Amid the growing incidence of heart diseases, the menace of heart failure is also rising. According to a recent report by the Asian Pacific Society of Cardiology (APSC), in India, Heart failure is responsible for 1.8 million hospitalisations every year.
The report also revealed that in the APAC region, heart failure patient clinical outcomes vary greatly from individual to individual, driven by many considerations including cultural and socioeconomic factors.
Moreover, the report also revealed that there is a lack of public and physician awareness regarding the disease, such as the sign and symptoms of heart failure.
“…the diagnosis of heart failure remains suboptimal in many parts of the region due to the lack of access to testing, which can lead to delays in recieving the necessary treatment,” the the report revealed.
The report, ‘Heart Failure Unseen: Unmasking the gaps and escalating crisis in Asia Pacific’, was presented at the body’s 27th congress
On the sidelines of this report launch, Financial Express.com spoke to Dr Jayagopal P B is the Director, HOD & Senior Interventional Cardiologist at Lakshmi Hospital, Palakkad, Kerala and he spoke about the status of cardiovascular diseases in India, the differences between heart failure and cardiac arrest, latest innovations among others. Dr. Jayagopal is the President of the Indian College of Cardiology and President-elect of the Cardiological Society of India – Kerala Chapter. Currently, he is in the ACC
Could you please highlight what is the status of cardiovascular diseases in Asia Pacific region? And where does India stands?
As far as cardiovascular disease is concerned, we have a major problem in heart attacks. And of course, the next major issue that we are focusing on today is a heart failure…heart failure is on the rise, there’s no doubt about it…and it’s a growing epidemic come in…the prevalence in the country is very huge…once the patient has a heart attack, the chance of them developing heart failure is very high. In fact, even the studies that we have done, when you look at the acute heart attack heart failure admissions, we find that 77% of them have a prior art attack or something related to blocks in the vessels. That’s one issue. Second, of course, high blood pressure, which is again, you know, the latest report, the published report from communicable disease and non communicable diseases, which just got published shows that it’s about more than 25% of our population suffer from high blood pressure.
So this is a major factor…And of course, other entities, you know, where you have something called a dilated cardiomyopathy, where one of the reasons is the heart enlarges on reason at all.
What is heart failure? How it is different from cardiac arrest?
Heart failure is essentially the inability of the heart to pump sufficient blood…if the heart is unable to pump that amount of bread, which is required for the daily requirements…the heart starts to fail. Now, in cardiac arrest the heart suddenly stops beating…if you don’t revive the patient immediately…it can have dangerous implication.
In India the out of pocket expenditure is extremely high. According to you, what is the financial implication of increasing prevalence of heart failure in India? And, according to you, what needs to be done at the government policy level?
I think the most of the, it’s really a lot of out of pocket expenses for this disease. So this is a situation where, you know, the challenges in as I had mentioned earlier, when somebody develops heart failure, essentially, these patients have to be on drugs lifelong. And not only that, they need to have follow ups and things like that, which is really going to be expensive. But fortunately, for us, the drugs, which are known to reduce the, let’s say, the disability, or the morbidity and mortality and heart failure, essentially for classic drugs…are now become available in India…it’s available throughout the country. And some of these drugs have really become off patent and, and affordable to patients today. So I think at the policy level, we need to first and foremost, first is the prevention of heart failure and say, What is the point having a heart failure and treating it? So if you want to prevent heart failure, you need to address the risk factors. So that is where I think the awareness of heart failure and the something needs to be addressed at the government level.
Just like you know, today, if you have a heart attack, people understand that that the there’s a need for an emergency angioplasty or a therapy, and which is more often funded by the government in at least in state where I come from. And more importantly, I think we should make sure that as a policy level, we get these things available at the at the local primary health center or the community health center level, and ASHA workers or let’s say, the, the nurse practitioners, and also the paramedics to probably see that, you know, these patients are followed up on a regular basis, because these are huge numbers. It’s impossible for the the the doctor fraternity themselves to take care of all this because I think they need a team effort, multidisciplinary team effort…team effort to really see that this is tenable. So I think the initiative is first and foremost, awareness of this gesture increase, both at the at the population level, patient level, and also the primary care level. And of course, the second important thing is once diagnosed, there must be the opportunity to get the therapy at the local levels.
What needs to be done so that the accessibility to important drugs, and advancements can be enhanced and improved?
Yeah, I think very important. The first thing is about diagnosis…The diagnosis takes place here, medically, in fact, this today, you know, thanks to digital technology, somebody as adults can transfer immediately. And we get to see that a patient is that within no time, he gets an access to therapy. Treatment wise, you know, these four classes of drugs that have really shown the difference. The only problem in our country is that you know, these drugs have to be escalated to the desired dosage in terms of reducing mortality, the age old ACE inhibitors, beta blockers are available…So I think that that also leads to the question asked earlier at the policy level, understanding what heart failure is and giving it importance. As I mentioned, this is more sinister than usual diseases, cancers and the breast cancer is curable, prostate cancer curable, look at the five year survival rate is…it’s much worse than these diseases. So, we should develop better approach to understand this disease and treating it further.
What are some of the recent advancements globally with respect to diagnosis of heart failure, and how much of these facilities are available in India?
I think the major things there are two things which are essentially done. One is in echocardiography, the simple echocardiography…this is available in India…But I think the most important thing is a blood test, which I mentioned earlier is NT-proBNP…it is not available all over. Major thing again, I think it’s that people are not really aware of this test. And of course, age, as age advances…we are at much higher risk. So I think this is a test which is, which has really changed the way that you look at heart failure diagnosis. And this unfortunately, is not available all over the country. I think there is a growing need for better awareness about this modality of diagnosis and also getting this accessible to everyone in the country. And if there is some reimbursement for example, at the at the at the primary care level or the government hospital for this blood test, that will lead to better diagnosis.