June 2016

Miles covered, Miles to be covered

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Cardiology

Transformation of Non-Standard Procedures into Standard Practices via Structural Changes, Partnerships & Cost-Effective Innovations

When it comes to matters of ‘heart’, we all tend to undoubtedly become weak. In past, the mere mention of heart-related diseases subtly dropped a hint about an ‘inescapable death warrant’ lingering in the corner or ‘a message from the God’ capable of turning any person into nothing but a bundle of nerves’. Unimaginably complicated procedures and exorbitant treatment costs made ‘cardiac diseases’ a horse of completely another colour. When we started working upon ‘cardiology, we aimed at ‘engaging’ ‘thought leaders’ to connect the missing dots to define till now largely unintelligible field of cardiology. We bring together the renowned experts to reveal new dimensions and affirm or denounce “common observations’. While many highlighted their concern over the emerging status of India as the ‘heart disease capital of the world’, the leaders talk more than what is visible to assist decision makers in understanding the key problem areas. Cardiac diseases is definitely more than lifestyle disorder and rich man’s diseases, with 14 million heart patients in urban areas and 16 million in rural areas.

Nothing is more exciting than to hear the thought leaders of cardiology voicing in unison their support to creating an ecosystem for narrowing down the knowledge sharing gaps between medical device manufacturers, clinicians and medical experts. With so much clarity like never before, they even candidly share the strategies to be built in the system and to be adopted by each individual to reform Indian healthcare. Though pretty impressed with the start-ups, they leave no stone unturned in throwing light over hiccups still standing like roadblocks in the path of innovation. Rapid innovation in software-driven platforms, as highlighted by one and all, will definitely go a long way in ensuring ‘preventive care’, but dearth of innovations in hardware needed in super-specialised treatment becomes a key limiting factor.

M-health and e-health platforms will play a crucial role of preventing cardiac disorders, but the lack of system-oriented support to indigenous manufacturing of high-end technologies that can enable cost-effective solutions remains a spoilsport in ensuring universal healthcare. With the cost involved, these technologies are able to target just 20 to 30 per cent of people.

With the occurrence of need-based structural changes, though quite delayed, leaders pin their hope on startups and policymakers who have shown support to structural changes required to build up a nation ready to meet the challenges of cardiac diseases.

We raised the following questions before the stakeholders to understand the key challenges of cardiology:

  • Do you think cardiac diseases are more than lifestyle disorders or a rich man’s disease? Please provide details.
  • With the simplification of technologies, prevention of cardiac diseases is within reach. Have we seen any decrease in the number of cardiac diseases?

Here we present some of the excerpts:

  Ajit-DesaiDr Ajit Desai, Consultant Cardiologist, Jaslok Hospital & Research Centre

  • Cardiac diseases are more than lifestyle disorders. They depend on hereditary/genetic factors, age, sex, exercise status, smoking, diabetes, hypertension, obesity, stress factor, tobacco chewing and lipid metabolism of body. Lifestyle modifications can take care of smoking, stress, diet and tobacco chewing, but cannot modify the other factors. It is no longer be a rich man’s disease, particularly in India and other developing countries.
  • There is no decrease in the number of cardiac diseases with the simplification of technologies. Technological advances have made changes in the treatment of cardiac diseases, but not in the incidence of those diseases. Although with better treatment and medications, we have reduced the morbidity and mortality of cardiac diseases.

 

Subrata-Lahiri

Dr Subrata Lahiri, Senior Consultant Cardiologist, Delhi Heart and Lung Institute, New Delhi

  • India is slowly moving towards becoming the heart disease capital of the world. While there are people who suffer from congenital heart defects, a condition due to lifestyle choices, majority of the population in our country suffers from acquired heart diseases due to unhealthy lifestyle. While heart disease can affect anyone, irrespective of age, gender or socioeconomic status, its incidence seems to be increasing among those between the age of 25 to 50.
  • Despite path-breaking advancements, the disease incidence continues to grow. With a 9.2 per cent annual growth rate, the incidence of cardiac diseases has been increasing the fastest in comparison to all other chronic illnesses. There is an urgent need to reverse this trend and focus on disease prevention, management and treatment together.

 

 M-Lawrance

Dr M Lawrance Jesuraj, Consultant Cardiologist & Electrophysiologist, KMCH Heart Institute, Kovai  Medical Center and Hospitals, Coimbatore

  • We cannot totally attribute all cardiac diseases as lifestyle disorders, but particularly ischaemic heart disease or block in blood vessels of the heart has significant relation with lifestyle, food habits and lack of exercise.
  • Although technical advances made in the field of cardiology have improved success in managing heart disease patients, we are seeing an increasing trend in the incidence of these diseases due to stressful lifestyle, food habits, etc.

 

Sourendra-Sankar

Dr Sourendra Sankar DasHead of Critical Care & Cardiology, Mercy Hospital, Kolkata

