INTERVENTION IN CHD WHEN AND

Transcription

1 SCENARIO OF CARDIOVSCILAR DISEASE IN NEPAL INTERVENTION IN CHD WHEN AND HOW DR. YADAV BHATT MBBS, MD (Med) DM (Cardiology) DNB Fellow in Interventional Cardiology MBBS, (Escorts heart MD institute) (Med) DR. YADAV BHATT DM (Cardiology) CARDIOLOGIST DNB GANGALAL Interventional NATIONAL HEART Cardiology CENTER (Escorts Heart Institute) PROFESSOR CARDIOLOGY NATIONAL ACADEMY OF MEDICAL SCIENCES GANGALA NATIONAL HEART CENTER CHIEF OF CATH LAB, NORVIC ESCORTS INTERNATIONAL HOSPITAL

2 SCENARIO OF CARDIOVASCULAR DISEASE IN NEPAL CHINA INDIA

3 Area: sq. kilometers Population: 27,000,000

4 CHINA HILLS HIMALAYAS INDIA TARAI NEPAL IS CLEARLY DEMARCATED INTO THREE REGIONS

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6 THE HIMALAYA REGION

7 THE HILLS

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9 International & domestic airports International flight connections ACCESSIBILITIES 13 online carriers:thai Airways, Austrian Air, Indian Airlines, Jet Airways, Sahara Air, China Southwest Airlines, Druk Airlines, Gulf Air, Qatar Airways, PIA, RNAC, Cosmic Air, Air Nepal Catering Services to:20 major international cities including Mumbai, Bangkok, New Delhi, Singapore, Hong Kong, Kolkata, Dubai, Shanghai, Osaka, Dhaka, Karachi, Thimpu, Abu dhabi, Varanasi, Kuala Lampur 22 Direct flights per week from Europe 15 Direct flights per week from middle east 24 Direct flights per week from far east 53 Direct flights per week from south asia 8-10 flights from china/week Adequate local ground transportation

10 Cardiovascular disease has become ubiquitous cause of morbidity and mortality

11 TRAGEDY WITH CVD ACCORDING TO WHO 30% OF GLOBAL DEATH IN 1998 DUE TO CVD = 15.3 MILLION LIVES LOST THAT YEAR LOW AND MIDDLE INCOME COUNTRIES CONTRIBUTED 78% OF DEATHS

12 SAHID GANGALAL NATIONAL HEART CENTER 80000/ year

13 CARDIOVASCULAR RISK FACTORS Tobacco consumption Year Place Population Prevalence Remarks 1983 Kathmandu (urban) >20,both sex 37 Current 1983 Kathmandu (rural) >20,both sex 68.4 Current 1983 Parsauni (Terai, rural) >20,both sex 54.7 Current 1983 Jumla (mountain, rural) >20,both sex 77.7 Current 1999 Dharan (East Nepal, urban) College students 24.8 Current 2001 Dharan (East Nepal, urban) >35 years, females 30.3 Current 2001 Dharan (East Nepal, urban) >35 years, females 16.5 Smokeles s 2004 Dharan (East Nepal, urban) >35 years, males 74 Current/e x Pandey MR. Hypertension in Nepal. Mrigendra Medical Trust Niraula SR. Tobacco Use among Women in Dharan, Eastern Nepal. J Health Popul Nutr 2004;22(1):68-74 Jha N et al. Prevalence of tobacco use among college students of Dharan, eastern Nepal. Nepal Journal of Science and Technology 2002; 4: Research report on NCD risk factors surveillance in Nepal, 2003 Vaidya A et al.prevalence of Coronary Heart Disease in the Urban Adult Males of Eastern Nepal: A populationbased analytical cross-sectional study 13

14 CARDIOVASCULAR RISK FACTORS Diabetes mellitus Year Place Age Prevalence % 2005 Dharan (East Nepal, urban) >35 years, males Kathmandu (urban) >40,both sex 19.0

