Beware of cardiovascular diseases this winter

Indians run a 35% higher risk of suffering from heart disease in the winters than the summers –

Research indicates a major disparity in the demand and supply of pacemaker implants in the country

Winter often brings along with it common ailments like the flu, coughs, depression and colds. Add to these ailments a more deadly one: heart attacks. Research proves that more fatal heart attacks, heart rhythm disorders and strokes occur during the winter than at other times of the year. The reason for this is the increase of alpha activity in our body’s receptors leading to a 5mm Hg higher blood pressure level than in the summer months. In addition to this reduction in the daily activity and exercise level is also directly linked to increased chances of heart disease.

It is estimated that the incidence of heart disease goes up by about 35% in cold weather with the maximum number of heart attacks occurring early in the morning. Worsening of heart failure and occurrence of heart electrical blockages are also more in this time of the year. All this leads to an increase in the number of stents, bypasses and pacemaker implants. Such an increase is not seen in diabetics or those who are on aspirin prophylaxis.

Pacemakers are medical devices that use electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart. They are the most common line of treatment for most heart rhythm disorders linked to low heart rate, one of the growing epidemics of the Indian society. However, there exists a great disparity in the requirement for pacemakers and the number implanted each year.

According a white book recently released by the Asia Pacific Heart Rhythm Society, in India in the year 2013 only 2 pacemakers were implanted per week per center (India has a total of 888 centers which are equipped to implant pacemakers). In Japan on the other hand over 9 pacemakers were implanted per week per center in the same year. This indicates the gap in the demand and supply.

Speaking on the topic, Padma Shri Awardee, President of the Heart Care Foundation of India and Sr. National VP and Secretary General Elect of the IMA, Dr. K K Aggarwal said,” The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart’s natural pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system. The number of patients in need of a pacemaker is growing by the year. It is estimated that over 1.5 lakh pacemakers are needed in India in a year however only 36,322 are actually implanted. Heart blockages may be asymptomatic or reversible. In such cases permanent pacemaker implantation is not required”.

“Recently our Prime Minister Mr. Narendra Modi started a campaign called Make in India. At the moment there are only a few local companies, which make pacemakers however, their market share is negligible. Indian companies must come forward and manufacture low cost, life-saving technology in the country”, he added.

Discussing the technological developments in the management of Heart Rhythm disorders, Director Cardiology at Saket City Hospital and Chairman, Organizing Committee 7th APHRS Scientific Session 2014, Dr Mohan Nairsaid, “Leadless pacemakers are the latest innovations in the field and are awaiting launch in the country. Unlike conventional pacemakers, leadless pacemakers are placed directly in the heart without the need for a surgical pocket and placing leads. The device is much smaller and consists of a battery and steroid eluting electrodes as sensors”.

“A pacemaker may need to be changed after 5 to 10 years depending on the usage and make. Once a pacemaker is implanted usually an MRI could not be done. However MRI compatible pacemakers are now available. All patients undergoing a pacemaker surgery should ask their doctors to talk about this issue,” he added.

The APHRS White Book further discloses that in India:
The implantation of permanent pacemakers increased from 27,518 in 2012 to 36,322 in 2013 (32% increase)
*The most common indication for pacemaker implantation all over the world is sinus node dysfunction followed by AV Block. But in India AV block forms 65% of the indications as against sinus node dysfunctions which is an indication in only 25% cases.
*Globally single chamber pacemakers are used only in chronic Atrial Fibrillation with low heart rate or in very elderly patients. In all other situations, dual chamber pacemakers are used. However in *India out of 36322, 14477 patients still get single chamber pacemakers. With single chamber pacemakers, one may not get a good quality of life in the long run.
*Out of 100 pacemakers implanted, 86% are new implants and 14% are replacement implants (old pacemaker being replaced).
*There are only 0.7 centers which implant pacemakers per million population in the country.
*In India 70% people pay for their own treatment including the cost of pacemakers. The government and the insurance sector both public and private, reimburse only 10% and 20% respectively One essential point to keep in mind in India is that after the death of a person, a pacemaker needs to be removed before a patient is put on fire as otherwise it runs the risk of exploding. Many centers globally believe in re-implanting extracted pacemakers however there are no consensus guidelines on this issue in India.