Globally, cardiovascular diseases (CVDs) are the number one cause of death and more people die every year from CVDs than any other cause. In 2016, approximately 17.9 million people died from CVDs, that accounted for 31 percent of all global deaths in that year. Low and middle-income countries are the most affected, as more than three-quarters of deaths are caused by cardiovascular diseases in these nations. About 37 percent of premature deaths in low and middle-income countries are due to cardiovascular diseases. Case fatality ratio of cardiovascular diseases in low-income countries is much higher as compared to middle and high-income countries. In 2013, all member states of the WHO agreed to be part of a ‘Global action plan for the prevention and control of NCDs 2013-2020’. As part of the plan, the countries aim to lower the number of premature deaths from NCDs by 25 percent by the year 2025 through nine voluntary global targets. Of these, two global targets are designed to directly work on the prevention and control of cardiovascular diseases.
Impact of Cardiovascular Diseases in India
According to a study published in a health journal (The Lancet) in 2018, cardiac diseases claimed more Indian lives (28 percent) compared to other non-communicable diseases. The number of deaths caused by cardiovascular diseases in India rose from 1.3 million in the year 1990 to an estimated 2.8 million in 2016. In India, the death rate continues to rise, while it has decreased substantially in the US in the past 15 years. The study also suggested that obesity may not be the root cause of CVD deaths in India. It was estimated that cardiovascular ailments were responsible for causing more than 2.1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. The study also showed that in the age group of 30-69 years, of the 1.3 million cardiovascular deaths, 0.9 million (68.4 percent) were caused by coronary heart disease and 0.4 million (28.0 percent) by stroke. Rural India has seen more CVD related deaths than urban India, which is alarming.
As per another study on CVDs by Elsevier, the death rate due to CVDs in the US fell to 41 percent between 1990 and 2016, while it saw an increase in India from 155.7 to 209.1 deaths per one lakh population in the same span. The reason for the low rates can be attributed to preventive measures like a healthy lifestyle, decline in risk factor trends like tobacco use, high cholesterol and blood pressure in the US population and a better secondary and acute care. As for ischemic heart disease and stroke, they account for about 15-20 percent of all deaths in India and 6-9 percent in the US. India can also lower CVD death rates and complications arising from CVDs through the implementation of population-level policies while simultaneously working towards strong and well-integrated health systems (local, regional as well as national).
New Trends in Cardiovascular Medicine
In 2019, trends point to many advancements in treatment of CVDs, like increased use of direct oral anticoagulants (DOACs) in atrial fibrillation (AFib) and other conditions, new standards in the management of mitral valve regurgitation (MR) in patients suffering from heart failure, larger use of transcatheter aortic valve replacement (TAVR), greater roles for implantable and wearable devices and the data collected by these devices, and the use of AI in cardiovascular medicine as well as focus on cost and value of treatments. The use of anticoagulation medicine(DOACs like dabigatran) in patients with cardiovascular diseases is set to increase due to the availability of drug-specific reversal agents. Wearable devices like built-in heart rate monitors and single-lead electrocardiograms (ECGs), may be increasingly used by doctors in 2019 to detect rhythm abnormalities in the heart and to predict whether or not anticoagulation medicine can be used.
AI (Artificial Intelligence) is set to change the cardiovascular field in many areas in 2019. It is already being used to fine-tune the selection of possible treatments by looking for patterns in molecular biology, structure-function, and clinical trial databases. It can remotely filter out clinically actionable data from the vast data collected by wearable devices. It can also lend itself greatly in the application of precision medicine by assessing the genetic information, environment, and lifestyle of patients, and zeroing in beneficial interventions based on the data. AI can also help in the integration of data from various sources that are used to treat CVDs like social media, the electronic health record (EHR), and wearables. It can increase the efficiency of treatment by lowering repetitive tasks, and prioritizing EHR-based alerts or messages, improving and automating image interpretation in the catheterization or echocardiography laboratory, and integrating data from relevant sources to present a favourable treatment plan for individuals.
AI is yet to, however, make a huge impact in clinical practice given its complexity and lack of data on reasons behind predicted outcomes or preferred treatments. However, patients are increasingly veering towards wearable devices that can potentially prevent CVDs. The accuracy of these devices is yet to be ascertained, but it may affect treatment outcomes when it comes to CVDs. Health devices may slowly be incorporated into clinical practice as more evidence of their importance in disease prevention/treatment emerges. In 2019, other trends point towards increased attention towards tricuspid valve disease, more growth of treatment alternatives for structural heart disease, as well as a significant understanding of the utility of interventional therapies and devices for atrial fibrillation. Considerable efforts may be made towards ensuring cost-effectiveness in cardiovascular disease treatments, be it lowering drug and device costs (coronary stents are expensive) or increased access to care and better and yet affordable technology.