Cardiovascular Diseases in India India has seen a rapid transition in its disease burden (number of cases/lakh) over the past couple of decades. The load of communicable and noncommunicable diseases (NCDs) is projected to get reversed in 2020 from its distribution in 19905 India is undergoing an epidemiological transition and is on the threshold of an epidemic of cardiovascular disease. Demographic projections suggest a major increase in cardiovascular disease mortality as life expectancy increases and the age structure of the growing population changes. Overall, cardiovascular diseases (CVDs) accounted for around one fourth of all deaths in India in 2008. CVDs are expected to be the fastest growing chronic illnesses between 2005 and 2015, growing at 9.2% annually A more worryingfact is that the incidences of CVDs have gone upsignificantly for people between the ages 25 and 69 to 24.8%, which means losing more productivepeople to these diseases 1
Prevalence of major cardiovascular diseases & related risk factors: Prevalence of Coronary Heart Diseases (CHDs) is between 7 13 per cent in urban and 2 7 per cent in rural India. A conservative estimate indicates that there could be 30 million CHD patients in India of which 14 million are in urban and 16 million in rural areas. If the current trend continues by the year 2020, the burden of atherothrombotic CVD in India will surpass other regions of the world. Prevalence of hypertension in India is 25% in urban and 10% in rural inhabitants. Prevalence of dyslipidemia is about 37.5% among adults of 15 to 64 years of age. 1.1. Factors for increasing in heart diseases in India The growth of heart diseases is dependent on anumber of interlinked factors such as aging, changinglifestyles and food habits, and other rapidly evolvingsocioeconomic determinants across developing nations. Socioeconomic determinants like improved access to healthcare, higher income levels and globalization, andurbanization drive increases in CVD risk factors. 2
Rise of CVDs in the economically underprivileged population The growth of heart diseases impacts not just the urbanand economically welloff population, but also theunderprivileged. In fact, the Indian rural population andurban poor are facing a "double burden" with incidencesof acute diseases continuing, there has been arapid growth in incidences of chronic diseases. Cardiac Care Cycle: Heart diseases are considered to be silent diseaseswhose symptoms are not evident in a patient sufferingfrom them till the disease is in an advanced state. The cardiac cycle has multiple stakeholder s includingthe government, healthcare providers, employers, healthinsurers, medical equipment manufacturers, NGOs, wellness centres and manufacturers of nutraceuticals, supplements and dietary food. All these stakeholdersplay a vital role in cardiac care in India. Various initiativesare already underway to improve prevention andintervention. 3
Key Challenges to Cardiac Care in India: The key challenges being faced in cardiac care in India are lower availability, accessibility, and affordability ofeffective and efficient treatment, coupled with lack of afocused policy towards NCDs including CVDs. Trends in cardiovascular interventions: 4
Today, cardiac hospitals in India perform over 100,000 open heart surgeries per year, one of the highest, worldwide. Additionally, it is estimated that in 2011 cardiology hospitals in India placed over 200,000 coronary stents by conducting over 120,000 coronary angioplasties. The total number of stents used has risen but what is striking is the usage of drug eluting stents (DES). As compared to 2005 where DES constituted 55.13 per cent of total stent usage, the numbers in 2006 are a phenomenal 72.11 per cent (Fig. 5). These figures exceed the percentage of DES implantation in some of the industrialized nations of Europe. Figure: Total number of stents and drug eluting stents (DES) usage patterns in India In the mid 1990 some 10,000 Coronary Artery Bypass Graft (CABG) surgeries were being performed annually in India. Presently the annual number is more than 60,000 according to industry sources. There has been a steady annual rise to the tune of 25 30 per cent in the number of coronary interventions over the past several years. This on one hand reflects the accessibility of the population to advanced cardiac facilities and on the other hand, portrays that the disease is now achieving epidemic proportions 5
Figure: Total coronary interventions in India The number of PAMIs (primary angioplasty in myocardial infarction) has increased in the recent years in India Figure: Data on intervention in acute MI (India) Cardiovascular Diseases Patient Load S.No. Indication Patient Load/year 1 Angina 400 700 2 Acute heart failure 200 400 3 Cardiac arrhythmias 200 400 4 Hypertension 1200 1800 5 Acute Coronary Syndrome 600 800 6 Acute Myocardial Infarction 600 1000 Cardiac Interventions 7 No. of coronary stents 800 1000 8 Angioplasties 800 1200 9 Coronary Artery Bypass Surgeries 350 600 6
Sample list of clinical studies done by MNIs in Cardiology: Cardiology Phase Sites Subjects 1 Hypertension III 6 120 2 Hypertension III 1 10 3 Cardiac Surgery/Hypertension II 1 20 4 Heart Failure III 23 1000 5 Congenital Heart Disease II 2 10 6 Hypertension 2 40 7 Chronic Heart Failure III 30 250 8 Acute Coronary Syndrome III 39 1400 9 Acute Coronary Syndrome III / IV 7 75 10 Chronic Coronary Heart Disease III 10 200 11 Hypertension IV 12 122 12 Heart Failure 3 96 13 Acute Coronary Syndrome III 15 200 Sample list of device studies done by MNIs in Cardiology: Devices Sites Subjects 1 Coronary Atherectomy 4 50 2 Congestive Heart Failure 9 180 3 Congestive Heart Failure Extn 6 40 4 Congestive Heart Failure Acute 1 40 7
Devices Sites Subjects 5 Coronary Stent 5 120 6 Mitral valve Regurgitation 5 20 7 Coronary Stent 12 40 8 Cardiac Device 1 10 9 Cardiac Device (Digital Ballistocardiograph) 1 90 10 Cardiac Stent Study 50 1830 8