A first-of-its-kind study funded by the Indian Council of Medical Research (ICMR), involving over 10,000 people, has concluded that Indian heart patients die 10 years earlier than those in the West due to a raft of factors, including inordinate delays in hospitalisation soon after the heart attack, that finally result in premature heart failure and death.
The research was led by Dr S Harikrishnan, renowned cardiologist at the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) in Thiruvananthapuram, Kerala. The prestigious institute is also setting up a ‘bio bank’ of samples — such as tissues taken from the heart valves of patients during surgery — for research in cardiology. The ICMR-financed research envisages creating a representative registry of heart failure in India.
“The risk of early heart failures could be because of a lot of reasons, including diabetes and the typical time taken for hospitalisation after a heart attack. The first hour after the heart attack is called the golden hour. Doctors can treat patients well enough to help them recover completely if a patient is admitted to the hospital in the first hour itself. In most such cases, there would only be a minimal damage in such cases following a heart attack. In India, however, the average time taken for hospitalisation of a patient who has suffered a heart attack is as long as six hours. This alone can complicate matters beyond comprehension,” Harikrishnan told Open.
He presented the findings of the ICMR-funded research recently at an online session of the World Congress on Acute Heart Failure organised by the Heart Failure Association of the European Society of Cardiology. Dr Harikrishnan was to take part in the meeting abroad, but in the end, he had to make a speech online thanks to the Covid-19 outbreak that made travelling cumbersome.
In the session, Harikrishnan pointed out that Ischemic heart disease was responsible for 70% of heart failure cases and that valvular heart diseases, including rheumatic heart diseases, also contributed to India’s heart ailment burden. According to the US-based National Center for Biotechnology Information (NCBI), Ischemic heart disease is the term given to heart problems caused by narrowed arteries that supply blood to the heart muscle.
The research covers 54 centres from 24 states and two Union Territories. SCTIMST said it is the coordinating entity for the ambitious project that involves eight others nodal centres including AIIMS Delhi; PGIMER Chandigarh; JIPMER Puducherry; Sri Jayadeva Institute, Bengaluru; NEIGRIHMS Shillong; MCH Kolkata; KGMU Lucknow; and UN Mehta Institute, Ahmedabad.
Dr Harikrishnan told Open that each nodal centre identified five ‘participating centres’ in its respective region to ensure representation in the exercise. Around 200 heart patients were recruited at each centre. As a result, more than 10,000 patients have been recruited so far for the project. It was findings from early results that were presented at the global e-meet. The recruitment of new patients will go on until June 30, the cardiologist said. ICMR had set aside Rs 2.8 crore for the project. The data from India was compared with data from Western countries, especially the US and Europe, Dr Harikrishnan said.
Recent articles in peer-reviewed journals have warned that heart disease increases mortality rates in COVID-19 patients.
A few genetic studies on small groups suggest that Indians and people of other south Asian countries carry a mutated gene that makes them more vulnerable than most other races to heart diseases. Studying this genetic susceptibility among large groups to confirm this hypothesis could pave the way for effective heart treatments in the future. Dr Harikrishnan is of the view that since the treatment of heart failure is resource-intensive, India should target both primary prevention (control of risk factors) and secondary prevention (continued care after occurrence of heart disease) to ease the financial burden of hospitalisation and further treatment.