McMaster University

McMaster University

Faculty of
Health Sciences

Heart disease and its treatment a serious concern for India: Study

By Susan Emigh
Published: April 24, 2008
Salim Yusuf
Dr. Salim Yusuf, professor of medicine and vice-president of research at Hamilton Health.

There are major gaps in the treatment of heart disease in the one country that has the most serious concern, India.

A new study published in the medical journal The Lancet today says India’s residents have a higher rate of serious heart disease at a younger age but they are less likely to receive quick care than in other developed countries.

The CREATE study, a prospective registry study of almost 21,000 patients across India, was directed by Dr. Salim Yusuf, director of the Population Health Research Institute at McMaster University and Hamilton Health Sciences. Dr. Yusuf is a professor of medicine of the Michael G. DeGroote School of Medicine and vice-president, research at Hamilton Health. Another McMaster author on paper was P.J. Devereaux, assistant professor of medicine.

Heart disease is the leading cause of death globally. In 2001, the disease accounted for 7.1 million deaths worldwide, 80% of which were in low-income countries. Between 1990 and 2020, these diseases are expected to increase by 137% for men and 120% for women in developing countries, compared with 30% to 60% in developed countries. Previous studies have said that by 2010, 60% of the world’s heart disease burden is expected to occur in India.

Dr. Yusuf’s team found that of the 20,468 patients given a definite diagnosis of a heart condition, 60% had the most serious types of heart disease – which compares with less than 40% in developed countries. The Indian patients were also younger than those in developed countries.

Three quarters of patients in CREATE were from lower middle class and poor backgrounds and were less likely to be able to afford routine treatments in hospitals and for secondary prevention. Time taken to reach hospital was much longer in India (5 hours) than in developed countries (2 hours and 20 minutes to 2 hours and 50 minutes). Reason for delays included using public or private transport instead of ambulance, traffic delays, long delays and lack of awareness of symptoms.

The authors also found major differences between treatment patterns in India and developed countries. Rates of coronary interventions such as balloon angioplasty (reopening blocked arteries by inserting and then inflating a small balloon) were lower, and treatments such as streptokinase (a drug that dissolves blood clots) were higher than in developed countries.

"This is probably because about three quarters of patients in India pay directly for their own treatments and angioplasty is considerably more expensive than medication," said Dr. Yusuf.

However, use of key medical treatments such as antiplatelet drugs, beta blockers, ACE inhibitors and lipid-lowering drugs were similar to that in developed countries, showing awareness of evidence-based treatments by Indian physicians, and also the relatively low cost of generic drugs in India. But use of all treatments except antiplatelet drugs differed across socioeconomic groups, with fewer poor patients received treatments proven to save lives.

Mortality rates among Indian heart patients were also higher than in developed countries, and highest among poor patients.

"Patients with acute coronary syndromes in India tend to be young and from low socioeconomic groups, and to have a higher rate of serious heart disease than do patients in developed countries," said Dr. Yusuf. "Strategies to reduce delays in access to hospital, and improve the affordability of urgent care could reduce morbidity and mortality from acute coronary syndromes in India."

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