The Pulse of a Nation: Unpacking India’s Escalating Heart Health Crisis and the Complex Web of Lifestyle, Innovation, and Inequality
By Arunima Rajan
In a conversation with Arunima Rajan, Dr Nishith Chandra, Principal Director of Interventional Cardiology at Fortis Escorts Heart Institute, delves into the changing face of cardiovascular health in India. He sheds light on the troubling trend of heart disease affecting younger people and explores how lifestyle shifts and cutting-edge technology are playing pivotal roles in transforming both treatment and prevention in the years ahead.
Could you give us an overview of the current state of cardiovascular health in India? How do you think it has evolved over the past decade, especially considering the younger population now showing signs of heart disease?
India faces a growing crisis in cardiovascular health, with heart disease being the leading cause of mortality. Over the past decade, the prevalence of cardiovascular diseases (CVDs) has shifted significantly. While traditionally considered a disease of the elderly, it is now increasingly affecting younger populations. Alarming reports indicate that people in their 30s and 40s are presenting with heart problems. This shift is due to various factors, including lifestyle changes, increasing urbanization, and a rise in risk factors like obesity, diabetes, and hypertension. The surge in heart disease among younger people signals an urgent need for better preventive strategies and more effective public health interventions.
How much of the burden of cardiovascular diseases do you attribute to lifestyle factors, such as sedentary behaviour, smoking, and unhealthy diets? What role does stress play in the increasing incidence of heart disease among younger people?
A significant portion of the cardiovascular disease burden in India can be attributed to lifestyle factors. Sedentary behaviour, the increasing prevalence of smoking (especially among younger populations), and unhealthy diets rich in trans fats, sugar, and salt are major contributors. Modern urban life often promotes inactivity and poor eating habits, which increases the risk of heart disease. Furthermore, stress—exacerbated by work pressures, urban living conditions, and a fast-paced lifestyle—plays a crucial role in increasing cardiovascular risk. For younger individuals, the stress of career, finances, and personal life, combined with lifestyle factors, forms a toxic combination that accelerates heart problems.
You've been at the forefront of interventional cardiology. Can you highlight some of the most promising advancements in this field that are making a difference in treating complex coronary diseases?
Interventional cardiology has made remarkable strides in recent years. New advancements have significantly improved the treatment of complex coronary diseases. One of the most exciting developments is the use of bioresorbable stents, which dissolve after fulfilling their function, reducing long-term complications. There has also been great progress in drug-eluting stents (DES) and innovations in percutaneous coronary interventions (PCI), which allow for more precise, less invasive treatments for blocked arteries. Techniques such as transcatheter aortic valve replacement (TAVR) have revolutionized the treatment of valve diseases, providing options for patients who are not candidates for open-heart surgery. These advancements have reduced recovery times, improved patient outcomes, and decreased mortality rates.
Preventive cardiology is becoming increasingly important. What are some of the most effective screening techniques available today that can help detect heart disease early on? And how can we encourage more people to undergo such screenings?
Preventive cardiology is key to reducing the burden of heart disease in India. Early detection can save lives, and screening methods like coronary artery calcium scoring, high-sensitivity C-reactive protein (hs-CRP) tests, and carotid intima-media thickness (CIMT) measurement have proven to be effective in identifying at-risk individuals. Echocardiograms, stress tests, and blood pressure monitoring also remain standard tools. Encouraging the public to undergo these screenings remains a challenge, particularly in younger populations who may not see themselves at risk. Awareness campaigns, community outreach, and partnerships with primary healthcare providers are crucial in promoting screening. Moreover, making screenings more accessible and affordable can increase participation.
Technology is transforming healthcare at an unprecedented pace. How are innovations like artificial intelligence, telemedicine, and robotic-assisted surgeries impacting the diagnosis and treatment of heart diseases?
Technology is rapidly transforming the landscape of cardiovascular care. Artificial intelligence (AI) is increasingly being used for predictive analytics in diagnosing heart diseases. AI algorithms can analyse vast amounts of patient data, identifying patterns that may be missed by traditional methods. Telemedicine has also played a key role in increasing access to care, especially during the COVID-19 pandemic. It allows patients in remote areas to consult specialists without the need for travel. Robotic-assisted surgeries, though still in their infancy in India, are making interventions more precise and less invasive, improving recovery times and outcomes.
