On World Heart Day, September 29, an assessment of the cardiac health situation and the imperatives.

The heart is a pump. When that pump becomes weak, it is not able to pump enough blood and provide nutrition to various organs of the human body. This condition is commonly referred to as ‘heart failure.'

The incidence of heart failure is increasing by the day in the developing countries despite advances in health care. This is because of increased life expectancy with resultant increase in the size of the aged population, and also better awareness about the condition or ailment. Heart failure is the final pathway to cardiac diseases such as heart attacks, valvular heart diseases, hypertension (high blood pressure), and heart muscle diseases (Secondary to infections, the use of certain drugs, diabetes and also unknown causes.).

The incidence is one per 1,000 population a year. Above the age of 80 years the incidence becomes 10 per 1,000. The risk of death in untreated cases is 5 to 10 per cent annually. The common symptoms in the early stages are breathlessness and fatigue. In the advanced stages the urine output will be low, there will be extreme breathlessness, and swelling in the legs and face due to fluid accumulation. A majority of studies have shown that high blood pressure, when it remains undetected and untreated, can result in the gradual enlargement of the heart accompanied by the weakening of heart muscles, resulting in heart failure.

The treatment is oriented towards relieving the symptoms, improving the quality of life and reducing mortality and instances of repeated hospitalisation. Studies have shown that the readmission rate within one year is up to 30 per cent in such cases. This results in increased demand for hospital beds. The patient's finances are hit, and there is an impact on insurance companies and employers.

The management is either by means of drug therapy, devices such as pacemakers of a special type to improve the pumping capacity of the heart, or, finally, cardiac transplantation. Pacemakers are quite expensive and have only limited battery life. Cardiac transplantation has its limitations in terms of the availability of suitable donors. So early detection and prompt medical treatment are key to managing the rising number of cases.

In the developed countries there are special (heart failure) clinics for such patients. Many of them may need domiciliary care. These aspects of care are yet to come to India. Pacemaker devices and cardiac assist devices such as the artificial heart (which is a bridge to cardiac transplantation) are expensive. The cost may come down as more patients seek to undergo such therapy. Many of these patients suffer a psychological impact also and develop depression due to chronic illness, recurrent hospitalisation and the financial burden.

The number of cases of heart failure is bound to rise exponentially in the years to come. We should not wait till a surge happens. There is a need to predict, prevent, and be prepared in order to tackle the situation, before heart failure cases grow to such high levels.

(Dr. I. Sathyamurthy is an interventional cardiologist and director of the Department of Cardiology of Apollo Hospitals in Chennai. He received the Padma Shri in 2000, the Dr. B.C. Roy National Award in 2001 and a D.Sc (Honoris Causa) from the Dr. M.G.R Medical University in 2008.)


A cardiac check-listSeptember 29, 2011