Matters of the heart

Debarshi Dasgupta

HEART DISEASE: Heart-related ailments now strike the most productive segment of India's workforce, mainly those between 30 and 40 years About 10 per cent of heart attacks are fatal.

That can be reduced to 4 per cent if adequate safety measures are put in place This includes better awareness about symptoms of heart attacks, preliminary checks, combined with an efficient network of ambulances and nursing homes Nursing homes should have equipment for cardiac resuscitation and a stock of clot-busting drugs that are life-saving in the initial stages of a cardiac arrest Ambulances to be equipped with ventilators and defibrillators, essential first-aid equipment for cardiac arrests Developing health infrastructure should go hand-in-hand with lifestyle change to deal with cardiac diseases.

As much of the discourse around containing the threat of cardiac diseases remains focused on choosing a healthier lifestyle, little is talked about how to reduce mortality from heart attacks.

Indians have been harangued ad nauseam with advice on eating healthy and leading a physically more active life. However, that has overshadowed the urgent need to upgrade the primary health infrastructure that continues to be largely responsible for approximately 1.5 million heart attack-related deaths each year, many of which are avoidable.

"Presently, 30-40 per cent patients of heart attack do not reach the hospital and succumb to any sudden cardiac arrest due to ventricular fibrillation (VF)," says Dr Ashok Kumar Omar, director, Emergency and Heart Command Centre, at the Delhi-based Escorts Heart Institute and Research Centre.

"Some 50 per cent of the mortalities due to myocardial infarction (a severe form of heart attack) occurs during the first hour, more so in the first few minutes after chest pain. With excellent medical facilities, the death rate after reaching the cardiac facility has been reduced to 7 per cent. However, mortalities due to heart attack may be further reduced to half if adequate safety measures are put in place."

The first step, therefore, to reduce fatality from cardiac arrests would mean acknowledging that you too may be at risk, and giving adequate attention to any symptoms. Tests like lipid profile, exercise test and non-invasive assessment of coronaries with CT-coronary angiography may prove effective in detecting the disease at an early stage amongst a high-risk population.

Critical to this is the creation of an advanced cardiac life support (ACLs) system using the network of existing nursing homes.

These nursing homes should have equipment for cardiac resuscitation and a stock of clot-busting drugs or thrombolytic drugs that may prove to be life-saving in the initial stages of a cardiac arrest. If needed, the patient should also be transferred to the nearest cardiac centre to undergo primary angioplasty. Allowing a patient access to these measures in the "golden hour" can save his or her life.

To prove effective, this system has to be then linked with a fleet of ambulances equipped with ventilators and defibrillators, which are essential first aid equipment for cardiac arrests. Moreover, these ambulances have to be manned by people who are trained in ACLs.

Such a set-up is going to be crucial as India's cardiac disease burden increases. The World Health Organisation estimates that 60 per cent of the world's cardiac patients will be Indian by 2010.

Moreover, heart-related ailments are now striking the most productive segment of India's workforce, mainly those between 30 and 40. Nearly 50 per cent of deaths in India caused due to heart ailments occur below the age of 70, compared with just 22 per cent in the West.

The risk associated with heart diseases has been halved in the West primarily because of the awareness about leading a healthier and more active life, and the early and effective management of cardiac arrests. On the other hand, it has doubled in India in the last 20 years. This is largely because of excessive fat intake, faulty diet, tobacco consumption and an increasing sedentary lifestyle.

Then there are unique factors that make Indians more vulnerable to cardiac problems, like our genetic makeup that prevents blood fats from being broken down, increasing cholesterol levels and thereby the risk of cardiac ailments.

Relatively newer risk factors amongst Indians have also been identified like abdominal obesity, the most common form of obesity in India, which is responsible for more insulin resistance.

- Outlook