Experts deliberated on the lack of trained cardiologists, remote cardiac care, increasing risk of cardiovascular diseases (CVDs) during Covid and digital technology on the concluding day of one day FEhealthcare.com Cardiology Summit 2021 which started virtually on September 29, 2021 and concluded the same day.
While delivering his inaugural address at FEhealthcare.com Cardiology Summit 2021 , Dr. Devi Prasad Shetty, Chairman & Founder, Narayana Health talked about advanced heart care treatment and its availability in India in the next 5 to 10 years.
In her special address on the occasion, Preetha Reddy, Executive Vice Chairperson of Apollo Hospitals said, “We can harness technology through telemedicine to make cardiac care accessible across geographies.”
According to the Cardiologists Society of India (CSI), there are only 5500 cardiologists available today in the country. Today with a population of 1.3 billion, there is only one cardiologist for the 30, 000 population in the country. Students are not opting for cardiology specialty and medical seats are not getting filled.
Speaking on the panel discussion of Short Supply of Cardiologists In India- A Crisis, Dr H Sudarshan Ballal, Director of Nephrology & Urology & Chairman of Medical Advisory Board of Manipal Hospitals Group pointed out inequitable distribution of healthcare personnel. Citing an example, he said, Nagaland has 1 cardiologist for 17, 000 population while Goa has 1 cardiologist for 350 population. There is a concentration of specialists in the west and south region of the country.
Dr K.K Talwar, Chairman of PSRI Hospital said, “There are certain things that need to be addressed like as per the cardiological society of India (CSI) amongst the number of physicians enrolled there are less number of cardiologists. Besides this, there is a need to have good faculty. There is a trend of good cardiologists moving from government to private sector and therefore numbers of cardiologists are going down.”
To which Dr Anoop Gupta, Interventional Cardiologist & Electrophysiologist Epic Hospital said, “Services need be provided at peripheral centres to make cardiac care accessible. In order to make cardiac care accessible to people despite lack of cardiologists in the remotest part of the country, there is a need to adopt hub spoke model to implement a good referral system where cardiologists at tertiary care centres can virtually connect through digital tools with physicians at a primary health centre or a district hospital.”
Speaking on the panel discussion of Cardiovascular Diabetes- A Growing Concern, Vikrant Shrotiya, Managing Director & Corporate VP of Novo Nordisk India said, “People with diabetes have four times higher risk of cardio-vascular disease. We are trying to find answers beyond glycemic control and settle issues around metabolic syndrome to find solutions for diabetes and cardiovascular diseases. Through our labs, we are trying to find the link between the drug which is meant for diabetes but also has a cardio-protective nature.”
Dr V Mohan. Chairman of Dr Mohan’s Diabetes Specialities Centre said, “Covid can also lead to diabetes in many ways like stress, anxiety and depression. Epidemiological studies have also shown the prevalence of cardio-vascular diseases (CVDs) in diabetes is at least double that in an age matched non-diabetic population. The risk for CVD in general and ischemic heart disease in particular starts at the stage of pre-diabetes. Diabetes is cardiovascular risk equivalent. Today, we have drugs which not only help in treating diabetes but also improve protection from CVD. GLP1 receptor analogues help to prevent heart attack and to bring down blood pressure and weight. Similarly, SGLT2 group of oral drugs have become the first line of drugs for the treatment of cardiac failure. They are actually meant to be diabetic drugs so the pathology involving the diabetes and heart simultaneously the answers coming in like a miracle like one tablet for diabetes and the heart and kidney is taken care of.”
While speaking on the panel discussion on Cardiology & Technological Innovations, Dr Yugal Kishore Mishra, Head of Cardiac Sciences & Chief Cardio Vascular Surgeon at Manipal Hospitals said, “Digital intervention during Covid-19 has helped patients who were held at home during the two waves of pandemic. Doctors and patients learnt a lot about how the required treatment can be made accessible.”
“With government legalizing tele-consultation and telemedicine, licensed video consultation has been a boon for patients who despite being enrolled in the hospital could not reach out to the hospitals. We reached out to numerous patients during the time of pandemic who required tele electro-cardiogram (ECG) recording and also telemedicine. This also led to starting online pharmacies and delivering medicines at the door step of patients,” Dr Mishra added.
