Cardiovascular Diseases in India What to Expect in 2019

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Cardiovascular Diseases in India What to Expect
in 2019
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• Cardiovascular Diseases in India has seen an
  alarming growth in last decade. In 1990 around
  15 of deaths in India were due to Cardiovascular
  diseases, now this has increased by 28 due to
  many different factors.
• Globally, cardiovascular diseases (CVDs) are the
  number one cause of death and more people die
  every year from CVDs than any other cause. In
  2016, approximately 17.9 million people died from
  CVDs that accounted for 31 percent of all global
  deaths in that year. Low and middle-income
  countries are the most affected, as more than
  three-quarters of deaths are caused by
  cardiovascular diseases in these nations. About
  37 percent of premature deaths in low and
  middle-income countries are due to cardiovascular
  diseases. Case fatality ratio of cardiovascular
  diseases in low-income countries is much higher
  as compared to middle and high-income countries.
  In 2013, all member states of the WHO agreed to
  be part of a Global action plan for the
  prevention and control of NCDs 2013-2020. As
  part of the plan, the countries aim to lower the
  number of premature deaths from NCDs by 25
  percent by the year 2025 through nine voluntary
  global targets. Of these, two global targets are
  designed to directly work on the prevention and
  control of cardiovascular diseases.
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• Impact of Cardiovascular Diseases in India
• According to a study published in a health
  journal (The Lancet) in 2018, cardiac diseases
  claimed more Indian lives (28 percent) compared
  to other non-communicable diseases. The number of
  deaths caused by cardiovascular diseases in India
  rose from 1.3 million in the year 1990 to an
  estimated 2.8 million in 2016. In India, the
  death rate continues to rise, while it has
  decreased substantially in the US in the past 15
  years. The study also suggested that obesity may
  not be the root cause of CVD deaths in India. It
  was estimated that cardiovascular ailments were
  responsible for causing more than 2.1 million
  deaths in India in 2015 at all ages, or more than
  a quarter of all deaths. The study also showed
  that in the age group of 30-69 years, of the 1.3
  million cardiovascular deaths, 0.9 million (68.4
  percent) were caused by coronary heart disease
  and 0.4 million (28.0 percent) by stroke. Rural
  India has seen more CVD related deaths than urban
  India, which is alarming.
• As per another study on CVDs by Elsevier, the
  death rate due to CVDs in the US fell to 41
  percent between 1990 and 2016, while it saw an
  increase in India from 155.7 to 209.1 deaths per
  one lakh population in the same span. The reason
  for the low rates can be attributed to preventive
  measures like a healthy lifestyle, decline in
  risk factor trends like tobacco use, high
  cholesterol and blood pressure in the US
  population and a better secondary and acute care.
  As for ischemic heart disease and stroke, they
  account for about 15-20 percent of all deaths in
  India and 6-9 percent in the US. India can also
  lower CVD death rates and complications arising
  from CVDs through the implementation of
  population-level policies while simultaneously
  working towards strong and well-integrated health
  systems (local, regional as well as national).

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• New Trends in Cardiovascular Medicine
• In 2019, trends point to many advancements in
  treatment of CVDs, like increased use of direct
  oral anticoagulants (DOACs) in atrial
  fibrillation (AFib) and other conditions, new
  standards in the management of mitral valve
  regurgitation (MR) in patients suffering from
  heart failure, larger use of transcatheter aortic
  valve replacement (TAVR), greater roles for
  implantable and wearable devices and the data
  collected by these devices, and the use of AI in
  cardiovascular medicine as well as focus on cost
  and value of treatments. The use of
  anticoagulation medicine (DOACs like dabigatran)
  in patients with cardiovascular diseases is set
  to increase due to the availability of
  drug-specific reversal agents. Wearable devices
  like built-in heart rate monitors and single-lead
  electrocardiograms (ECGs), may be increasingly
  used by doctors in 2019 to detect rhythm
  abnormalities in the heart and to predict whether
  or not anticoagulation medicine can be used.
• AI (Artificial Intelligence) is set to change the
  cardiovascular field in many areas in 2019. It is
  already being used to fine-tune the selection of
  possible treatments by looking for patterns in
  molecular biology, structure-function, and
  clinical trial databases. It can remotely filter
  out clinically actionable data from the vast data
  collected by wearable devices. It can also lend
  itself greatly in the application of precision
  medicine by assessing the genetic information,
  environment, and lifestyle of patients, and
  zeroing in beneficial interventions based on the
  data.

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• AI can also help in the integration of data from
  various sources that are used to treat CVDs like
  social media, the electronic health record (EHR),
  and wearables. It can increase the efficiency of
  treatment by lowering repetitive tasks, and
  prioritizing EHR-based alerts or messages,
  improving and automating image interpretation in
  the catheterization or echocardiography
  laboratory, and integrating data from relevant
  sources to present a favourable treatment plan
  for individuals.
• AI is yet to however, make a huge impact in
  clinical practice given its complexity and lack
  of data on reasons behind predicted outcomes or
  preferred treatments. However, patients are
  increasingly veering towards wearable devices
  that can potentially prevent CVDs. The accuracy
  of these devices is yet to be ascertained, but it
  may affect treatment outcomes when it comes to
  CVDs. Health devices may slowly be incorporated
  into clinical practice as more evidence of their
  importance in disease prevention/treatment
  emerges. In 2019, other trends point towards
  increased attention towards tricuspid valve
  disease, more growth of treatment alternatives
  for structural heart disease, as well as a
  significant understanding of the utility of
  interventional therapies and devices for atrial
  fibrillation. Considerable efforts may be made
  towards ensuring cost-effectiveness in
  cardiovascular disease treatments, be it lowering
  drug and device costs (coronary stents are
  expensive) or increased access to care and better
  and yet affordable technology.

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