India has made significant progress w.r.t advancements made in the cardiac care domain. From minimally invasive procedures to digital therapeutics, this segment has frog-leapt in the last decade. The cardiac care segment of Indian healthcare is poised to improve clinical outcomes and help India realise its goal of a heart-healthy and conscious society. World Heart Day celebrated on September 29th, brings to light the significant milestones our nation has achieved in curtailing the rising burden of cardiovascular diseases through a predictive, preventive and proactive approach.
By Sonali Patranabish
Cardiac care finds itself at the forefront of advancements and innovations, pursuing relentless progress in the world of healthcare. The last decade has witnessed significant advancements and transformations in the field of cardiac care. The evolving landscape of cardiac care has seen an outstanding shift from open-heart surgeries to minimally invasive interventions. The growth curve of cardiovascular disease management has frog-leaped resulting in improved patient outcomes, advanced prevention strategies, versatility in therapeutic options, refined cardiac interventions and enhanced diagnostic capabilities.
The cardiovascular disease burden in India has seen a quantum leap in recent times with coronary artery disease assuming high prevalence in the Indian subcontinent. CVD has been claiming the lives of millions in our country presenting itself as a pressing concern in the healthcare landscape. One cannot deny the overbearing impact of the rising CVD burden on the economic potential of our nation. As per a report published by the Harvard School of Public Health and the World Economic Forum report, in the period from 2012 to 2030, India will see substantial economic loss amounting to $2.17 trillion. Given the acute crisis of insufficient health resources and long-standing issues of affordability and accessibility, it is time India takes cognizance of this situation and takes proactive measures to infuse hope and stability.
However, the integration of technology has revolutionised the approach towards cardiac care. Technology has transformed treatment modalities and the approach towards CVD management. It is truly empowering individuals to play a proactive role in managing risk factors, making informed decisions with real-time data and getting timely valuable insights to navigate further course of action.
Demystifying the trajectory of cardiac care
With the multitude of risk factors pitted against the Indian population, Indians find themselves more susceptible to CVD in comparison to the Western population. Deaths due to CVD below the age of 70 stand at 52 per cent for India in comparison to the Western population at 23 per cent. This rings an alarm for all stakeholders in the healthcare industry to bolster their stand towards combatting NCDs.
This gory narrative has seen a phenomenal shift in recent times with key initiatives to enhance awareness, accessibility to medical facilities, and affordability of new-age therapies and products gaining impetus. Pioneering solutions and technologies like teleconsultations and digital therapeutics have revolutionised the cardiac care space in India.
Dr PRLN Prasad, Consultant Interventional Cardiologist, Gleneagles BGS Hospital Kengeri, Bengaluru opines, “The integration of cutting-edge technologies such as AI-driven diagnostics, robotic-assisted surgeries, and digital therapeutics has revolutionised the landscape of cardiac care.”
"The field of cardiac care is undergoing a significant transformation, with a notable shift towards non-invasive approaches for treating conditions like valvular pathologies, reducing the need for open-heart surgeries,” opines Dr Parin Sangoi, Consultant Interventional Cardiologist at Wockhardt Hospitals, Mumbai Central.
Key innovations shaping the cardiac care segment
The realm of innovations in cardiac care has entered a heady space, expanding its horizons while empowering and emancipating the lives of millions. A blend of innovative approaches like robotic surgery, regenerative stem cell therapy, nanotechnology, digital therapeutics etc are proving to be promising treatment modalities for CVD.
Advancements in pharmaceutical research have led to the development of novel drugs to manage cardiovascular conditions.
“ARNI for heart failure is so effective that I have seen many patients with severe pumping problems recovering completely,” opines Dr VC Chauhan Interventional Cardiologist, Bhailal Amin General Hospital, Vadodara.
He adds that very effective lipid-lowering medicines like Incliseran and weight-reducing medicines like Semaglutide are available.
“In patients with hypertrophic cardiomyopathy who remain symptomatic despite adequate medicines, where myectomy (major surgery) or septal alcohol ablation were the only high-risk options, Mavacamptan, a novel medicine working on RNA gives wonderful results reducing LVOT gradient to almost nil in few weeks,” opines Dr Chauhan.
Dr Prasad states that advanced imaging techniques and non-invasive testing have enabled early detection and more accurate diagnosis, paving the way for personalised treatment plans.
He further adds that Invasive cardiology has also seen significant strides with minimally invasive procedures like transcatheter valve replacements improving patient outcomes and reducing recovery times.
