Use the Heart for Action

It has long been realised that cardiovascular disease (CVD) is the top most killer of the humanity and it continues to be so. World Heart Day is a day observed every year on 29^th September since the year 2011 to make people aware of it and take preventive steps. It is sponsored by World Heart Federation an international body which includes more than 200 heart foundations, scientific societies and patient organizations in more than 100 countries. It is an active hub, promoting heart health and driving change at the local, regional and global level.

The theme this year is to “Use the Heart for Action” as a campaign from the years 2024 to 2026. These need supporting the individuals to care for their heart and empowering them to urge the leaders of their countries to take CV health seriously and join a global platform for action. The action is to deliberate with impactful execution of the efforts to keep the heart healthy. It has been realized that the global progress against CVD is flatlining. Though rates of CV deaths globally have fallen in the last three decades, this trend has begun to stall and, without concerted efforts, is at risk of reversing.

It is well known that up to 80% of premature heart attacks and strokes can be prevented. With the advances in the CV sciences, we now have the tools and knowledge to mitigate harms to CV health. But often these tools which can help diagnose, prevent, and treat CVDs are not benefitting the communities who need them most. Around 4 in every 5 CVD deaths occur in low- and middle-income countries. The progress in cardiovascular health is increasingly concentrated in High-Income countries - a glaring health inequity that must urgently be addressed. More than half a billion people around the world continue to be affected by CVD, which accounted for 20.5 million deaths in 2021

We know the risk factors leading to heart attacks. INTEHEART study led by Prof Salim Yusuf way back in 2004, identified 9 risk factors which explained 90% of the heart attacks occurring worldwide. There would be a regional variation though. It is therefore imperative that we need to find out the prevalence of these risk factors. In a study on Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17) carried out on 113043 individuals (70% from rural areas). The overall weighted prevalence of diabetes was 11.4%, pre-diabetes 15.3%, hypertension 35.5%, generalized obesity 28.6%, abdominal obesity 39.5% and dyslipidaemia 82.5%. All metabolic NCDs except prediabetes were more frequent in urban than rural areas.

Unfortunately, the burden due to CVD in India is remarkably higher than the global experience. The figures are the age standardised death rate for CVD in India (282 deaths/100,000) was higher than the global level (233deaths/100,000) and it is not showing any signs of respite. This has been a matter of lot of discussion and has been ascribed to several factors: rapid urbanization, change in dietary patterns, sedentary life style and increasing pollution.

Improvement in healthcare has no doubt resulted in improved longevity. The figures of an average of 49.7 years of 1973, have risen to 67.9 years as of 2012. It is estimated that by the year 2050, while the total population is expected to grow by 56%, the population in the age group more than 60 years will grow by 326%. The rapidly ageing population adds to the high propensity of premature CVD, and the large burden of CVD in India.

With these figures available, the administrators running the country need to have national and state level programs to work on health education and provide facilities for implementing them. Prevention is the key. The problem is lack of allocated resources. Our govt at the centre spends 2.6% of the country’s GDP on healthcare. Several national and international authorities, however, believe it should be at least 5% or more of the GDP for the developing countries.

This figure is considerably smaller than the figures of 17.3% by the USA, which is the highest in the developed countries. Govt could have schemes of asking people to contribute in healthcare bonds with incentives like taking care of the donor’s families for their health needs. This could increase the resource for health care from a paltry 2.5% of the GDP. It would also be appropriate for the big business houses and philanthropic organizations to come forward and adopt some regions of the country and supplement the efforts made by the state.

We at the Gauri Kaul Foundation, an NGO, through a CSR grant from Indian Oil incorporation, have taken a task of assembling a “Heart Clinic on wheels” for South Kashmir’s 3 districts (Pulwama, Shopian and Kulgam). This specially designed ambulance with several diagnostic equipment’s including a portable echocardiography unit, will move to different parts after announcing the date schedules.

It will screen the population in batches and guide the people the preventive strategies. Patients with significant problems would be ferried to our Prasad Joo Khan Heart Centre in Village Hawal, Distt, Pulwama for further management of providing essential treatment. Patients needing hospitalization would be sent to the closest hospitals. This will be our contribution on this year’s world Heart Day to South Kashmir.

The efforts like this which are being done by voluntary organisations in different parts of this country, need to be done at a much larger scale.

Providing facilities for screening and treating the risk factors leading to CV diseases in large populations like ours is an uphill task but worth pursuing. We all need to join the efforts of the administration to curb this serious threat which is continuing to grow.

 Prof Upendra Kaul, accomplished Cardiologist, Recipient of Padmashri and Dr B C Roy Award