5 times more deadly: The heart disease that’s killing Indians faster

medium118414728A groundbreaking study from the National Heart Failure Registry of India has unveiled a stark and deeply concerning reality: heart failure patients in India are dying nearly a decade earlier than those in high-income countries.The research, which tracked 10,850 patients across 53 medical centres, paints a grim picture of India’s heart failure burden. It reveals that cardiac conditions remain severely undertreated and poorly managed, leading to a high mortality rate.The study reports that 22.1% of Indian heart failure patients die within a year of diagnosis. This is significantly higher than in many developed nations, where improved treatment and early intervention have led to better survival rates.A one-year mortality rate refers to the percentage of patients who succumb to the disease within a year of being diagnosed with heart failure. In other words, more than one in five heart failure patients in India do not survive beyond 12 months.The research also identifies infective endocarditis as the most fatal heart condition, with a 50% mortality rate — making it almost five times as lethal as ischemic heart disease, where narrowed arteries reduce blood supply to the heart.Infective endocarditis is a life-threatening infection of the inner lining of the heart’s valves and chambers. It is usually caused by bacteria or fungi entering the bloodstream, often through dental procedures, surgeries, or infections elsewhere in the body. Without timely treatment, it can rapidly lead to heart failure or stroke.The study further highlights that the average age of heart failure patients in India is just 59.9 years — alarmingly younger than in Western nations, where diagnosis typically occurs much later in life.This early onset of heart failure in India is driven by genetic predisposition, environmental factors, poor healthcare access, late diagnosis, and inadequate disease management. Many patients do not receive proper treatment in time, worsening their condition. medium118414761Why we need to worryOne of the most distressing aspects of the study is the staggering one-year mortality rate of 22.1%. This means that more than one in five heart failure patients in India do not survive beyond a year of their diagnosis.The gender disparity is also pronounced, with women facing even higher mortality rates — 28.9 per 100 patients per year compared to 26.3 for men. Beyond the fatality statistics, the disease also exerts a relentless burden, with 17.2% of patients requiring hospital readmission within a year, further straining an already overburdened healthcare system.Regional disparities in treatment outcomes further compound the issue. Patients in urban centres such as Delhi, Mumbai, and Bengaluru have access to specialised cardiac care and advanced interventions, yet those in smaller towns and rural areas are left with limited resources. The study highlights that states with lower healthcare infrastructure report higher mortality rates, underlining the need for a decentralised approach to treatment availability.Ischemic heart disease emerged as the dominant cause, affecting nearly 72% of those studied. Other contributing conditions included dilated cardiomyopathy, rheumatic heart disease, congenital heart disease, and infective endocarditis, all of which present varying degrees of risk.Rheumatic heart disease, a preventable affliction linked to childhood infections, doubles the mortality risk compared to ischemic heart disease. Congenital heart disease presents an even bleaker prognosis, nearly tripling the risk. The deadliest of all, infective endocarditis — though rare — exhibits a devastating one-year mortality rate of 50%, making it almost five times as lethal as ischemic heart disease.The study states, “Rheumatic heart disease and congenital heart disease continue to pose serious risks in India, disproportionately affecting younger patients and leading to significantly higher mortality rates compared to other forms of heart failure.” medium118414822How the study was conductedThe study was conducted as part of the National Heart Failure Registry, a large-scale effort to track heart failure trends across India. Researchers collected data from 10,850 patients admitted to 53 hospitals across 21 states and four Union territories.Patients were recruited between January 2019 and July 2020, and their progress was monitored over the following year. The study followed a rigorous methodology, ensuring accurate documentation of disease etiology, patient demographics, and clinical outcomes.Follow-up assessments were conducted at three, six, and 12-month intervals, primarily through telephone interviews due to logistical challenges posed by the Covid pandemic. The study used statistical modelling techniques, including Cox proportional hazard models, to compare mortality risks across different heart failure etiologies.In comparison to global data, India’s heart failure burden is notably severe. Developed nations with well-established healthcare systems report significantly lower one-year mortality rates due to comprehensive screening programmes, higher utilisation of advanced therapies such as ventricular assist devices, and better post-discharge patient monitoring.In contrast, India’s fragmented healthcare system lacks uniformity in heart failure management, leading to inconsistent patient outcomes.Why do Indians have weak hearts?Heart failure in India presents a complex challenge, as it is influenced by a confluence of medical, social, and environmental factors. Limited access to specialised healthcare remains one of the biggest obstacles, particularly for patients in rural and semi-urban areas, where cardiologists and advanced treatment facilities are scarce.Many of the latest life-saving drugs and interventions, such as implantable defibrillators and advanced heart failure therapies, are often unavailable or unaffordable. Government healthcare schemes provide limited coverage, and out-of-pocket expenses continue to be a major burden on patients, preventing them from seeking timely intervention.Environmental factors also play a crucial role in exacerbating the heart failure crisis. Air pollution, which has reached hazardous levels in many Indian cities, has been linked to increased cardiovascular disease risk, with studies indicating a direct correlation between poor air quality and worsening heart conditions.Dietary habits, too, contribute significantly — high consumption of processed and fried foods, excessive salt intake, and low vegetable consumption all increase the likelihood of hypertension and heart disease. Coupled with sedentary lifestyles and increasing obesity rates, these factors create a perfect storm for cardiovascular diseases to thrive.Diabetes and hypertension, both of which are widespread in India, further aggravate heart failure risks. The country has the second-highest number of diabetes cases in the world, with millions of people unaware of their condition until complications arise. Poorly managed diabetes leads to cardiovascular complications, often culminating in heart failure. Similarly, high blood pressure, which affects one in three Indian adults, remains a silent killer due to lack of awareness and irregular monitoring. medium118418036What is the way forward?Experts say that without a national heart failure strategy, patient survival rates will remain stagnant. A structured approach that includes expanding early diagnostic efforts, improving primary healthcare capacities, and enhancing the affordability of treatments could substantially alter outcomes. Implementing a heart failure registry in every state, similar to those in high-income countries, would provide real-time data for targeted interventions.Additionally, the voices of patients must be included in shaping public health responses. Patients diagnosed with heart failure often express frustration over late diagnoses, financial struggles, and the lack of follow-up care post-hospitalisation.Addressing the crisis requires a multi-pronged approach. The expansion of heart failure screening programmes and early diagnostic efforts can help identify at-risk patients before their conditions worsen. Strengthening primary healthcare systems to handle early-stage cardiac care will reduce the burden on tertiary care hospitals.Improving access to affordable medication and interventions through better public health policies and government-subsidised programmes is crucial in ensuring equitable treatment for all patients. Moreover, raising awareness through community-based programmes, school curricula, and mass media campaigns can encourage healthier lifestyle choices and prompt early medical consultations.India stands at a crossroads. The data from this study is both a warning and a call to action. Without swift and effective measures, the country risks losing countless lives prematurely to a disease that, with the right strategies, can be managed and mitigated.