India, expected to account for 60 per cent of the world's heart disease cases by 2010, could prevent many deaths by ensuring the poor get better access to treatment, Indian and Canadian researchers said on Friday.
Their study published in the journal Lancet found that people with heart disease in India get slower care than people in developed countries and are more likely to die.
The rare in-depth look at heart disease care in India also shows heart patients tend to be younger, with an average age of 57, than heart patients in many other countries.
The researchers paint a picture of heart attack patients heading to hospitals in rickshaws rather than ambulances, and paying for the cheapest possible treatments out of their own pockets.
India will account for 60 per cent of the world's heart disease cases by 2010, Dr Denis Xavier at St John's National Academy of Health Sciences in Bangalore and colleagues there and in Canada said. South Asians have a higher prevalence of risk factors for heart disease and tend to get it earlier.
"Strategies to reduce delays to access to hospital, and to improve the affordability of urgent care could reduce morbidity (sickness) and mortality," they wrote in the journal Lancet.
Heart disease is the leading cause of death globally, killing about 7.1 million people each year. It is caused by fatty deposits that harden and block arteries, high blood pressure which damages blood vessels, and other factors.
The findings are the first comprehensive view of heart disease in India and can help lead to improvements in care, said Kim Eagle, a US researcher at the University of Michigan, who was not involved in the study.
"Few patients used ambulance"
"As the Indian economy grows, there is a possibility for further increase in cardiovascular disease before we see a decline similar to that being witnessed in developed countries," Eagle wrote in a commentary in Lancet.
Xavier's team studied 21,000 heart attack patients across 89 centres in 50 cities for their four-year study. They found time taken to reach the hospital was much longer in India at 300 minutes compared to between 140 minutes and 170 minutes in developed countries.
"Few patients used an ambulance to reach the hospital; most used private or public transport," they wrote.
The patients they studied were less likely to get surgery to clear clogged arteries than people in other countries because about three-quarters of patients in India pay directly for their own treatments.
Indian heart patients were just as likely as patients elsewhere to get recommended heart drugs such as blood thinners, clot busters and cholesterol-lowering drugs.
"This shows awareness of evidence-based treatments by Indian physicians, and the wide availability and the relatively low cost of generic drugs in India," the researchers wrote.
"The mortality rate was highest in poor patients," they added. Death rates were higher almost entirely because of differences in treatments and not risk factors, they added.