No other disease kills more Indians than cardiovascular disease. According to the Global Burden of Disease study published in The Lancet journal, mortality due to cardiovascular diseases almost doubled in India between 1990 and 2016 from 1.3 million to 2.8 million deaths. As India’s disease epidemiology shifts towards greater incidence of non-communicable diseases, there is an imminent need to unleash preventive healthcare strategies at the primary healthcare level. According to WHO, almost 80% of premature heart disease and stroke is preventable by timely action.
Poor management
Around 75% of cases of cardiovascular disease can be predicted by established risk factors – which include physical inactivity, tobacco use, elevated blood pressure, poor lipid profile and excessive body weight. However, lack of awareness about regular check-ups and lack of guidelines and training for primary healthcare practitioners to assess risk factors of all patients and offer advice on a regular basis implies we have poor management of risk factors.
Diabetes is a major risk factor whose presence significantly elevates the risk of heart disease. Similarly, hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths in India. With almost 70 million people living with diabetes, India is often referred to as the diabetes capital of the world. On the other hand, the overall incidence of hypertension was estimated to be 29.8% in the Indian population. Unfortunately, delayed diagnosis and mismanagement of both diabetes and hypertension remain a major concern in the country. A study concluded that about 33% of urban and 25% of rural Indians were hypertensive. However, only 25 % of rural and 38% of urban Indians were being treated for hypertension. This delayed diagnosis and treatment is significantly responsible for the development of heart disease among a large number of people in India. Evidently, effective diagnosis and management of these twin epidemics at the primary healthcare level can significantly help reduce the burden of heart disease deaths in the country.
Delayed diagnosis
A large number of people with high cardiovascular risk including excessive weight, high blood cholesterol and hypertension remain undiagnosed. In many cases, diagnosis is made only when the patient becomes symptomatic and suffers a cardiac event like a heart attack or stroke.This can be prevented by improving access to effective preventive interventions at the primary health care level. Instituting strong preventive mechanisms to manage risk factors will have a substantial impact in stopping the progression of the disease and preventing complications such as heart attack, stroke and kidney disease.
Primary healthcare is at the frontline of healthcare delivery and prevention. In case of any mild or major health hiccup, the neighbourhood physician is the one we rush to. Being a community-based doctor, he is also in a good position to advocate and suggest behavioural and lifestyle changes in the community he treats. It is important therefore to leverage primary healthcare facilities in disease prevention in a major way. Primary healthcare practitioners and non-physicians like nurses must be effectively trained to assess risk factors of all patients visiting their clinics irrespective of the health complaint they come up with. People with high-risk factors must be made to undergo diagnostic tests to rule out diabetes, elevated blood pressure as well as poor cholesterol levels. At the primary care level, hypertension is also preventable through a proper diet and physical exercise
Digital tools
Digital tools have in recent times emerged as potent prevention weapons to keep a tab on risk factors for better management of heart disease. Low tech solutions embedded in smartphones and wearable devices to check the pulse and blood pressure in those most at risk are effective ways of detecting CVD in the population and controlling risk factors. Remote cardiac monitoring devices to detect cardiac arrhythmias and digital devices to test blood sugar constantly without finger pricks are emerging technologies in this domain that hold significant promise in improving prevention mechanisms. Apart from equipping primary healthcare physicians into a preventive model, it is also recommended that new-age digital technology be leveraged to improve diagnosis.
(The writer is the CEO, Omnicuris, India’s largest online CME platform)