Dr CN Manjunath, Health News, ET HealthWorld

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Shahid Akhter, Editor-in-Chief, ETHealthworld, spoke with Dr CN Manjunath, Dean and Director, Sri Jayadeva Inst. from Cardiovascular Sciences & Research, to learn more about CVD prevalence, progress and challenges ahead.

CVD: Prevalence
In fact, 25% of deaths in India are due to cardiovascular disease, and we all know it is a lifestyle related disease and the number one killer among all lifestyle related diseases. Other lifestyle-related illnesses include high blood pressure and diabetes. We have strokes, cancer and, of course, screen addiction.

Thus, the prevalence of heart disease has increased. Over the past five years, the prevalence of cardiovascular disease has increased by almost 20%. Heart attacks are the leading cause of death and unfortunately in India almost 30% of people who develop heart attacks are under the age of 40, which means heart attacks in young Indians and older Indians average become vulnerable to heart attacks.

So, care in India mainly focuses on tertiary care which I am talking about. It is mainly concentrated in A-level cities and now it is entering B-level cities, so there is no consistent quality of cardiac care across the country. So in Karnataka we have 60 medical schools, public and private, so most of these hospitals have a cardiology unit as well as a cath lab because the best treatment for a heart attack today is a timed treatment. ; for every thirty minutes of delay in starting treatment for a heart attack, the risk of death increases by 7%, so the most important thing we need to provide is prompt treatment, even in semi-urban and rural areas .

Cardiovascular care in Karnataka
So at this point, at least in Karnataka, what happens is that the small hospitals first treat them with clot dissolving therapy, which is called thrombolytic therapy, and then they are moved to a location where catheterization laboratory facilities are available.

If an option is offered, the best treatment for a heart attack is angioplasty, and we call it “primary angioplasty”. Due to the inaccessibility of this cath lab, many people do not have access to it, but still, even if a cath lab is not available, the best thing to do is to treat them immediately with a clot-dissolving drug, and we have to work on what’s called the hub and spoke model. The departments will be smaller hospitals. The hospitals in Taluk are primarily central hospitals and will be where a cath lab is located.

Thus, the number of patients who receive timely treatment is only about 50-60%. Whether it is thrombolysis or PCI, 30 to 40% of patients still have a late presentation in hospital. Because the goal of treating a heart attack patient number one is to save their life, a few questions about it and also to preserve their heart function, because you have to survive with good heart function, then we can have a better quality of life.

So at this point Karnataka has around 225 cath labs, which is a good number. Across the country, we have nearly 2,000 cath labs, so if you consider the extent of the disease in this country and also the burden of cardiovascular disease, which was around 3% in 1960, it today affects around 6 to 8% in urban areas and around 5% in rural areas.

Initially, everyone assumed that a heart attack or cardiovascular disease was a disease of the urban elite. No, it is now a disease of the poor, a disease of the workers and a disease of the villages. So in my opinion India needs around 6,500 cardiac catheter lab facilities.

Jayadeva Institute of Cardiovascular Sciences
The Jayadeva Institute of Cardiovascular Sciences and Research is an autonomous institute of the Government of Karnataka and the Honorable Chief Minister of Karnataka is the Chairman of the Board, while the Minister of Medical Education is the Co-Chairman and director, and member secretary.

And the Jayadeva Institute of Cardiovascular Sciences now has a 650-bed heart hospital exclusively dedicated to cardiac care. We have another large facility in Mysore, which has 400 beds, and the third facility is in Kalburgi, which has 350 beds. So, in 3 to 4 weeks, courtesy of the Infosys Foundation, we will be adding another 350-bed cardiac installation to the premises of the existing Jayadeva Hospital in Bangalore. So with all of these things, we have an 1,800 bed heart center, which makes it one of the biggest heart care destinations in India.

PPP in the health sector
I think the PPP model, in my opinion, works well as long as the first element is solid, which is public-private partnership. If a public institution is doing very well, then because it needs a watershed, a patient load and patient contributions, the first P must be strong, then only the PPP model works.

The number of catheterization laboratories is very low; maybe four or five years ago there were only 500 or 600 cardiac catheterization labs, so there has been a sudden increase in cardiac catheterization labs over the last three or four years, and what happened in some mid-sized hospitals, because previously it was all an international mix. The international cath lab mix, either from Germany, Holland or America like this is very expensive, in the range of 3 to 4 crore, and not all hospitals can afford it.

This affordable cath lab was badly needed. It was the need of the hour to bring this cardiac care to semi-urban and rural areas or to small to mid-sized hospitals.

Advances in catheterization laboratories
At the same time, we need a high quality catheterization lab switch that is also affordable and cost effective. So in that sense,
I believe it was one of our long time dreams for India to produce their own cath labs in this way because private limited involution imaging technology has developed a large facility and they have over 200 installations, and yes, certainly earlier the the same happened.

At that time, CT scans were around 1.5 crore, and only large, large hospitals had CT scans. Now we go to any corner, even a small town, and I think in a few years we will have more and more cath labs, especially where the number of cases is lower, where the number of patients is lower, but they still want to have a catheterization lab, they still want to opt for an economical type of catheterization lab.

So I think that’s where India can probably make headway.

Msg for young cardiologists
The message for the aspiring cardiologist is: “Yes, decision making is very important, which is why decision making is more important than interventions. The decision making is more important than the incisions.

In fact, the treatment should not be more harmful than the disease, and at the same time, we should also know, of course, that there is now a technological explosion going on, so young cardiologists are energetic and should have a lot exposure to all of these procedures. They also need to know when not to perform a procedure. At the same time, we also need to understand the financial context of the patient and, within that financial context, how best to provide quality care.
So price flexibility should exist because some people are wealthy, some people are middle class and some people don’t have access to price flexibility, so we should be reaching out to all strata of society.

And at the same time, they should always be open to discussion, they should be open to second opinions, so that it increases the trust of the public and the patients, so it’s very, very important.

And you shouldn’t hesitate to learn from others, so ego and arrogance shouldn’t be there when you walk into the cathlab. Indeed, in our establishment, I posted at the entrance of the cardiac catheterization lab “Please enter the cardiac catheterization lab without ego or arrogance” because, ultimately, patient safety is important.

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