15 CARDIOVASCULAR RISK FACTORS Hypertension Year Place 1983 Kathmandu (urban) 1983 Kathmandu (rural) 1983 Parsauni (Terai, rural) 1983 Jumla (mountain, rural) 1998 Kathmandu (low altitude) Khumbu (high altitude) 2004 Dharan (East Nepal, urban) Population Prevalence % >20,both sex 9.98 >20,both sex 5.98 >20,both sex 8.11 >20,both sex 5.30 Sherpa, men >35 years, males Kathmandu >18 Men Female Overall Pandey MR. Hypertension in Nepal. Mrigendra Medical Trust Research report on NCD risk factors surveillance in Nepal, 2003 Vaidya A, et al. Exploring the iceberg of hypertension: A community based study in an Eastern Nepal town. KUMJ (2007), 5(3): Shrestha UKet al. 15

16 HYPERTENSION STUDY NUMBER 1114 ( 2005) MEN 541 FEMALE 573 AGE YEARS MEAN 37.8 ±16.3

17 HYPERTENSION PREVALENCE OF HTN 22.2% IN MEN 17.3% IN WOMEN OVERALL PREVALENCE 19.7% AGE DISTRIBUTION 4.1% < 30 YEARS >40% IN > 50YEARS

18 PREVALENCE OF HYPERTENSION AGE DISTRIBUTION AGE GROUP HTN SUBJECTS TOTAL NUMBER PREVALEN CE % < >

19 HTN JNC VII CATEGORY NUMBER PERCENTAGE NORMAL PRE- HTN HTN

20 HTN AWARENESS 44.7% ASYMPTOMATIC 55% SYMPTOMATIC 76% HEADACHE 48.8% DIZZINESS 58.9% UNAWARE OF THEIR HTN 41.1% AWARE OF THEIR HTN

21 CHANGING TREND IN HTN STUDY IN 1981: PREVALENCE 5.98% (WHO 1978 CRITERIA ± 165/95) LATEST 2005 STUDY (SAME CRITERIA) PREVALENCE WOULD BE 11%

22 EXPLORING THE ICEBURG OF HTN Diagnosed and controlled (34.01%) Diagnosed and uncontrolled (24.13%) Undiagnosed (41.86%)

23 CARDIOVASCULAR RISK FACTORS LIPIDS mg% NAKANISHI 1997 KARKI 2004 LIMBU 2008 TC 152± ± 184± TG 121± ± ±88.7 HDL 28± ± ±11.7 LDL 84.97± ±42.0

24 CARDIOVASCULAR RISK FACTORS SEDENTARY LIFESTYLE < 10 mins of walk / day No physical activity Job, leasure time, house hold 4 days a week Broca s index-ht in cm 100 Smokeless--- khaini etc

25 CARDIOVASCULAR RISK FACTORS METAB0LIC SYNDROME IN INDIA 1/3 rd URBAN POPULATION HAVE METABOLIC SYNDROME ONSET AT AGE MENIFESTATION YEARS LATER Ie. AT AGE YEARS

26 CARDIOVASCULAR RISK FACTORS Obesity Year Place Kathmandu (urban) 1983 Kathmandu (rural) 1983 Parsauni (Terai, rural) 1983 Jumla (mountain, rural) 2004 Dharan (East Nepal, urban) 2004 Dharan (East Nepal, urban) Population Prevalence Remarks >20,both sex 24.3 Broca s Index >20,both sex 12 Broca s Index >20,both sex 9.2 Broca s Index >20,both sex 8.3 Broca s Index >35 years, males 40.1 BMI >35 years, males 51.2 WHR Sedentary lifestyle Year Place Population Prevalence Remarks 2003 National 18-69, both sex Kathmandu (urban) 25-64, both sex Dharan(East Nepal, urban) >35 years, males 44.1 Pandey MR. Hypertension in Nepal. Mrigendra Medical Trust Vaidya A et al. Association of Obesity and Physical Activity in Adult Males of Dharan, Nepal. KUMJ 2006; 4(2): World Health Organization. World Health Survey, Nepal. Research report on NCD risk factors surveillance in Nepal,

