated on September 29 every year.
WHD 2012
This year the theme for WHD was ‘One World, One Home, One Heart’, with the stress on curbing CVDs among women and children. Worldwide, there were a variety of activities organised on the occasion of WHD in order to spread awareness. Some of them included health checks, organised walks, runs and fitness sessions, public talks, stage shows, scientific forums, exhibitions, concerts, carnivals and sports tournaments.
In India, it was celebrated based on three important factors: spreading awareness, initiating programmes for financing poor patients and encouraging major developments in the field of cardiac treatment.
Spreading the word
Several premium hospitals and healthcare bodies organised various awareness programmes across the country that focussed on various aspects of CVDs in order to make people aware of the rising risk factors. Some of them were:
Campaign to reduce cholesterol levels: Fortis Healthcare organised an initiative to test cholesterol levels in National Capital Region (NCR) as part of the company’s corporate social responsibility (CSR) activity. As part of the campaign, free cholesterol tests were conducted at all Fortis facilities and select SRL Labs in the NCR region covering Delhi, Gurgaon, Noida and Faridabad. A total of 14,161 people starting from 18-year olds to senior citizens availed the benefit of this initiative.
Pledging an oath: 3000 NCC cadets across India spread the message of a healthy heart in association with Billion Hearts Beating Foundation and Apollo Hospitals. The campaign aimed at informing people about the basic actions they can introduce into their daily lives to lead a healthy heart existence. To enhance and sustain good heart health in the country, the cadets across five metros – New Delhi, Bangalore, Hyderabad, Chennai and Kolkata – took the pledge to mark World Heart Day.
Awareness on CVDs in women and children: Bombay Hospital, Indian Medical Association and General Practitioners’ Association joined together to create awareness among healthcare professionals and general public on risk factors for women and children. Experts spoke on the advances in management of hypertension and on acute myocardial infarction. Apart from this, Cardiological Society of India (CSI) organised “World Heart Fest 2012”. Held at the NSIC Grounds, Kalkaji in New Delhi on September 30, 2012, a day after the World Heart Day; it was a daylong awareness event dedicated to the prevention of heart diseases and it was powered by Maruti Suzuki Dezire and partnered by Quaker Oats. This awareness event, which included free cholesterol and sugar check, cardiac check-ups, healthy heart tips and expert advice, was conducted to kick-start a larger prevention drive to fight heart diseases by the CSI.
Financing the cause
Affordability is another barrier in reducing CVDs and to address this issue, Healthy Heart for All (HHFA) programme, a Medtronic business model innovation project provides a financing scheme loan to help qualified families cover the cost of cardiac care for their loved ones. It aims to increase awareness and diagnosis of heart diseases by providing high quality, affordable cardiac care and treatment to underprivileged patients. It also does it through promoting financial assistance to implant heart devices such as pacemakers, stents, ICD and CRTP, HHFA partners with hospitals for aiding heart patients.
HHFA started its first pilot project at Durgapur, in September 2010 and is currently present in 18 cities namely Delhi, Kolkata, Ranchi, Durgapur, Coimbatore, Salem, Trichy, Tirnalveli, Calicut, Palakkad, Cochin, Mumbai, Pune, Ahmednagar, Ahmedabad, Bangalore, Mysore, and Mangalore. In a short span, HHFA has partnered with 50 hospitals across these cities and has disbursed 116 medical loans to patients under EMI and easy financing options for heart devices implants. Patients can pay back their loans in easy installments (starting from Rs 600/- a month) in their scheme. The other example in this regard is of the Asian Heart Institute, Mumbai who has tied up with the Rajiv Gandhi Yojana Scheme which reduces the cost of treatment for poor patients. With the help of this collaboration, AHI was able to serve many poor patients with good quality treatment at no cost.
Treatments
Besides providing awareness, cardiologists in India are also seeking and adopting innovative treatment modalities to fight against CVDs. One such method is the Transcatheter aortic valve implantation (TAVI), an innovative method for replacing diseased aortic valves. Premium hospitals are resorting to this technique which was first developed by Dr John Webb at St Paul’s Hospital in Vancouver about a decade ago. It has become a more common procedure in the past five years. However, in India the concept is still in its nascent stage. The technique involves inserting a replacement valve made of cow tissue, strengthened with a stainless steel stent, into the human heart. The valve is inserted into the body by a catheter in the femoral artery [in the groin] and moved through the chest into position. The patient’s malfunctioning aortic valve is pushed out of the way and replaced. If the femoral approach is deemed unsuitable, the valve can be inserted into the heart (again, using a catheter) by making a small incision on the left chest wall, just below the nipple. The entire procedure takes about half the time needed for conventional open-heart surgery. Another interesting treatment method introduced is angioplasty with a 6.5 mm stenting. A 52-year male patient who was on medication for 1½ years due to high BP was brought to AHI. The patient complained of chest pain (left sided), mild, continuous in nature since July14, 2012. The pain extended to left shoulder and left arm. In such circumstances, normally a patient is advised a bypass surgery. However, AHI performed an angioplasty with a 6.5 mm stenting and this eliminated the need for a bypass. It is probably the first time that the procedure has been done with such a long stenting. Usually stenting is only of 4 mm. Thus, innovative measures are also being used to curb CVDs.
Investment in research
Along with the healthcare sector, the pharma sector has also joined the fight against CVDs. Pharma companies in India are now pumping billions of pounds into research and development that focuses on Indian genotypes and variations for the development of drugs which can be used to treat CVDs.
Needing a change
Thus, the healthcare industry is definitely doing its bit and deploying different strategies to nullify the threat posed by the rising incidence of CVDs. Now, it is to be hoped that Indians would somehow get the message that only a healthy heart can sustain for longer years and take the initiative to lead a healthy lifestyle which would in turn be beneficial to the heart.