Cardiometabolic diseases, such as cardiovascular disease (CVD), diabetes, and kidney disease, remain the leading causes of death worldwide. According to experts, integrated care can play a crucial role in managing and treating cardiometabolic diseases.
Cardiometabolic diseases are a group of common but often preventable conditions including heart attack, stroke, diabetes, insulin resistance and non-alcoholic fatty liver disease.
According to a 2018 study, the Asian Indian ethnicity are predisposed to cardiovascular diseases (CVD) at an earlier age. In an e-mail interaction with Financial Express.com, Joanna Sickler, VP External Affairs and Global Health Policy, Roche Diagnostics spoke about integrated care that spans the disease pathway from early diagnosis to comprehensive management, role of technology in integrated care, and challenges among others. Excerpts:
What is the status of Cardiometabolic diseases, such as cardiovascular disease (CVD), diabetes, globally as well as in India?
With the rising global burden of Non-Communicable Diseases (NCD), cardiovascular diseases (CVDs) are becoming the leading cause of death, affecting over 500 million people worldwide. In 2021, CVDs accounted for over 20.5 million deaths and 38% of premature deaths (people less than 70). In low- and middle-income countries, over 75% of CVD deaths take place. Add to this, the financial cost of cardiometabolic disease which is immense. The global economic burden of heart failure alone exceeds USD $100 billion per year, majority of which is attributed to direct healthcare costs. Between 2015 and 2030, the economic burden of CVD in Organisation for Economic Co-operation and Development (OECD) countries alone is expected to exceed USD $4 trillion and diabetes will be close to USD $1.5 trillion.
In South Asia, which includes India and neighbouring countries, we have around 60% of the global cardiovascular disease (CVD) burden. India in particular, is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCD) surpassing the burden of Communicable diseases like water-borne or vector borne diseases, TB, HIV, etc. According to the World Health Organization, a total of 77 million people above the age of 18 years are suffering from type 2 diabetes and nearly 25 million are prediabetics, putting people at higher risk of cardiovascular diseases and its complications. This represents an additional pressure on the health system.
Now as were various international reports, around 1.1 million premature deaths in low-income and middle-income countries could be avoided annually by reducing the diagnostic gap for six priority conditions: diabetes, hypertension, HIV, and tuberculosis in the overall population, and hepatitis B virus infection and syphilis for pregnant women. With regard to cardiovascular diseases, up to 80% of premature heart attacks and strokes are preventable by regular screening and appropriate management of illness. This gives an opportunity to come together and transform the disease care pathway and it starts with prevention and timely detection.
What are the diagnostic challenges of tackling these diseases globally?
The burden and impact of cardiovascular diseases is not equally distributed. Certain groups are more likely to develop them and struggle to access care. There are clear socioeconomic, race and sex inequalities in cardiovascular-related mortality and morbidity. These are primarily driven by social determinants of health, including work, social isolation, environmental and living conditions and discrimination. Although detecting cardiovascular disease as early as possible and treating it in a timely manner is extremely important to prevent complications and premature deaths, up to 47% of the global population has little or no access to diagnostics. This number decreases to only 19% in low and middle income countries. A fundamental transition is required from ‘sick’ care to ‘health’ care. This includes recognising the diagnostics are a very low percent of spend in the overall patient journey. In fact, global estimates are that diagnostics are used in making 70% of clinical decisions and represent only 2% of the healthcare costs.
Access to safe, high-quality diagnostics solutions plays a fundamental role in ensuring that people can access care when and where they need it. Diagnostics infrastructure has a crucial role to play in strengthening the health system, achieving universal health coverage and meeting Sustainable Development Goals targets. Therefore, increasing investment in diagnostics capacity and establishing a national cardiovascular action plan leveraging the use of existing technology is critical to improve care along the care continuum and promote better care for all.
According to you, what can be the role of technology in the care and treatment of these diseases? Can you share some examples and how we can implement these in India?
Diagnostics and digital solutions can enable improved care results for patients and help maximise efficiencies in health systems. But life-saving innovation is only meaningful if it reaches those who need it. Access to quality diagnostics solutions can empower patients to access the timely detection they need and avoid delayed diagnosis which are costly for individuals and the healthcare systems alike. While we see that NCDs are estimated to account for 63% of all deaths in India of which the cardiovascular diseases lead with 27% overall mortality, it is imperative to integrate diagnostics into the last mile of the vast public health infrastructure of the country to ensure good health and reduce disease burden.
Optimising the use of existing laboratory infrastructure and expanding high-volume cost-effective testing technologies is critical to meet the needs of large populations like India. For Instance, before the pandemic, Real-Time PCR (RT PCR) was considered a very niche technology that only a handful of labs around the country could offer. COVID-19 challenged the diagnostics industry to rapidly build their capabilities to a point where today India has over 3000+ testing laboratories
that perform molecular testing. Now, this gives an unprecedented opportunity to provide state-of-the-art, first-in-class technology in order to build a strong, robust and a future ready healthcare system.