What role do you see artificial intelligence playing in cardiology, both in terms of early diagnosis and improving the precision of interventions? Have you seen any specific AI-based tools being effectively adopted in Indian hospitals?
Artificial intelligence holds great promise for cardiology, particularly in early diagnosis and precision medicine. AI-based imaging tools can help cardiologists interpret scans with greater accuracy, detecting subtle changes in the heart that might indicate the early stages of disease. AI is also being used in risk stratification, helping doctors determine which patients are most likely to benefit from certain treatments. Some Indian hospitals have begun to adopt AI tools, particularly in metropolitan areas, though wider implementation will require investment in technology and training.
Despite advancements in treatment, access to cardiac care remains a challenge in India, especially in tier II and III cities. What steps are being taken to bridge this gap, and how can healthcare providers collaborate with the government to improve access?
While advancements in cardiac care have been significant, access to these services remains a challenge in tier II and III cities and rural areas. Initiatives such as mobile health clinics, telemedicine platforms, and partnerships between private healthcare providers and the government are essential in bridging this gap. Public-private partnerships could be instrumental in ensuring that specialized cardiac services reach underserved areas. Government schemes such as Ayushman Bharat have also played a part in increasing access to healthcare, but further expansion and focus on cardiac care are needed.
The theme for World Heart Day 2024 focuses on cardiovascular health equity. In your view, what steps can be taken to address inequities in access to quality heart care, particularly in rural areas and underserved communities?
The theme of World Heart Day 2024—cardiovascular health equity—underscores the need to address disparities in access to quality heart care. In rural and underserved communities, a lack of awareness, limited infrastructure, and financial barriers exacerbate the problem. To bridge this gap, policies must focus on strengthening primary healthcare systems, training more healthcare workers, and incentivizing the setup of cardiac care units in remote areas. Mobile health units and telemedicine platforms could also be pivotal in reaching these populations, ensuring that early diagnosis and treatment are available.
We know that COVID-19 has had an impact on heart health globally. Have you seen any long-term effects on patients recovering from the virus, especially in terms of cardiovascular complications?
COVID-19 has had a profound impact on cardiovascular health. Even among those who recover from the virus, many are left with lingering complications such as myocarditis, arrhythmias, and an increased risk of heart attacks. Post-COVID syndrome or “long COVID” has made it clear that the virus’s effects on the cardiovascular system can be long-lasting. Patients with preexisting heart conditions are especially vulnerable, and there has been an uptick in heart-related issues post-recovery. Ongoing monitoring and rehabilitation are essential for these patients to prevent further complications.
Looking ahead, what do you see as the future of cardiovascular care in India? What are the key challenges we need to address, and what innovations are you most excited about in the next five years?
Looking ahead, the future of cardiovascular care in India will likely be shaped by technological advancements and a greater focus on preventive medicine. However, significant challenges remain, including the need for better healthcare infrastructure, especially in rural areas, and addressing lifestyle-related risk factors. Innovations in AI, telemedicine, and minimally invasive procedures offer hope, but they must be made accessible across the country. In the next five years, a concerted effort between the government, healthcare providers, and technology innovators will be crucial to addressing these challenges.
As a leader in interventional cardiology, what advice would you give to the next generation of cardiologists and healthcare professionals in terms of staying ahead in a rapidly evolving medical landscape?
For the next generation of cardiologists, staying updated with the latest advancements is key. The field of cardiology is rapidly evolving, and mastering the use of new technologies such as AI, robotics, and advanced imaging techniques will be essential. Additionally, young cardiologists should focus on preventive care and patient education, as these will play increasingly important roles in reducing the burden of heart disease. Continuous learning, collaboration, and a patient-centred approach will help them succeed in this dynamic landscape.
How important is patient education in preventing heart disease, and what can hospitals and doctors do to ensure patients are empowered to make informed decisions about their heart health?
Patient education is fundamental in the prevention of heart disease. Hospitals and doctors must work together to provide patients with accurate, accessible information on heart health. Lifestyle modifications, early screening, and medication adherence are areas where patients need clear guidance. Workshops, online resources, and community health initiatives can empower patients to take control of their cardiovascular health, leading to better outcomes and a healthier population overall.