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The Way Forward Towards Management Chronic Heart Failure

How telehealth has improved the accessibility and continuity of care for heart patients.

by Dr Manish Bansal

Heart Failure: A Burgeoning Epidemic in India

Cardiovascular disease has now become the leading cause of morbidity and mortality in India, making for a quarter of all deaths.1

Heart failure is one of the major forms of cardiac disease and is associated with considerable morbidity and mortality. In recent years, the incidence of heart failure has increased exponentially as a consequence of the ageing population2 and unexpectedly, improvements in the acute management of cardiac illnesses. For many patients who survive initial cardiac insults like acute myocardial infarction, the resulting damage to heart muscles can impact heart function and in the long term, become a substrate for heart failure.

To ease cardiovascular disease, especially heart failure burden in India, it is critical to explore innovative solutions for empowering clinicians and patients alike, for better diagnosis and treatments.


Urgency for Clinicians to Stay Current With Latest Medical Knowledge

Cardiology is one of the most dynamic and fast-moving fields of medicine. It is a practice with a large international research base, with more than 100 medical journals dedicated to heart research alone. To deliver on their promise for better patient outcomes, keeping abreast with the latest in medical innovation is a necessity.

Exemplifying this need is the recent breakthrough finding that a diabetes drug3 could be used to treat heart failure patients. Previously only dispensed for diabetes patients, its efficacy to reduce rates of heart failure hospitalisation and mortality has led to the drug being used in cardiac patients, even in the absence of diabetes. Awareness of such developments is key to improving patient outcomes.

Although the ongoing COVID pandemic presented huge healthcare challenges, fortunately, it has accelerated access to knowledge in India. Due to safe social gathering restrictions, cardiology webinars and conferences have moved online, which has allowed more Indian clinicians to attend them locally and internationally. Furthermore, the online setting has also allowed greater participation of international experts and faculty in meetings in India.

Also gaining traction in the region is the usage of web-based platforms like ClinicalKey and Medscape as alternative sources of knowledge, beyond the traditional printed journals.

Despite these promising developments, unfortunately, the application of evidence-based medicine in India remains challenging due to the relative lack of robust systems to ensure mandatory continuous professional development, coupled with time constraints clinicians have. As a result, physicians may continue to prescribe a medication that may no longer be in accordance with the latest guideline recommendations.

In these circumstances, an integrated system to consolidate accurate, concise, and actionable literature supported by better infrastructure could be greatly beneficial to cardiologists and general physicians.


Emerging Role of Telehealth in the Practice of Cardiological Medicine

In conjunction with the improving knowledge of clinicians, there is also an equal need to improve the accessibility of care for patients in India.

Due to the high cost of cardiological procedures and follow-ups, many patients are not able to afford the treatment of cardiovascular diseases. Furthermore, the lack of affordability also equates to high discontinuation rates as 74 per cent of health spending in India has been out-of-pocket (OOP) with many individuals lacking health insurance,4 a reflection of the gap in the care continuum cycle.

Greater adoption of telehealth platforms in the field of cardiology has driven improvements on this front. Initially believed to be impractical and infeasible, implementation during the pandemic proved otherwise, where there had been positive outcomes for patients and improved continuity of care.

Patients who have chronic cardiac conditions, including those who have undergone surgery or catheter interventions, usually require frequent follow-ups in the hospital, but many often choose not to show up. This is one of the major reasons for subsequent adverse outcomes. However, now, the ability to connect with their doctors online has allowed patients who live far away from specialist centres to schedule routine follow-ups with their cardiologists without the need for travel, which can save them time and money.

Telehealth has also facilitated consultations in acute heart problems, where patients and clinicians alike can discuss remotely with experts in the field from any hospital and take their advice when encountering challenging complications. Furthermore, technological advances have also led to the development of several monitoring devices that can be used for the early recognition of warning signs and facilitate timely response to patients remotely located.

Even with the current understanding of the limitations of telehealth in providing emergency care or assessing new symptoms and developments, there is still a huge potential for telehealth, especially in rural areas in India where less than 10 per cent have access to a hospital.4

Providing remote access can lower the barriers for patients to seek help early and consider preventive health check-ups.


Final Thoughts

At present, low affordability and the lack of accessibility are large barriers to the providence of cardiological care in India.

While building a strong knowledge base for doctors to support patients through appropriate treatments and tapping on new technologies such as telehealth can alleviate and potentially positively impact mortality rates, collaboration and innovation are necessary for greater change.

Specific to heart patients who often require repeated emergency hospitalisations, many still miss the opportunity to access early medical intervention. Beyond the need to implement infrastructure in rural areas to cater to such scenarios, point-of-care solutions like monitoring tools may be the future of cardiological care sooner than expected.

At the same time, from clinicians’ perspective, given the considerable volume of literature in the cardiology field, an important initial step to improving cardiological care would be greater access to consolidated, easy-to-follow, and actionable evidence-based information. [APBN]

About the Author

Dr Manish Bansal, Director of Clinical and Preventive Cardiology in Medanta, has almost twenty years of experience in treating all forms of cardiac illnesses, including coronary artery disease, valve diseases, cardiomyopathies, etc. His expertise lies in early detection, prevention, and management of coronary artery disease with over 250 research publications.