Managing The Rise Of Heart Failure In The Indian Market

* In India, heart failure affects roughly 8 to 10 million people,[1] prompting 1.8 million hospitalizations annually

* Research suggests COVID is a strong risk factor for myocarditis, which can lead to heart failure

* Cardiovascular diseases affect Indians at least a decade earlier than their western counterparts[2]

* Experts suggest need for regular screenings and improved treatment adherence

Months after the second wave of the COVID pandemic, India’s heart failure patients are still experiencing setbacks. With healthcare services focused on combatting the spread of infections, care for cardiovascular diseases, including heart failure, has been significantly disrupted.[3] India reported that 30 percent fewer cardiac emergencies reached health facilities in rural areas in March 2020 compared to the previous year.[4]

Heart failure is a progressive disease, wherein the heart muscles are weakened. While this does not suggest the heart has stopped, it does mean that the organ is not able to pump enough blood to meet the body’s requirements. Heart failure affects approximately 8 to 10 million people in India, [5] contributing to roughly 1.8 million hospitalizations annually, nationwide. Despite its substantial burden, the condition remains largely under-recognized and poorly understood.

Dr. Bagirath Raghuraman, Senior Consultant, Cardiology and Program Director, Heart Transplant at Narayana Institute of Cardiac Sciences, Bangalore commented, “With the growing burden of heart failure in India, there is an urgent need to recognize it as a public health priority. In our hospital, we see several young patients being diagnosed with heart failure every month. Raising awareness of this chronic condition is imperative to ensure warning signs are recognized, streamlining early diagnosis and disease management. However, another barrier to care that needs to be overcome is poor adherence to treatment. Many heart failure patients in Bangalore do not follow their prescribed treatment regimen for various reasons from increased number of tablets to cost of medications. This non-adherence can snowball into further complications, resulting in increased risk of hospital admissions.[6] Awareness and support can facilitate early and effective disease management and adherence, so heart failure patients can live longer lives while reducing adverse symptoms.”   

Rising incidence amongst younger Indians

Cardiovascular diseases affect Indians at least a decade earlier than their western counterparts, in their most productive years.[7] This worrying trend is attributed to several factors, including stressful lifestyles, poor dietary habits, alcohol or drug misuse and lack of adequate physical activity. Identifying early symptoms of heart failure is essential. Common symptoms include shortness of breath (dyspnea), fatigue, swelling in ankles, legs or the stomach, and difficulty sleeping. Less typical signs include nocturnal cough, wheezing, loss of appetite and palpitations.

Trickle-down effect: NCD and COVID huge risk factors of Heart Failure

The exponentially rising incidence of NCDs like hypertension and diabetes has emerged as a critical health problem in India, contributing to the escalation of heart failure cases. Patients with diabetes have over twice the risk of developing heart failure than people without diabetes.[8] With India home to the second largest diabetic population in the world, in addition to the pandemic disrupting routine care, and altered lifestyle patterns affecting diabetics’ glucose control, there is an urgent need for diabetics to attend regular screenings for heart failure. Heart failure can also be attributed to myocarditis or the inflammation of the heart muscle (myocardium). COVID is a significant risk factor of myocarditis, increasing an individual’s myocarditis risk by 15.7%,[9] which is seen more prominently in older patients and males.[10]

Timely detection through routine check-ups can pave the way for prompt disease management. 

Managing Heart Failure

The quality of life of a heart failure patient is even worse than that of patients with depression and kidney problems.[11],[12]  Effective disease management is essential, especially at early stages of the condition, to prevent greater health complications.

Holistic treatments combine non-pharmacological and pharmacological management. Lifestyle and dietary recommendations include smoking cessation, stress management, adequate fluid intake, reduced salt intake, immunization, and exercise, based on functional capacity. However, a common barrier to heart failure treatment is patients’ poor adherence to treatment, which is essential to overcome to yield treatment benefits.

On World Heart Day, it is imperative to recognize the rising burden of heart failure and raise awareness on the urgent need for regular check-ups, diagnosis and disease management.