  • If we go through the following risk factors for heart disease, such as hypertension, diabetes, dyslipidemia, alcohol, tobacco and positive family history, then it can be said that it is partly a lifestyle disease and certainly not only a rich man’s disease. Hypertension & diabetes have strong genetic predisposition along with lifestyle, and these can manifest in people of all socioeconomic strata. Dyslipidemia definitely has got relation with eating habits and also the amount of exercise/work out someone is doing. People with sedentary lifestyle are at more risk of developing dyslipidemia, which in turn can cause heart disease (ischaemic heart disease (IHD)/myocardial infarction (MI)). People hailing from lower socioeconomic or middle class are observed to be active and also their dietary habits are controlled. Hence, the problem prevails more in the higher income group. Whereas consumption of alcohol and tobacco are prevalent in all socioeconomic groups and in the recent times, especially youngsters have developed a greater affinity towards this habit. So, the lifestyle is definitely a prime cause of cardiovascular disorders, and it is more risky if there is positive family history, such as parents suffering from such diseases or any other disorders like diabetes. In today’s fast-paced living, stress is a major factor which gives rise to common diseases, such as hypertension and diabetes. This trend also shows a steady rising graph of cardiac deaths, and it is witnessed that major deaths are happening due to non-communicable diseases (NCDs). So, it can be concluded that cardiac disease is more of a lifestyle disease than a rich man’s disease.
  • I agree that simplification of technology has happened and a number of awareness programmes has been undertaken by various medical and social organisation, but it is yet to reach all the spheres of every community. Social awareness is still inadequate and needs more emphasis rather than interactions in the practice of cardiology. If proper precautions are not taken on time, then the situation will become more serious due to various socioeconomic issues. The alarming fact is that the young generation is affected the most and their health might be at a high risk. Youngsters are constantly working and hardly get time to exercise and follow proper diet. As a result, they easily contract hypertension. Diabetes is found commonly among youths in their 20s and 30s. A sedentary lifestyle only exacerbates the situation.

 

Shrikant-Parikh

Dr Shrikant ParikhCEO & Director, A3 Remote Monitoring Technologies Pvt Ltd

  • Life expectancy is steadily rising, so is the incidence to cardiovascular disease (CVD). The incidence in case of CVD is rising at an ever accelerated rate in India. More people for more years of their lives need to be monitored for being inflicted with CVD. This is a serious burden on the medical infrastructure. In parallel, the healthcare costs – in hospital and before and after hospitalisation – are steadily rising. It is consuming a greater percentage of global gross domestic product (GDP). This is reaching an unsustainable level. The combination of these two trends – each exacerbating the other – will lead to an unworkable and unsustainable situation, where the medical infrastructure may reach a breaking point. It is accepted that the clever use of technology, especially where the technology takes medical care in some forms right to the patient is the “way to go”. This can improve the effectiveness and efficiency of the existing infrastructure by a magnitude without any significant increase in infrastructure. A3 Remote Monitoring Technologies is precisely focused on this set of “remote medical technologies”, especially those that have a direct life-saving potential. A3 Remote Monitoring Technologies has developed a comprehensive set of technologies, power of which is amply proven by hundreds of lives it has managed to save (and counting!).
  • Our technologies enable a cardiologist to remotely monitor at a “multiple levels of synchronicity”. Also, a local paramedic gets some instant indication of certain critical heart conditions. The cardiologist, straight from his or her smartphone can manage cardiac emergencies anywhere in the world to a large extent, in a high speed, high precision and low turnaround manner. There are multiple live remote “monitoring and managing” technologies whereby the doctor is equipped and empowered to save a life in certain situations. Importantly, these technologies are designed for the tough Indian conditions. There are more technologies in pipeline and being tested. Our technologies enable a golden hour intervention by a cardiologist in a comprehensive manner.

 

SK-Agarwal

Dr SK AgarwalSenior Interventional Cardiologist, Kailash Hospital and Heart Institute, Noida

  • Heart diseases may be present since birth or may be acquired during the course of one’s life. Innovations in cardiac treatment have reduced mortality rates in those with congenital/rheumatic or valvular heart disease, and conditions with limited or no lifestyle links. However, unhealthy lifestyle choices made by people in the 21st century continue to inch India closer to the title of the ‘heart disease capital of the world’. There has been a drastic increase in the incidence of coronary heart disease in our country over the past decade due to poor lifestyle. All these over time trigger conditions, such as hypertension, dyslipidemia and obesity, which are the direct causes of atherosclerosis or narrowing and/or blockage of the blood vessels that supply the heart. Atherosclerosis is one of the most common forms of heart disease and the leading cause of heart attacks and angina. Heart disease can happen to anyone, rich or poor, women and men. The recent studies reveal that out of the 30 million heart patients in India, 14 million reside in urban areas and 16 million in rural areas. Stress levels are high amongst the entire population at large and are not restricted to a particular geography. India is thus in need of a comprehensive strategy aimed at reducing it’s heart disease burden. This is only possible through a national-level programme based on a public-private partnership aimed at disease prevention, management and treatment. Living a healthy lifestyle is our best defence against heart disease. Lifestyle changes, I believe, are as simple as ABC; A- Avoid tobacco, B- Become more active and C- Choose nutritious food options. These can surely go a long way in preventing this life-threatening disease.
  • Various efforts that have been made by organisations and bodies towards raising awareness about the increasing incidence of heart disease; however, there has been limited impact and we still have a long way to go. What we are in need of is a sustained national-level campaign. Stress levels are on an all time high and we are living in an age characterised by westernisation and urbanisation. People are more competitive and career oriented as ever before, making them ignore their health from an early age. Heart disease is now striking people as early as in their 20s, which is a factor of great worry for the medical fraternity. Technological development brings with it a massive scope of raising large-scale awareness about the implications of making unhealthy lifestyle choices in the long run and the need for the reversal of heart disease. Therefore, it is important that we make the most of it. The new developments in cardiac intervention have also made it possible for those with an existing heart disease to live longer and lead better quality of life. Statistics indicate that more than 200,000 open-heart surgeries are performed every year in our country, indicating an annual increase of 25 to 30 per cent in cardiac interventions. Better treatment options coupled with the right kind of preventive awareness programmes can go a long way in decreasing the disease incidence and increasing one’s lifespan.

 

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