Rising burden of cardiovascular disease

India needs to boost prevention strategies at primary healthcare level, says Savitha Kuttan

Cardiovascular Disease, Global Burden, Lancet journal, Healthcare strategies, Chronic conditions, Diabetes, Hypertension, Heart disease, Delayed diagnosis, Detecting CVD, Risk factors, Healthcare physicians, Prime Minister Narendra Modi, Physical activity, Social enterprise, Quality of healthcare

No other disease kills more Indians than cardiovascular disease. According to the Global Burden of Disease study published in The Lancet journal, mortality due to cardiovascular diseases almost doubled in India between 1990 and 2016 from 1.3 million to 2.8 million deaths. As India’s disease epidemiology shifts towards greater incidence of non communicable diseases, there is imminent need to unleash preventive healthcare strategies at the primary healthcare level.

Equipping our primary health practitioners to correctly assess risk factors, effectively manage chronic conditions such as diabetes and hypertension and timely diagnosis and referring heart disease can go a long way in cutting rate of mortality. According to WHO, almost 80% of premature heart disease and stroke is preventable by timely action. Integrating primary healthcare physicians into a national prevention model for cardiovascular disease can reap rich dividends in terms of prevention of disease and reducing its curative cost burden.

Poor management of risk factors remains a concern

It is estimated that around 75% of cases of cardiovascular disease can be predicted by established risk factors – which include physical inactivity, tobacco use, elevated blood pressure, poor lipid profile and excessive body weight. However, lack of awareness about regular check-ups and lack of guidelines and training for primary healthcare practitioners to assess risk factors of all patients and offer advice on a regular basis implies we have poor management of risk factors.

Diabetes is a major risk factor whose presence significantly elevates the risk of heart disease. Similarly, hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths in India. With almost 70 million people living with diabetes, India is often referred to as the diabetes capital of the world[1]. On the other hand, the overall incidence of hypertension was estimated to be 29.8% in the Indian population. Unfortunately, delayed diagnosis and mismanagement of both diabetes and hypertension remains a major concern in the country. A study concluded that about 33% urban and 25% rural Indians were hypertensive. However, of these only 25% rural and 38% of urban Indians were being treated for hypertension.

This delayed diagnosis and treatment is significantly responsible for the development of heart disease among a large number of people in India. Evidently, effective diagnosis and management of these twin epidemics at the primary healthcare level can significantly help reduce the burden of heart disease deaths in the country.

Delayed diagnosis of heart disease

A large number of people with high cardiovascular risk including excessive weight, high blood cholesterol and hypertension remain undiagnosed. In many cases, diagnosis is made only when the patient becomes symptomatic and suffers a cardiac event like a heart attack or stroke. Not only the threat to the life of the individual is high at this stage but high technology medical interventions are also required for curative treatment.

This can be prevented by improving access to effective preventive interventions at the primary health care level. Instituting strong preventive mechanisms to manage risk factors will have a substantial impact in stopping the progression of the disease and preventing complications such as heart attack, stroke and kidney disease. This will also ensure constant monitoring and timely referral of patients as well as significantly reduce the healthcare costs associated with treatment.

Leveraging primary healthcare

Primary health care is at the frontline of healthcare delivery and prevention. In case of any mild or major health hiccup, the neighborhood physician is the one we rush to. Being a community based doctor, he is also in a good position to advocate and suggest behavioural and lifestyle changes in the community he treats. It is important therefore to leverage primary healthcare facilities in disease prevention in a major way. Primary healthcare practitioners and non physicians like nurses must be effectively trained to assess risk factors of all patients visiting their clinics irrespective of the health complaint they come up with.

People with high risk factors must be made to undergo diagnostic tests to rule out diabetes, elevated blood pressure as well as poor cholesterol levels. At the primary care level, hypertension is also preventable through a proper diet, physical exercise and a well-tailored hypertension control programme to reduce the incidence of stroke, heart disease and kidney disease.

At the same time, the primary physicians must also be trained to advocate healthy eating and living habits to all patients visiting their clinics. Consumption of local fruits and vegetables should be promoted along with reduction in intake of salt, refined sugars and trans fat. Control of diet and physical activity will result in reduction in incidences of obesity, hypertension, high cholesterol levels and diabetes. People must also be educated to identify signs of a cardiac event and the need to immediately respond to them.

Digital tools for prevention

Digital tools have in recent times emerged as potent prevention weapons to keep a tab on risk factors for better management of heart disease. Low-tech solutions embedded in smartphones and wearable devices to check the pulse and blood pressure in those most at risk are effective ways of detecting CVD in the population and controlling risk factors. Remote cardiac monitoring devices to detect cardiac arrhythmias and digital devices to test blood sugar constantly without finger pricks are emerging technologies in this domain that hold significant promise in improving prevention mechanisms.

Apart from equipping primary healthcare physicians into a preventive model, it is also recommended that new age digital technology b leveraged in a major way to improve management and diagnosis.

Take Fit India campaign to the grassroots

Prime Minister Narendra Modi’s recent thrust on creating a fitter and more active India has come at the right time. With the advent of technology and proliferation of motorised transport, our physical activity levels have declined drastically over the past three decades. The rise in incidence of cardiovascular disease is a direct consequence of this shift. In fact, the World Health Organisation recognises physical inactivity as a global health problem. The American Heart Association (AHA) notes that regular exercise leads to heart-healthy habits. It prevents major risk factors such as obesity, high blood pressure and poor cholesterol levels.

Making the ‘Fit India’ campaign more than a slogan and making it a mass movement at the grassroots is critical to our collective fight against cardiovascular diseases and other lifestyle ailments. Making at least 30 minutes of daily workout mandatory in schools and educational institutions can help instill a culture of fitness among the young generation. Similarly, incorporating 30 minutes of physical activity must also be made mandatory in offices and corporate organisations. It is also important for the government agencies and urban planners to provide safe and hygienic public places such as parks, cycling zones and grounds in all towns and cities to enable people adopt physically active lifestyles.

Savitha Kuttan, CEO, Omnicuris, a social enterprise working towards improving quality of healthcare.