Delayed care despite facilities adds to heart disease burden: Doctors

Despite having a wide network of hospitals treating heart diseases, the patients reaching these hospitals continue to be delayed even now.
Image used for representational purpose only.
Image used for representational purpose only.

THIRUVANANTHAPURAM: Despite having a wide network of hospitals treating heart diseases, the patients reaching these hospitals continue to be delayed even now. The failure to reach the hospitals within the golden hour increases the fatality rate and also makes people patients because of heart failure. Angioplasty or the procedure used to widen blocked or narrowed coronary arteries within the golden hour is considered effective.

“It has been found that patients reach hospitals after a delay of 2.3 hours to seven hours. Five hours is the average. As a result, the rate of heart failure increases. Already, we have one of the highest cardiac failure rates of 1.68% as per our survey.

The outcome of angioplasty on patients after a six-hour delay is poor. If the delay is beyond 12 hours, there is no benefit at all,” said Dr B Krishnakumar, professor of the department of cardiology, Thiruvananthapuram Medical College Hospital. “We could perform angioplasty faster after the chest pain clinics were established. We aim to reduce the duration further. However, there is still an undue delay in taking the patients to district hospitals and from there to the medical college hospitals,” he added.

At Thiruvananthapuram MCH, an angioplasty is performed in an hour after the patient reaches the hospital. However, the patients often reach a tertiary care hospital after a delay of four to five hours. The state has 160 cath labs to perform an angiogram or angioplasty which helps the patients (except in Idukki, Pathanamthitta and Wayanad) to reach these facilities within 20 minutes of heart attack symptoms.

To reduce the delay, the cardiology department floated the idea of training Asha workers or other volunteers in a locality to intervene on behalf of the patient. The volunteer will be trained to use a digital ECG machine and the readings are sent to the WhatsApp group of cardiologists. Once they identify it as a case of heart attack, transportation will be arranged to shift the patient to a tertiary care hospital at the earliest.

Most heart attacks happen suddenly when one of the arteries leading to the heart becomes blocked and cuts off the blood flow. Lack of oxygen affects the capability of heart muscles to pump blood. A heart failure occurs when the heart muscles don’t pump blood as well as it should have.

“The patient should be aware of the warning signals and reach the treatment facility during the golden hour. We can prevent 50-60% of heart failure due to heart attack by avoiding the delay,” said Dr Harikrishnan S, principal investigator of the Centre of Excellence in Heart Failure and professor of Cardiology of Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST).

Narrowed heart arteries (that could lead to heart attack) were found to be the major reason for heart failure (72%), followed by diseases affecting heart muscles that lead to poor pumping of blood to the body parts (18%), according to the National Heart Failure Registry (NHFR) report in 2018-2000.

Heart failure was considered an end-stage disease in which two-third of patients died in the first five years, according to a heart failure registry prepared by SCTIMST in 2013. A pan-India study by the NHFR shows that one in seven patients died in the first 90 days of follow-up, in 2018-2000.

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The New Indian Express