27 Prevalence of Metabolic Syndrome MALES 16.9% FEMALES 8.7 % TOTAL 12.4 Sharma D at al, NHJ 2009

28 RISK FACTORS in CAD PATIENTTS SMOKING 82% HTN 40% DAIBETES 22% HLP 25%

29 METABOLIC SYNDROME CRITERIA AHA / NHBLI 1. WAIST CIRC: >= 90 cm male >= 80 cm female 2. TG >= 150 mg% 3. HDL <= 40 mg% male <= 50 mg female 4. BP >= 130 mmhg >= 85 mmhg 5 BLOOD SUGAR >= 100 mg % (F)

30 CARDIOVASCULAR DISEASES Nepalese in general have poor knowledge of CV health Limbu YR, et al. Public knowledge of heart attack in a Nepalese population Survey. Journal of Acute & Critical Care. 2006; 35(3):

31 RHEUMATIC HEART DISEASE PREVALENCE RHD: 1.2/1000

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34 PATTERN OF VALVULAR INVOLVEMENT IN RHD N= 9521 RHD CASES MALES ( 40.6%) 5654 FEMALES (50.4%)

35 RHD - VALVULAR INVOLVEMENT MS/ MR 16.7% MR 16.1% MS 15.5% MR/AR 12.1% MR/MS/AR 11.8% AV 4.21% MV INVOLVEMENT 95.79% VALVULAR INVOLVEMENT 7.2%

36 RHD INTERVENTIONS 400 PERCUTANEOUS MITRAL VALVOTOMIES LAST YEAR 1300 SURGERIES DONE LAST YEAR 30% WERE RHD CASES

37 CONGESTIVE HEART FAILURE BECOMING COMMONEST DISEASE IN THE WORLD SAME TREND IN OUR COUNTRY

38 ADMISSION IN INTENSIVE CARE 8% 20% 13% 5% RHD 28% DCM VHD IHD Arrhy ACS 18% 8% HTN

39 ADMISSION IN INTENSIVE CARE 20% 5% CHF IHD Arrhy 8% 13% 54% ACS HTN

40 CORONARY ARTERY DISEASE Population studies indicate high CHD burden Population-based Estimation of Prevalence of CHD in Nepal Year Place Prevalence 1997 Kathmandu (urban) Dharan (urban) 5.7 ( ) Shrestha UK et al. (Personal communication) Vaidya A et al.prevalence of Coronary Heart Disease in the Urban Adult Males of Eastern Nepal: A population-based analytical cross-sectional study 40

41 CORONARY ARTERY DISEASE Among hospital admissions CAD 21.7% MALES 74% FEMALES 26%

42 RISK FACTORS in CAD PATIENTTS SMOKING 82% HTN 40% DAIBETES 22% HLP 25%

43 RISK FACTORS in CAD PATIENTS 22 % 25 SMOKING 82 HTN HLP DIABETES 40

44 TRENDS IN CAD YOUNGER POPULATION NO PREVIOUS ANGINA INFERIOR MI FREQUENT CAUSE OF DEATH

45 CONGENITAL HEART DISEASE CONGENITAL HEART DISEASE PREVALENCE 1.3/1000 COMMONEST LESION ATRIAL SEPTAL DEFECT VENTRICULAR SEPTAL DEFECT

46 CATH LAB PROCEDURES 3000 CASES/ YEAR 10% 9% 9% 5% 2% CAG PTMC PTCA 51% RHC PACING EP/RFA 14% OTHERS

47 CARDIOVASCULAR SURGERY 1300/ YEAR 17% 5% 39% Congenital valvular CABG 9% Vascular others 30%

48 WHAT ARE WE DOING Where advanced health care service is in accessible.

49 RHD FREE PENICILLINE PROPHYLAXIS

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54 Problems Lack of adequate research on risk factors and other aspects on CVD Lack of intermediate-level manpower No national policy/programme on CV diseases Centralization of specialist heart care CVD not included in primary health care system Cost of intervention/surgery unaffordable Insufficient emphasis on preventive measures

55 THANK YOU