Cardiovascular Diseases in India has seen an alarming growth in last decade.

In
1990 around 15% of deaths in India were due to Cardiovascular diseases, now
this has increased by 28% due to many different factors.
Globally, cardiovascular diseases (CVDs) are the number one cause of death
and more people die every year from CVDs than any other cause. In 2016,
approximately 17.9 million people died from CVDs that accounted for 31
percent of all global deaths in that year. Low and middle-income countries are
the most affected, as more than three-quarters of deaths are caused by
cardiovascular diseases in these nations. About 37 percent of premature deaths
in low and middle-income countries are due to cardiovascular diseases. Case
fatality ratio of cardiovascular diseases in low-income countries is much higher
as compared to middle and high-income countries. In 2013, all member states
of the WHO agreed to be part of a ‘Global action plan for the prevention and
control of NCDs 2013-2020’. As part of the plan, the countries aim to lower the
number of premature deaths from NCDs by 25 percent by the year 2025
through nine voluntary global targets. Of these, two global targets are designed
to directly work on the prevention and control of cardiovascular diseases.
Impact of Cardiovascular Diseases in India
According to a study published in a health journal (The Lancet) in 2018, cardiac
diseases claimed more Indian lives (28 percent) compared to other non-communicable
diseases. The number of deaths caused by cardiovascular diseases in India rose from 1.3
million in the year 1990 to an estimated 2.8 million in 2016. In India, the death rate
continues to rise, while it has decreased substantially in the US in the past 15 years. The
study also suggested that obesity may not be the root cause of CVD deaths in India. It
was estimated that cardiovascular ailments were responsible for causing more than 2.1
million deaths in India in 2015 at all ages, or more than a quarter of all deaths. The
study also showed that in the age group of 30-69 years, of the 1.3 million
cardiovascular deaths, 0.9 million (68.4 percent) were caused by coronary heart disease
and 0.4 million (28.0 percent) by stroke. Rural India has seen more CVD related deaths
than urban India, which is alarming.
As per another study on CVDs by Elsevier, the death rate due to CVDs in the US fell to
41 percent between 1990 and 2016, while it saw an increase in India from 155.7 to
209.1 deaths per one lakh population in the same span. The reason for the low rates can
be attributed to preventive measures like a healthy lifestyle, decline in risk factor trends
like tobacco use, high cholesterol and blood pressure in the US population and a better
secondary and acute care. As for ischemic heart disease and stroke, they account for
about 15-20 percent of all deaths in India and 6-9 percent in the US. India can also
lower CVD death rates and complications arising from CVDs through the
implementation of population-level policies while simultaneously working towards
strong and well-integrated health systems (local, regional as well as national).
New Trends in Cardiovascular Medicine
In 2019, trends point to many advancements in treatment of CVDs, like increased use of
direct oral anticoagulants (DOACs) in atrial fibrillation (AFib) and other conditions,
new standards in the management of mitral valve regurgitation (MR) in patients
suffering from heart failure, larger use of transcatheter aortic valve replacement
(TAVR), greater roles for implantable and wearable devices and the data collected by
these devices, and the use of AI in cardiovascular medicine as well as focus on cost and
value of treatments. The use of anticoagulation medicine (DOACs like dabigatran) in
patients with cardiovascular diseases is set to increase due to the availability of drug-
specific reversal agents. Wearable devices like built-in heart rate monitors and single-
lead electrocardiograms (ECGs), may be increasingly used by doctors in 2019 to detect
rhythm abnormalities in the heart and to predict whether or not anticoagulation
medicine can be used.
AI (Artificial Intelligence) is set to change the cardiovascular field in many areas in
2019. It is already being used to fine-tune the selection of possible treatments by
looking for patterns in molecular biology, structure-function, and clinical trial
databases. It can remotely filter out clinically actionable data from the vast data
collected by wearable devices. It can also lend itself greatly in the application of
precision medicine by assessing the genetic information, environment, and lifestyle of
patients, and zeroing in beneficial interventions based on the data.
AI can also help in the integration of data from various sources that are used to treat
CVDs like social media, the electronic health record (EHR), and wearables. It can
increase the efficiency of treatment by lowering repetitive tasks, and prioritizing EHR-
based alerts or messages, improving and automating image interpretation in the
catheterization or echocardiography laboratory, and integrating data from relevant
sources to present a favourable treatment plan for individuals.
AI is yet to; however, make a huge impact in clinical practice given its complexity and
lack of data on reasons behind predicted outcomes or preferred treatments. However,
patients are increasingly veering towards wearable devices that can potentially prevent
CVDs. The accuracy of these devices is yet to be ascertained, but it may affect
treatment outcomes when it comes to CVDs. Health devices may slowly be
incorporated into clinical practice as more evidence of their importance in disease
prevention/treatment emerges. In 2019, other trends point towards increased attention
towards tricuspid valve disease, more growth of treatment alternatives for structural
heart disease, as well as a significant understanding of the utility of interventional
therapies and devices for atrial fibrillation. Considerable efforts may be made towards
ensuring cost-effectiveness in cardiovascular disease treatments, be it lowering drug and
device costs (coronary stents are expensive) or increased access to care and better and
yet affordable technology.
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