Heart failure is quickly becoming the most pressing health problem in India. Millions of people live with heart failure disease, many of them unreported. There are now good treatments that relieve symptoms and improve prognosis. But not everyone gets the treatment they should, and unfortunately, few are ready to go down the road of heart transplants and LVADs.
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of ventricles to pump blood. Heart failure is often a long-term (chronic) condition, but it can sometimes develop suddenly. It can be caused by many different heart problems. The condition may affect only the right side or the left side of the heart. These are called right-sided HF or left-sided HF. More often, both sides of the heart are involved.
Patients who have already undergone cardiac procedures and are still symptomatic, will get tremendous benefits from cardiac replacement therapies like heart transplants or ventricular assist devices. Pacemakers may save lives from sudden cardiac deaths, but they do not prolong life in patients with pump failure.
There may be a time when you or your family members are sick of treatments from different physicians for heart problems. And once your physician or cardiologist closes the option that anything more can be done, and that there is no further treatment available, you should contact an advanced heart failure centre.
The treatments available at these centers for end stage heart failure are either heart transplant or ventricular assist device. Both are highly effective, but due to less awareness on the subject, most people don’t know about them or are wary of trying them.
Heart transplant surgeries in India are also rare, not because of the lack of medical skills, but unfortunately, because of the lack of availability of organs. Awareness levels on organ donation are extremely low and few people are ready to donate organs.
On July 31st, late in the night, I got a call that a heart might become available at another city hospital. At this hospital, a young man had tragically died following an accident, and his family members had very generously agreed to donate his organs. While my team at Max, Saket retrieved the heart and brought the organ to our hospital, the patient was quickly prepared for the surgery by the team. Once retrieved from a brain-dead patient, the heart has to be transplanted with-in a very tight window of four hours. After a successful heart transplant, the patient is doing well. Related Link for Heart Transplant
However this scenario is not possible in all situations because of the lack of organs available for transplantation. Therefore in situations when life expectancy is limited or patient cannot be weaned off from temporary mechanical support, the solution left is implantable LVAD (Left Ventricular Assist Device). This is a reliable and long term therapy which improves organ perfusion and thus quality of life. Life expectancy of such subset is very poor if not treated in time and they die in 6 months to one year.
More than 28000 LVADs have been implanted globally and 10000 patients are on device at present. Out of these, more than 500 patients are on this device for more than 10 years. LVAD is the only alternative that offers a ray of hope to thousands of patients whose hearts are too weak to survive and those waiting for a heart transplant.
India has a long way to go before we can match the demand for heart transplants in the country. Most of those who manage to make it to the wait list for heart transplants eventually don’t survive the wait, which is a minimum of 3-4 months. This scenario proves to be especially fatal for those who are battling with end-stage heart failure. They cannot wait for a heart to be available. LVAD could be the answer for these patients. The Newer generation LVADs have comparable survival rates to heart transplant.
Heart Disease In India
The biggest studies of deaths in India show heart ailments have replaced communicable diseases as the leading killer in rural & urban India. The results are surprising because they indicate a reversal in disease patterns in the country from communicable diseases to non- communicable or lifestyle diseases.
Delhi & NCR has the most number of heart patients between the ages of 25 and 45, as per a survey. ‘Young hearts high on cholesterol’ was conducted by Assocham ahead of the World Heart Day Sep 29 and revealed that Delhi was followed by Mumbai, Ahmedabad and Bangalore. It found that around 38% of the men between 25 and 45 years in Delhi-NCR have alarmingly high cholesterol, which is one of the key risk factors for heart disease.
It’s time that awareness on various forms of treatment for cardiac patients increases so that people know that if all fails, they do have other options.