While not leaving out open heart surgeries, the foremost treatment modality for CVD, Prasad adds, "Open-heart surgeries have benefited from better surgical methods and sophisticated equipment, reducing risk factors and enhancing success rates.”
Structural heart diseases contribute to a significant part of CVD in our country. Congenital heart defects like Atrial septal defects ventricular septal defects and valvular heart disorders like aortic stenosis and mitral regurgitation can today be addressed with advanced treatment modalities instead of adopting invasive procedures like open heart surgeries. Advanced age, high risks and delayed recovery used to limit patients with available treatment options at one point in time, however, modern technologies have opened doors for those with these inherited heart disorders.
CATH labs in turn are redefining interventional cardiology. Equipped with cutting-edge technology, these state-of-the-art labs use catheter-based procedures to treat heart conditions with accuracy. Equipped with real-time imaging, CATH labs have made minimally invasive cardiac procedures a breeze to execute.
Furthermore, ultrasound technology serves as a key diagnostic tool in heart conditions. Without using a radiation source these effective diagnostic tools enable healthcare professionals to make informed decisions and execute procedures specifically tailored to individualistic needs.
Dr Kayan Siodia, Consultant Cardiology at PD Hinduja Hospital & MRC, Khar states that the cardiovascular domain has seen an imminent rise in minimally invasive surgeries.
“Minimally invasive coronary artery bypass grafting (MICAS), Robot-Assisted surgeries with da Vinci surgical system, and endoscopic mitral valve repair to name a few. In interventional cardiology, we have seen increasing use of plaque modification tools like lasers, orbital atherectomy, rotablation, intravascular lithotripsy, ultra high-pressure OPN balloons and intravascular imaging for procedure guidance like intravascular ultrasound (IVUS), optical coherence tomography (OCT), near-infrared imaging spectroscopy (NIRS)," opines Dr Siodia.
Dr Sangoi states that non-invasive approaches to cardiac care are gaining traction. Treatment of conditions like valvular pathologies is carried out using the non-invasive approach reducing the need for open-heart surgeries. Trans aortic valve replacement (TAVR) and Trans Catheter Mitral valve repair (TMVR) are revolutionary approaches in invasive cardiac care ensuring better clinical outcomes.
He further adds that procedures such as Transcatheter Aortic Valve Replacement (TAVR) and Percutaneous Coronary Intervention (PCI) are improving patient outcomes in terms of recovery times and post-operative complications.
Dr Siodia also adds that mitraclip, triclip and tric valve are other treatment options that have completely revolutionised the management of valvular diseases.
“Imaging technologies like Optical Coherence Tomography (OCT) and Intravascular Ultrasound (IVUS) are revolutionising precision medicine, offering detailed visualizations to optimise treatments.” opines Dr Sangoi.
Dr Sangoi also adds that Left Ventricular Assist Devices (LVADs) have helped to improve survival rates and quality of life in patients with advanced heart failures and serve as mechanical support, especially during heart transplantation.
Advancements have also been made to treat aortic valve diseases like aortic dissection and aneurysm. Instead of resorting to open heart surgeries which replace the damaged aorta with an artificial graft, advancements like stents can be implanted through delivery devices requiring minimal invasion.
“In invasive cardiology, newer technologies like IVL (intravascular lithotripsy) and Orbital Atherectomy are helping us tackle heavily calcified coronary artery blocks with much higher success rate and thus avoiding open heart surgery,” opines Dr Chauhan.
Dr Chauhan shares a few other advancements like the third-generation drug-eluting stents that have made angioplasty an easily maneuverable procedure. He further adds that a leadless pacemaker is another such advancement where no skin incision or pocket is needed.
Srimayee Chakraborty, Partner – Healthcare Services, EY Parthenon India, mentions, “Bypass surgery, specifically coronary artery bypass grafting (CABG), is experiencing several advancements in clinical techniques and protocols. In the last 10-20 years, off-pump/ beating heart surgery has already become the preferred choice of clinicians over on-pump surgery for CABG surgeries.”
Chakraborty further goes on to state, "Techniques like minimally invasive cardiac surgery and endoscopic vessel harvesting are leading to reduced trauma at surgical sites improving recovery and reducing chances of infection while usage of arterial grafts over saphenous vein grafts are leading to improved outcomes and reduced length of stay.”
