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Times Of India
29 September 2012
Mumbai, India

Nearly 32 million Indians suffer from some heart disease, according to extrapolations from the Global Burden of Diseases study. Give this huge number that is almost the population of Canada, cardiac care is not surprisingly one of the busiest medical specialties in India.

Within this field, the Cardiological Society of India’s statistics show that progressively more heart patients now opt for angioplasty, the minimally invasive procedure to remove blockages in blood vessels. In 2011, 1.5 lakh Indians chose angioplasty–almost 29% more than the number in 2010. "This figure has been growing annually by 25– 30% in the last few years," said Dr Sundeep Mishra who, as CSI’s National Interventional Council chairman, maintains the national registry.

Since only 55% of the cath labs actually send their statistics to the council, the number is bound to be higher. Dr Mishra believes over 2.5 lakh angioplasties are performed annually. In contrast, about 1.5 lakh cardiac bypass surgeries are performed a year, said cardiac surgeon Dr Ramakanta Panda of Asian Heart Institute. The reasons for the angioplasty demand range from people’s fear of open heart surgery, growing number of cath labs and availability of affordable stents.

"The spending power of India’s middle class has improved," said Dr Mishra.

Dr Panda concurred. "The numbers of heart patients who come to doctors are just the top of the iceberg. Many cannot afford treatment, many are frightened of interventions and only want medical treatment," he said, adding that India’s heart burden runs into millions.

There is a silver lining to the growing cardiac care facilities in India: the care itself is getting better. The CSI registry throws up big positives in India’s battle against cardiac ailments. The biggest positive seems to be the time taken for the average cardiac patient to reach a cath lab. The door–toballoon time is a medical term to calculate the time between the patient reaching a hospital and doctors removing the blockage. The 2011 statistics from CSI say that that average time is 48.6 minutes, though it varies from a minimum of 12 minutes to a maximum of 120 in some hospitals.

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"International norms suggest that the average door–toballoon time is 90 minutes. If India’s average is 48.6 minutes, it is excellent," said cardiologist Ganesh Kumar from Hiranandani Hospital in Powai. The CSI statistics show that the number of primary angioplasties, which is done within six hours of a patient getting a heart attack, is increasing. Many hospitals across the country now offer primary angioplasty, with many of their staff members living on the campus to facilitate better time management. In 2008, 10,465 primary angioplasties were performed across India, accounting for 9.23% of all angioplasties that year. In 2011, 20,541 primary angioplasties were done, accounting for 13.5% of the total procedures.

CSI said that although half the number of procedures is performed in a handful of cities, there is a trend of smaller centres coming up across India. "People no longer travel to big cities for interventions. Pune, for instance, has overtaken Mumbai in the number of angioplasties," said Dr Mishra.

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