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New drugs and clinical trials for novel treatment options enable cardiologists to save patients from heart failure. Going by the spike in heart diseases and disorders post Covid-19, cardiologists face the challenge to treat if patients do not come in early.
On the occasion of the World Heart Day observed annually on September 29, with the theme Beating cardiovascular disease (CVD), cardiologists pinpoint diabetes and tobacco as the top two risk factors for heart disease in India. Diabetics are three times more prone for a heart attack than non-diabetics. . Smoking is also dangerous, due to which we are seeing many young patients of heart attack.
Noting that Covid-19 patients suffer heart attack and heart failure in the post-Covid period, their incidence has gone up by more than one-fourth in the last one year, said Dr L K Jha, associate director, cardiology, Sarvodaya Hospital, Sector 8, Faridabad.
“Patients who had to be hospitalized or put on ventilator due to Covid are now much more vulnerable to heart complications, and we are seeing a considerable surge in such cases. Covid affects the heart in two ways. First is direct infection of the heart muscle, due to which it weakens, leading to heart failure. The second is after Covid, a mild infection persists in the body for many months. The arteries remain inflamed, leading to the tendency of clotting inside the heart. This results in heart attack and other complications. Severe Covid cases need to take precautions as blood tests measure inflammatory markers like ESR and High-sensitivity C-reactive Protein (hs-CRP), added Dr Jha.
According to Dr Kumar Kenchappa, consultant, Interventional Cardiology, Manipal Hospital, Hebbal, Bengaluru, new drugs are available for heart failure management. There is ample data to prescribe SGLT2 inhibitors like empaglifazolin/dapaglifazolin which are basically antidiabetic drugs. A new molecule Vericiguat which is a soluble guanylate cyclase stimulator (sGC stimulator) enhances Nitric Oxide activity on the endothelium for use in acute decompensated heart failure patients. There is also Cangrelor which is an injectable antiplatelet medication, which can be used during PTCA (percutaneous transluminal coronary angioplasty). Besides clinical studies like the ADVOR trial indicate acetazolamide is beneficial in acute decompensated heart failure.
The biggest challenge is the acceptance of the disease by the patients and family who are always in denial and doubt the diagnosis which causes delay in treatment. Patients usually reach late to the hospital after the golden hour which is over 60 minutes of onset of cardiac symptoms resulting in unfavourable outcomes, said Dr Kenchappa.
“Deteriorating heart health amongst younger generation is becoming a grave area of concern for India country. This condition which was predominantly seen in 55 years age-group is now affecting people in 20s and 30s owing to poor lifestyle, bad diet, increase in stress and negligence for conditions like sugar and BP, said Dr. Gundurao Harish Joshi, consultant, adult cardiology, Narayana Multispeciality Hospital, HSR Layout, Bengaluru.
Owning to better treatment modality being available, around 95% of those admitted within the golden hour which is within one hour can be saved, however, preventing the onset is far most effective, Dr Joshi added.
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