Dr Siodia further states that advancements have even been made on the cardiovascular imaging front like 3D Echo, 4D MRI and intracardiac echocardiography (ICE). 3D printing and modelling allow the creation of personalised models of patients' hearts, allowing for better planning and simulation of complex procedures.
Crux of Cardiac Care – Digitisation
Personalised cardiology has been a thorough game changer for heart health in India. Personalised medicine has proved to be efficacious in prevention as well as prediction, when applied to cardiac care, personalised cardiology can help prevent heart attacks. 80 per cent of heart attacks and strokes are preventable, riding on this fact cardiologists and personalised cardiology services can offer valuable insights, lifestyle and dietary recommendations to ensure individuals have a healthy heart. Personalised cardiology services are a conglomerate of innovative solutions leveraging technology, data, AI and other remote monitoring tools.
Smart cardiac care devices have opened up avenues for patients to track down their vitals and focus on their heart health.
Subodh Gupta, CEO, Lord's Mark Microbiotech states that precision medicine is transforming cardiac care through genetic testing and technologies such as AI-driven diagnostics, telemedicine, and remote monitoring.
He further goes on to add, “Wearables and mobile apps for heart monitoring are gaining traction, enabling real-time tracking of heart health. In parallel, digital therapeutics are offering new ways to treat and manage heart conditions remotely."
Dr Siodia underscores the impact of digitization, which has paved the way for devices which can record, detect abnormalities and remotely transmit data to doctors. Remote monitoring technologies have enabled the tracking of patients' vitals, cardiac function, and rhythm from home. Implantable loop recorders help to record cardiac rhythm for up to three years.
Dozee's AI-based ballistocardiography (BCG), enables contactless monitoring of vitals like heart rate, blood pressure, SPO2 levels, and ECG. The EWS in turn alerts caregivers enabling timely medical intervention.
“Newer AI-based software helps integrate and analyze data from imaging, laboratory, biological, genomic, medical history and clinical parameters enabling efficient patient stratification and guiding therapeutic interventions. Also, AI-based imaging analysis is supplementing conventional software for cardiac MRIs and CT,” opines Dr Siodia.
OMRON Healthcare India in a bid to improve cardiovascular awareness has launched the first home BPM+ECG Monitoring device. This AI-based handheld ECG device can detect arrhythmias, including atrial fibrillation (Afib), bradycardia and tachycardia.
Smart Cardia is yet another AI-based platform that uses remote monitoring to streamline cardiac care. The SmartCardia 7L patch enables real-time transmission of ECG and vitals in cases of severe cardiac arrhythmia. This technology leverages AI to give timely alerts to healthcare providers in the form of data, and auto alerts on the cloud allowing them to make informed decisions.
Lyfe, a digital therapeutics platform, is India's first remote cardiac rehabilitation programme that can be accessed from the confines of one's home and is set to transform the dynamics of patient care. Approved by CDSCO as a class C medical device this empowers patients to maintain a healthy heart while also serving as a post-discharge integrative care solution.
Genetic testing to gauge an individual's heart health is also gaining steam.
MyDNA Cardio Geneguard by Lords Mark Biotech is a genetic test that helps an individual identify their predisposition to heart diseases. This test provides early risk assessment, valuable insights as well as a personalised roadmap in terms of interventions and lifestyle changes.
The future
The future of cardiac care is pivoted towards creating a comprehensive cardiac monitoring and management system. Tailored solutions like smart devices and wearable ECG monitors are going to shape evolving patient needs while empowering clinicians to make informed decisions.
“Combined with AI-driven diagnostics and the digitization of healthcare through telemedicine, the future of cardiac care in India is incredibly promising,” opines Dr Sangoi.
“While invasive treatments and emergency care will always have their place, the key to reducing the burden of heart disease is catching the risks early. This is where genetic testing will play an indispensable role.” opines Dr Gupta.
Dr Siodia opines that personalized cardiac care will take centre stage rather than the traditional one-size-fits-all all approach. The future of cardiac care is individualized genomic-based therapeutics and minimally invasive approaches.
He further adds that innovations like transcatheter valves, implantable devices and remote monitoring systems are likely to increase going forward.
Dr Susheel Kumar Malani, Cardiologist, DPU Super Speciality Hospital states that while we can expect improvements in surgical techniques, gene therapies targeted therapies, robots, cellular or regenerative medicine for organ transplantation, and percutaneous implantation of heart valve prostheses that can withstand multiple repetitions is expected to gain ground in the forthcoming years.
