Journal of the Practice of Cardiovascular Sciences

LETTER TO THE EDITOR
Year
: 2020  |  Volume : 6  |  Issue : 3  |  Page : 301--302

Cardiology Practice in India: Need for a Paradigm Shift


Rakesh Agarwal 
 Department of Cardiology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India

Correspondence Address:
Dr. Rakesh Agarwal
Department of Cardiology, IPGMER and SSKM Hospital, Kolkata, West Bengal
India




How to cite this article:
Agarwal R. Cardiology Practice in India: Need for a Paradigm Shift.J Pract Cardiovasc Sci 2020;6:301-302


How to cite this URL:
Agarwal R. Cardiology Practice in India: Need for a Paradigm Shift. J Pract Cardiovasc Sci [serial online] 2020 [cited 2021 Sep 16 ];6:301-302
Available from: https://www.j-pcs.org/text.asp?2020/6/3/301/304532


Full Text



 Introduction



Cardiology practice in India, even in large multispecialty hospitals, has largely been singular. This means, a patient enters a cardiology ward, gets treated by a single physician or his/her team, and is discharged in time for follow-up later. There is no resort to a multipronged approach that can significantly change the quality of life of a cardiac patient as well as his/her treatment. We discuss five ways which when incorporated into cardiac management of every patient can go a long way in changing how we practice cardiology in our country for the better.

Multidisciplinary cardiac teams

A multidisciplinary cardiac team of physicians would include at least one clinical cardiologist, an interventional cardiologist, a cardiac surgeon, a critical care specialist, and a nursing specialist. In India where separate noninvasive cardiology units are still in their infancy, if logistics permit, a cardiac imaging physician and an arrhythmia specialist should be part of the team too. These teams should meet frequently and decide on patient care as part of what we commonly call “grand rounds.”

It has been previously shown that a multidisciplinary team approach involving a cardiologist, a medical intensivist, a cardiology fellow, internal medicine residents, intensive care unit nurses, pharmacists, and respiratory therapists can lead to decreased in-hospital mortality and mechanical ventilation.[1],[2]

Taking care of social determinants of cardiac disease

Social determinants for cardiovascular diseases are well known and well studied. Some cardiac patients can vastly benefit from changes in social factors accounting for their disease. Education on cardiovascular disease should include multiple tips including amelioration of poverty, ownership of private vehicles, good-quality housing, taking holidays and sunbathing, having a proper employment, and changes in housing.[3] In the Indian context, it may not be possible for an institution-based approach to take care of each of these social determinants. However, a comprehensive approach in association with governmental and nongovernmental organizations can pragmatically deal with these factors. Creating new posts for social workers in institutions providing cardiovascular care can be the first step. These social workers can act as a point of contact between patients and the organizations that would help them adapt to their new lifestyles.

Another proven technique is creation of social groups where patients with a particular disease interact, share their stories, and do activities together. These can be supervised in the beginning by a counselor or a physician, which can ameliorate the stigma and depression often associated with cardiac diseases.

Counseling and nonpharmacologic therapy

Despite multiple studies that lay bare the raw benefits of multiple nonpharmacologic approaches for the prevention and mitigation of cardiac diseases, their adoption and practice remains scarce. For example, avoidance of smoking; moderation in alcohol intake; physical activity; a balanced healthy diet; and control of blood pressure, diabetes, and dyslipidemia have been shown to go a long positive way.[4] In a busy cardiology practice, particularly in government setups in an over populated country like India, counseling is a less stressed and often underrated part of cardiology treatment. Trained counselors and educative teams need to be formed in cardiology departments and patients should be referred to them early during the course of their illness for maximum benefits. An ideal team would include participation of a nutritionist, an exercise therapist, a counselor, and a de-addiction specialist.

Enrollment in clinical trials

India has been reported to have high enrollment rates for clinical trials,[5],[6] even higher than the USA. Still, data from Indian subsets are generally lacking despite the humongous population of the country. There is an urgent need for the Indian medical fraternity to design clinical trials suited to the Indian scenario, and evaluate the results with the formation of specific Indian guidelines.

Utility of mobile health

In recent years, application of mHealth has increased. With subscribers and users of smartphones increasing worldwide and in India, this simple utility can prove to be a great game changer in cardiac disease modification in India. For example, Apple Watch has been shown to detect atrial fibrillation and can be used in at-risk population.[7],[8] For those who cannot afford the technology, we need industries to come up with simple solutions for the Indian scenario, with data testing and adequate clinical research before launching products.[9] Even for simplicity, messages and utilizing broader applications such as WhatsApp for educational message delivery, using step-counter applications for exercise monitoring, and video applications with directed links to education videos can play a part in our battle against cardiovascular disease.

 Conclusions



We firmly believe that utilizing a multipronhed approach including multidisciplinary teams, technology, comprehensive education and social programs, and advanced locally conducted clinical research can change the landscape of cardiac disease management in India. This can usher in an era of shining India where the world looks up to us for our management victories, and we can provide our share of contribution to the field of medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

11. Fanari Z, Barekatain A, Kerzner R, Hammami S, Weintraub WS, Maheshwari V. Impact of a multidisciplinary team approach including an intensivist on the outcomes of critically Ill patients in the cardiac care unit. Mayo Clin Proc 2016;91:1727-34.
22. Fumagalli S, Chen J, Dobreanu D, Madrid AH, Tilz R, Dagres N. The role of the Arrhythmia team, an integrated, multidisciplinary approach to treatment of patients with cardiac arrhythmias: Results of the European heart rhythm association survey. Europace 2016;18:623-7.
33. Kreatsoulas C, Anand SS. The impact of social determinants on cardiovascular disease. Can J Cardiol 2010;26 Suppl C:8C-13C.
44. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004;364:937-52.
55. Don M. Clinical Trials and Safety Reporting Under Schedule Y. Pharmabiz; 2005.
66. Shah JY, Phadtare A, Rajgor D, Vaghasia M, Pradhan S, Zelko H, et al. What leads Indians to participate in clinical trials? A meta-analysis of qualitative studies. PLoS One 2010;5:e10730.
77. Bostrom J, Sweeney G, Whiteson J, Dodson JA. Mobile health and cardiac rehabilitation in older adults. Clin Cardiol 2020;43:118-26.
88. Raja JM, Elsakr C, Roman S, Cave B, Pour-Ghaz I, Nanda A, et al. Apple Watch, wearables, and heart rhythm: Where do we stand? Ann Transl Med 2019;7:417.
99. Agarwal R. The unhealthy side of mhealth: A cautionary note. CHRISMED J Health Res 2016;3:302.