In addition to that, near-patient and point-of-care testing that make an immediate difference in patient management and strengthen the laboratory network, are critical to creating a more resilient health system. For example, Acute coronary syndrome (ACS) which covers a range of conditions, including myocardial infarction, remains a major cause of mortality among people over 35 years of age. It is important to optimise point-of-care diagnostics methods and speed up triage and identification of the most appropriate course of action, if we are to drive a reduction in this high mortality rate. This way, we can ensure access to basic cardiovascular diagnostics, meeting the needs of the population. A good example of this is the approach taken by the Central Denmark Region, where they have equipped all ambulances with a POC Troponin T device for use in suspected ACS cases. The integration of innovative POC diagnostics have helped healthcare professionals in the Denmark region to reduce mortality and effectively initiate timely treatment to patients.
Similarly, increasing burden on the healthcare system demands the establishment of STAT labs in India. At Roche, we had done a survey among 700 hospitals in India that demonstrated that lack of appropriate STAT lab caused overcrowding and longer prolonged ED length of stay (LOS). Introduction of a Stat lab dedicated to the ED within the central laboratory can help shorter laboratory TATs and shorter ED LOS for admitted patients, by approximately 1 hour. These are just a few examples which can be incorporated by Indian hospitals and healthcare institutes to ensure timely access to effective diagnostics, leading to more lives saved and reduced mortality burden for the nation. It’s also important to leverage a multi-sectoral approach to put in place national action plans for cardiovascular diseases, which are enabled by the collaboration with multiple stakeholders, including government, industry, patient and health professional groups.
How integrated care that spans the disease pathway from early diagnosis to comprehensive management can improve outcomes for patients? What are the hurdles that lie in the implementation of such programmes in India?
Adopting an integrated and multidisciplinary approach including cardiologists, general practitioners and nurses, is critical to improve disease management from early diagnosis to comprehensive management and enable better care for all. It allows the detection of cardiovascular disease earlier and treating it in a timely manner, which is extremely important to prevent complications and premature deaths. Here, I would like to give an example of Heart failure patients. Heart failure is a major public health problem in Asia, especially in countries such as India. The single greatest concern that doctors face today is diagnosing heart failure based on symptoms alone. In up to 50% of cases, heart failure patients can be misdiagnosed resulting in adverse impact, such as inappropriate care or treatment, which adds burden for patients and costs to healthcare systems. Screening, improved diagnosis and better disease monitoring are paramount and can lead to improvd patient outcomes. Cardiac biomarkers such as NT-proBNP, can help to provide a full clinical picture that aids in the diagnosis and management of heart failure. Having a full clinical picture, with the right objective information, allows physicians to make the best decisions in heart failure management to benefit patients.
Similarly, effective biomarkers need to be integrated in disease management programmes to ensure people with cardiometabolic diseases, which includes cardiovascular disease and diabetes, receive guideline-based care. Many case studies have shown improved patient outcomes, health system and economic benefits with such an approach.
Moreover, such approaches are the foundation to prevention strategies that focus on early detection and comprehensive management which are pivotal to enable better care for all while reducing health system burden.
What has been the role of Roche Diagnostics in this area?
As the global in-vitro diagnostics leader, Roche has been at the forefront to help improve people’s lives by maximising confidence in decision making in cardiac through constantly raising the standard in diagnostics. We have been committed to addressing today’s major health challenges, including the burden caused by cardiovascular diseases. We are constantly working to offer integrated innovative diagnostics and digital solutions to support timely decision making and
maximise efficiencies within disease management programmes. Our comprehensive cardiac portfolio includes NT-proBNP, Troponin T, and high-sensitivity troponin tests, algorithms and digital solutions and these diagnostic tools have been instrumental in ensuring appropriate medical intervention for patients.
We also work in collaboration with governments, healthcare professionals and patients to close the care gaps and transform cardiovascular disease management to ensure people living with, or at risk of, heart diseases can receive care where and when they need. In this way we are redefining healthcare pathways for patients right from early detection to the best possible interventions.
Here, I would like to highlight the significance of participating in the World Heart Summit organised by the World Heart Federation wherein we had a great intellectual gathering of policy makers, diplomats, business leaders and civil society representatives to discuss the way forward for better access to CVD medicines and diagnostics. We discussed the importance of pivotal strategies to improve cardiovascular disease management and the value of diagnostics solutions in enabling timely decision making to maximise efficiencies and provide better care for all. These platforms offer a unique opportunity to learn from experts around the world and gain insights into new approaches to design new care pathways.
