Heart disease hits Indians early, diabetes, high BP make it worse





Study By US Assn Covers 85,000 PatientsAlmost 70% Suffer From Hypertension And 10% Have Heart Problems

In the Indian pool of heart patients, almost every second patient has high blood pressure, every fourth has diabetes and every fifth had plaque deposits in his her arteries.

This scientific picture of Indian heart diseases, at a time when Prime Minister Narendra Modi is touring the US, comes from the American College of Cardiology's newly set up study centres across India. ACC is a not-forprofit medical association th at works out guidelines for cardiac treatment which are invariably followed globally.

The ongoing study provided data of 85,295 patients who clocked 2.11 lakh visits to out-patient departments of 15 hospitals from Mumbai to Patna over the last 26 months.Of these patients--from both urban centres and rural areas--60,836 were found to have heart disease.

"In capturing all-India data, this is one of the most scientific studies,'' said Dr Prafulla Kerkar, the head of Parel's KEM Hospital's cardiology department. He is also the chairperson of ACC's Pin nacle registry's India Quality Improvement Programme.

In the backdrop of World Heart Day on Monday , the ACC data underlines that the average age of a heart patient in India is 52 years. "If one looks at ACC's American registry , the average age is much higher in the sixties.Clearly , Indians get hit with heart disease much earlier,'' said Dr Ganesh Kumar, cardiologist at Hiranandani Hospital in Powai and vicechairperson of the study .

The ACC study , for the first time, shows how badly diabetes affects the Indian heart. It provides the breakup of the 13,077 patients with diabetes who visited the 15 centres a total of 35,441 times. Here, we found a doubling of the diseases. For instance, 32% of the diabetic patients had narrowed arteries or coronary artery disease. Almost 10% of them had heart failure and 70% had hypertension. The corresponding numbers for non-diabetic patients are half,'' said Dr Kumar.

He said the actual number of diabetic patients with heart complications would run into millions."The amount of time and money lost due to treatment would not only be high for a particular family, but it would translate into a huge economic burden for the country as well. In fact, this is what the US is going through today with the increasing number of heart failure patients,'' he added.

Heart failure and atrial fibrillations are two relatively new heart conditions that Indian doctors have begun tracking."The ACC data provides an insight into the type of patients walking into our heart clinics,'' said Dr Kerkar. "If more centres across India are roped in to maintain data of heart disease, then we can understand the complete nature of our heart burden.We will be able to design better heart health policies,'' he added.





India suicide capital with 2.6L casesyr, a third of global total





India records by far the largest number of suicides in the world, accounting for nearly a third of the global total and more than twice as many as China, which is second on the list. India also has the highest rate of suicides among young people--those aged 15 to 29 years.

These were among the sobering facts revealed in a report released by the WHO, "Preventing Suicide, A Global Imperative". The report noted that an estimated 8 lakh suicide deaths occurred worldwide in 2012. It is the second leading cause of death in the 1529 age group.

India in 2012 recorded nearly 2.6 lakh suicides, dwarfing China's 1.2 lakh.Its overall rate of suicides (incidents per lakh population) was 12th at 20.9. The worst countries on this parameter were North and South Korea, Guyana, Lithuania and Sri Lanka. Hungary, Japan, the Russian Federation and Belarus also had higher suicide rates than India. The Scandinavian countries, Sweden, Norway and Denmark--often perceived as societies with high suicide rates--had much lower rates.

In richer countries, three times as many men commit suicide as women, but in low and middle-income countries, the male-to-female ratio is much lower at 1.5 men to each woman.

Globally, suicides account for 50% of all violent deaths in men and 71% in women. Only in Iraq and Indonesia was the proportion of women to men among those committing suicide higher than in these countries.

India, despite its horrific statistics, has actually seen a decline in the tendency to commit suicide since 2012, with the rate declining by 9.2% over this 12-year period.

China, in the same period, saw its suicide rate drop by 59%.

India is a clear exception to the global pattern of the 70+ age group having the highest suicide rates. At 21.1 per lakh population, suicides among this age group are only about as common as among the entire population.

The report revealed that ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally. It also listed various risk factors that contribute to suicides.

Risk factors associated with the health system and society at large include difficulties in accessing health care and in receiving the care needed, easy availability of the means for suicide, inappropriate media reporting that sensationalizes suicide and increases the risk of "copycat" suicides, and stigma against people who seek help for suicidal behaviours, or for mental health and substance abuse problems.





New project aims to track and treat 20,000 `silent' TB patients by 2017





The city's two-yearold tuberculosis control programme has got another booster shot. In a bid to draw out `silent' patients who delay getting a diagnosis, medical vouchers for free medicines and diagnostic tests are being made available.

In a project funded by the Bill & Melinda Gates Foundation and implemented by international NGO PATH, patients with cough living in slums or poor localities will get the voucher to gently prod them to undergo an X-ray .The programme, called the Private Provider Interface Agency (PPIA), will focus on the 12 wards identified as highrisk for TB and cover almost 9 million people.

"During our interactions with doctors, we found they are reluctant to mention TB to patients on their first visit and choose instead to write out antibiotics for their persistent cough," said Dr Arun Bamne, who is a consultant with the BMC for the TB control programme. The patient feels better because the antibiotics check the tuberculosis for some time, but the problem invariably returns, at times in a potent form.

The PPIA programme will try to break this cycle, said PATH project director Dr Shibu Vijayan. "The vouchers, which are being used in the Indian public health sphere for the first time, will act as an incentive," said Dr Vijayan, adding that the same programme is being implemented in Mehsana, Gujarat, and in Patna, Bihar. In Mumbai, the aim is to draw 20,000 more patients into the programme by 2017.

The city received the first booster dose for TB control in 2012 when reports of totally drug-resistant TB cases cropped up for the first time.The Union government immediately released special funds, granted hi-tech infrastructure and drew up a special plan for Mumbai. As a result, detection rates soared, with the number of drug-resistant cases climbing to almost 3,700 in the last two years.

"Despite the best effort and services, the public health system at best draws 50-60% of the targeted population. There is a huge population that prefers the private sector," said BMC's TB officer Dr Minni Khetrapal. As the private sector doesn't follow standard protocols, it is feared not all patients get equal or right treatment."Using programmes such as the PPIA, we want to be able to cover 100% of the population," added the doctor.

To start with, the pro gramme has identified 40 small and medium hospitals where the voucher can be used. "Patients who go to informal doctors with complaint of cough will be sent for a free X-ray at the nearest hub hospital we have identified," said Dr Vijayan. If the X-ray shows worrisome signs, the patient will be sent for a subsidized GeneXpert scan, costing barely Rs 500 as against the Rs 1,500 in other labs.

"If the GeneXpert test shows the patient has normal TB, he can use the voucher to buy free medicines for up to six months from a chemist," said Dr Bamne. If the GeneXpert shows the patient has drugresistant TB, he will be inducted into the BMC-run free treatment programme. The BMC gets medicines, costing Rs 2-5 lakh for each patient, from the Revised National Tuberculosis Control Programme.