According to Dr Ulhas Pandurangi, Department Chief of Cardiac Electrophysiology & Pacing Arrhythmia, The Madras Medical Mission, “In order to address heart rythm problems and heart failure, one –tenth of the patients use remotely monitorable devices, wearable patches and digital health tools. Our team monitors more that around 5000 + people, 24 X 7 which is going to be increasing because patients have realized that without coming to the hospital, they can be monitored and monitored continuously.”
“In the market digitals tools are available which can non-invasively check Sugar, BP, insulin level and the technology is coming that before any changes in ECG, the digital tool can monitor heart attack non-invasively and alert the patient much beforehand towards patient safety. That is why digital technology is the way forward in cardiac care,” he further added.
Dr Deepak Padmanabhan, Consultant Electrophysiologist at Shri Jayadeva Institute of Cardiac Sciences & Narayana Institute of Cardiac Sciences said, “Virtual meetings has enhanced our learnings and made us reach out to people in a more acceptable manner. We have been able to maintain a level of engagement with patients despite the pandemic with the use of virtual technology. Teaching CPR is very necessary today as within 30 seconds to 1 minute, blood supply to the brain ceases and beyond every 3 minutes which is delayed in providing resuscitation to the patient, the chances of survival decreases.”
“Whosoever witnesses a cardiac arrest, should there be somebody to provide resuscitation to that patient. It should be diagnosed that there has been a cardiac arrest and do appropriate interventions in that patient to ensure that the blood flow to the brain and the heart is maintained. If there is a good spread and penetration of defibrillators, use automated defibrillators in the vicinity which should be readily available to restore the rhythm,” he added.
Speaking on the panel discussion, Dr (Prof) J. P. S. Sawhney, Chairman, Department of Cardiology, Sir Ganga Ram Hospital, ‘There is a growing trend of asymptomatic premature heart disease in the younger population. There is a need for management of risk factors of CVD through life style modification and regular exercise of 30 minutes everyday. Less intake of sugary beverages, less intake of salt, reduction of stress and medication like statins and anti-glycemic drug can help control risk factors of cardiac diseases.”
While sharing his views, Dr Rajeev Agarwala, Chairman, Cardiology, Jaswant Rai Specialty Hospital said, Sleep hygiene is very important to prevent CVD. Sedentary habits are risk factors which are cumulative over a period of time. It is also important to understand risk factors like noise pollution and air pollution. Salt, sugar, sleep and stress are learned behavior. Communities need to cope up with the stress. Conventional and new risk factors have to be taken into account. No one is asymptomatic unless we test them. Risk factors like diabetes, hypertension and family history of diabetes need to be taken into account.”
While speaking on the panel discussion on Cardiac Care Accessibility, In Remote Locations, Dr Nand Kishore Kapadia, Director of Heart & Lung Transplant Centre, Kokilaben Dhirubhai Ambani Hospital, said “Current scenario is that tier two to three cities are improving. Some of the villages with a population of 20, 000 , telemedicine can be a boon and is slowly being adopted.”
Echoing similar views, Dr Ajay Kaul, Chairman of Cardiac Sciences, Fortis Hospital, Noida said, “Digital interventions have enabled patients to share ECG reports to cardiologists at tertiary healthcare centres today. Now this is a duable and feasible proposition in the interest of patient safety and should be taken forward.
Speaking on the panel discussion on Cardiac Care In Post Covid Era, Dr Ajit Sankardas Mullasari, Director of Cardiology, The Madras Medical Mission, “In order to address cardiac care during covid and post covid, there is a need to create public private partnership so that smaller rural pockets can be connected to the bigger private tertiary health care centres through hub and spoke model.”
Dr Jamshed Dalal, Director of Cardiac Science, Kokilaben Hospital, Mumbai said, “Due to covid, many patients could not come to the hospital and did not monitor their heart were at the higher risk during the pandemic. There is a need for digital interventions and community interventions to address the same.”
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