Mumbai: The majority of heart failure patients across India troop to doctors for help long after the disease had advanced to severe levels, according to a new ninecity study released on Sunday. Worse, the study found that just about 11% of those seriously-ill patients actually underwent treatment because the costs associated were prohibitively high.
Doctors feel that knowledge about heart problems and their symptoms in India is mainly restricted to heart attacks, which is mainly caused by blockages in heart's arteries. The fatality associated with a fast-beating or a slowly-beating heart is not well known among Indians.
"Over 60% of the heart-failure patients included in the study went to a doctor only after their heart's pumping function had reduced by half,'' said Dr Ajay Naik, an interventional cardiologist who presented the findings of the first-ever Panarrhythmia and Heart Failure Registry at a medical conference held in the city on Sunday. Life expectancy for a severe heart failure patient is between one and five years.
Even Mumbai, the financial hub with comparatively better awareness and medical care, fared poorly.
Killing Lack Of Awareness
Heart fails when its pumping action is poor. At times, poor pumping causes a build-up of fluid called congestion in the lungs and other body tissues
According to the American Heart Association, people of 40 years of age and more have a 1-in-5 chance of developing congestive heart failure in their lifetime 'Only 11% heart patients take treatment'
Mumbai: A multi-city study raises alarming concerns about the lack of awareness about heart failure and the high cost of treatment.
Dr Amit Vora, interventional cardiologist with Lilavati Hospital who conducted the Mumbai leg of the study, said, "It was a revealing study because we found that even among the affluent persons, acceptance about arrhythmia (irregular heart beat) and heart failure was poor. Even delivery of treatment or adherence to treatment was poor.''
In other words, the number of patients who actually get a permanent pacemaker to stabilise their heart beat or CRT (cardiac resynchronisation therapy to correct the heart's conduction problems) on their doctor's advice is poor.
A major cause for this, apart from the poor awareness, is the cost factor, conceded the study, which was sponsored by a multinational company. "Treatment for arrhythmia and heart failure could range from Rs 40,000 to Rs 8 lakh,'' said Dr Ajay Naik.
Not surprisingly then, consider the study's analysis of 1,000 patients with regard to treatment. While 73 patients were advised a permanent pacemaker, only 19 actually got it. Among 97 other patients who were advised to undergo radio frequency ablation to electrically cure their heart's uneven rhythm, only 20 opted for it. Although 139 patients were advised to undergo a cardiac re-synchronisation therapy (CRT), only five underwent the procedure which costs between Rs 3 and 8 lakh. Similarly, of the 119 who were advised to get an implantable cardioverter cefibrillator (to set right the heart's electrical impulses), only 3 got it.
Women, who made up for onethird of the 2,200 patients studies, came in with more severe symptoms than men perhaps because of socioeconomic reasons.
Incidentally, this is the first study to map the various types of heart failure problems among Indians. "So far, we used western data. While India has generated some data, this pertains to heart attacks,'' said Dr Vora. About 60% patients suffer from heart failure and another 15% with atrial defribillation. "These conditions are considered the final frontiers in heart disease as they have high fatality associated with them.'' The other conditions are bradycardia (where heart beats slowly) and supraventricular tachycardia (uneven beats in upper chambers).
"But less than1 11% of those advised treatment actually took treatment,'' said Dr Naik. The reasons, he said, ranged from poor diagnosis by primary physicians or the patient's refusal to go to the next level of consultants. "At times, different views from various cardiologists themselves may confuse the patients. Finally, the costs are prohibitive at Rs 40,000 to Rs 8 lakh.''
HEART OF THE MATTER
RISK FACTORS
Previous heart attacks Coronary artery disease Irregular heartbeat (arrhythmia) High blood pressure (hypertension) Heart valve disease (especially of the aortic and mitral valves) Cardiomyopathy (disease of the heart muscle) Congenital heart defects Alcohol and drug abuse
SYMPTOMS
Trouble breathing or lying flat because of shortness of breath Patient feels tired, weak, and is unable to exercise or perform physical activities Weight gain from excess fluid Chest pain Neck veins are swollen Skin is cold and sweaty Pulse is fast or irregular Restlessness, confusion and low attention span
TREATMENT
Medicines Angioplasty Inotropic therapy in which drug is given through a small catheter placed directly in an artery. Heart valve repair or replacement Pacemaker insertion Correction of congenital heart defects Coronary artery bypass surgery Mechanical assist devices Heart transplantation
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