Hospitals to Ensure Hearts to Go On

"My heart will go on!" Hyderabadis can probably croon in sync with the famous Titanic number, albiet literally, with the increasing number of heart-care facilities in the twin cities. Yet, not all is hunky dory, with the number of heart-related ailments only on the rise, alarmingly more among youngsters.

While there are no readily available statistics on the numbers of people afflicted or dying of cardiovascular diseases in the city or for that matter the country, they are only growing, like in most parts of the world. Worldwide, cardiovascular diseases, including coronary heart disease and strokes, said to have accounted for deaths of 16.9 million people in 1999, which is 30.3 per cent of the total 55.9 million deaths.

The number one cause of death in developed countries, heart disease is expected to be the number one cause of death in developing countries by 2010, and estimated to kill 24.8 million worldwide in 2020.

World over, there have been attempts to bring about awareness about heart-ailments and develop heart-care. One such attempt has been done by the World Heart Federation, World Health Organisation and UNESCO in the form of the World Heart Day, and following the overwhelming response to the first World Heart Day last year, the second World Heart Day is being observed today, September 30.

In India, like elsewhere, medical associations and hospitals, both government and private-corporate, are planning various events as part of the World Heart Day 2001, whose motto this year is 'a heart for life'.

The All India Heart Foundation has planned a number of activities including a walk, lectures by doctors, screening of videos about the harmful effects of smoking and about a healthy diet, along with a display of a variety of heart healthy foods. There will be a week-long programme for heart check-ups at the National Heart Institute, the Heart Hospital of the Foundation, and a panel discussion led by doctors on several aspects of heart disease.

In Hyderabad, it's a low-key affair with most cardiologists not even aware of the Heart Day, though with 17 cath labs -- the highest in the country, it has become a well-known heart-care centre in India.

Yet, some corporate and government hospitals famed for heart care are planning cardiac camps, seminars and panel discussions.

The Care Hospital, for instance, in partnership with the Rotary Club of Hyderabad, is organising a preventive cardiology camp advising patients on healthy diet, exercise, and lifestyle alteration like quitting smoking etc, according to CMD Dr B Soma Raju.

The growing incidence of heart diseases in the youngsters worries Dr Raju: "In the West, the highest number of heart attacks are in patients around 60 years. Here, it's common to find even people in 30s and 40s affected with heart ailments."

The city boasts of one of the highest number of consultations and surgical procedures. Approximately 300 angioplasty and stunting procedures, similar number of arterial bypass and 3,500 angipgrams are done per month in the city alone. Roughly 4,500 hospital admissions relating to heart ailments are done.

While awareness is growing, so is the incidence. "Increasing migration to urban lifestyles, lack of physical exercise, obesity, and diabetes are taking their toll, says Dr Raju. Care Hospital, which does 10 admissions a day, finds 3/4th of its cases to be acute coronary ailments. However, it is the advances in the treatment and facilities that are a cause for cheer, he says. Preventive aspect is being given a lot of attention. The reduction of cholesterol to reduce risk of attacks through use of statins, which also toughens the arterial wall, is a major advantage. But, the only hindrance in cardiac care is the inability to predict an attack.

Another noted advancement is the use of minimal invasive surgery, the offpump surgery as against the traditional surgery done using heart-lung machines. Even in children and infants, most defects can be fixed or at least partially corrected, he says.

However, the high costs involved in treatment through either drugs or surgery is something that prevents 90 per cent of the population from accessing the same. A surgical procedure costs anywhere upwards of Rs 85,000. This is minus the costs of hospitalisation.

The high costs are due to the expensive imported equipment and disposables used in the surgery, such as coronary stunt, puncturing needles, balloons, connecting tubes etc, Dr Raju says.

But, with a high number of cath labs, which are under-utilised there is a tendency by hospitals to overdo procedures, in order to make money, some cardiologists admit. Something that Dr P C Rath, senior consultant and director cath lab at Apollo Hospitals, disagrees with.

"Our hospital gets most patients from the middle class who are reimbursed by the government for health care, and if most can afford a car or a house for Rs 5-7 lakhs, they are willing to spend rs 1-2 lakhs for saving life," he says, adding that while 75 per cent of cases are given the same advise by cardiologists across board, but there are grey areas in some cases, which might be of some debate.

"Depending on the experience of the doctors, the patients need to decide whose advise to follow," says Dr Rath, who is lecturing a symposia on heart attacks being conducted by the IMA Hyderabad on World Heart Day.

Agrees Dr D Seshagiri Rao, head of II cardiology unit at Nizams Institute of Medical Sciences (NIMS): "There are systematic guidelines thay most cardiologists follow. A patient coming with pain in the chest is tested using ECG, then echocardiogram. Then depending on the need treadmill testing is done. Only if the tests are positive indications, angiography is done."

Meanwhile, there are attempts at indigenising the equipment or re-using some equipment after sterilisation to make it cost-effective and reachable to the poor.

Care Hospitals is investing Rs 5 crores in the next 6 months to expand their R&D unit which is manufacturing some equipment, and also intends to make the existing Charity Fund for the poor a Rs 5 crores fund.

Apollo, which does almost 1,000 admissions per month, too has a concessional package for the poor, where in case of emergencies, it writes off some expenditure on a case to case basis, charging only for materials and disposables. Recently, it has opened a hospital in a rural area with a telemedicine teleconsultancy facility for the rural poor, Dr Rath adds.

Majority of the low and medium income patients, however, go for NIMS, a semigovernmental institution, due to the cost-effective treatment and care, with 15-20 admissions a day. "Six per cent of the population is afflicted with heart problems in India. The volumes in NIMs are the largest in South India in terms of patient load and procedures," he says. The NIMS has relief fund, which covers 2/3rd of the costs for poor white card holders.

"We might conduct a free camp or something, though it's not yet finalised, for the Heart Day," he says, adding that Hyderabad will see a greater event in the form of an international medical conference, conducted by the Cardiologial Society of India on Dec 6 this year end.