Access to quality and timely healthcare continues to elude Indians

Health Care, Heart Care Foundation of India, Medicine Comments Off

A stringent and comprehensive policy that addresses varied aspects of healthcare delivery is the need of the hour

New Delhi, 23 May 2018: As per a recent study by Lancet, India ranks 145th among 195 countries in terms of quality and accessibility of healthcare, behind its neighbors like China, Bangladesh, Sri Lanka, and Bhutan. Although India’s improvements on the healthcare access and quality (HAQ) index hastened from 2000 to 2016, the gap between the country’s highest and lowest scores widened (23•4-point difference in 1990, and 30•8-point difference in 2016).
India also performed poorly in tackling cases of tuberculosis, rheumatic heart diseases, ischemic heart diseases, stroke, testicular cancer, colon cancer, and chronic kidney disease among others. There are also large disparities in subnational levels of personal HAQ in several countries, especially China and India.
Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Healthcare is not an electoral issue in India and government investment in public health has been very poor – at just about 4.7% of its GDP. Access to quality and timely healthcare is a universal right. However, many Indians, especially those below the poverty line, are unaware of this very right. There are hospitals where BPL families can avail treatment at no cost. But the fact that there is no redressal mechanism to make the aware of these options exacerbates the problem and they end up paying out of their pockets. Then there are issues such as poor management, corruption, accountability, and ethics which compound the problem. States such as Tamil Nadu and Kerala can serve as examples. In these, health services are part of the electoral mandate, and therefore, the quality of services is better.”
Part IV of the Constitution of India talks about the Directive Principles of State Policy. Article 47 under part IV lists the “Duty of the State to raise the level of nutrition and the standard of living and to improve public health”.
Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “The need of the hour is an urgently integrated action on health care to make it universally accessible and affordable at the same time. This will not only help address the health needs but also have a positive effect on poverty and growth levels. A strategy that makes citizens more competitive and act as an asset to the country’s growth is what is required at this juncture.”
While the demand for access to better and quality healthcare services continues, each one of us has a responsibility to take care of ourselves.
• Develop healthy habits including eating, sleeping, and exercising right.
• Do not overdo anything. From drinking to using the cell phone, everything must be in moderation.
• Follow ancient wisdom. Do Yoga and Meditation for your mental and spiritual wellbeing and maintain equilibrium. Allow your body to heal itself.
• Get periodic checkups done. Early detection of most health problems can help in correcting lifestyles to slow the degeneration process and lead a longer and healthier life.
• Both active and passive smoking are harmful for the body. In addition, manage your blood cholesterol, blood pressure as well as diabetes and maintain optimum weight. Limit your salt intake.

Lipid management: Individualize treatment

Health Care Comments Off

Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality. An acute cardiac event can be prevented by effective management of risk factors including dyslipidemia, which is a major risk factor for initiation and progression of the atherosclerotic process and thereby to cardiovascular events. Hence, managing thedyslipidemia-related cardiovascular risk in these patients is important for secondary prevention of CAD.

Major professional cardiology and endocrinology associations have issued guidelines on management of dyslipidemia, which differ in their approaches in managing lipids in these patients regarding assessment of risk, lipid goals and targets and pharmacological treatment.

Latest in this list of guidelines on management of dyslipidemia are recommendations from the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) released in 2017. These guidelines have for the first time defined an “extreme” cardiovascular risk category and also bring back the concept of ‘target’-based lipid management.

The AHA/ACC guidelines issued in 2013 had recommended “appropriate intensity” of statin therapy for the four groups of primary- and secondary-prevention patients instead of treating dyslipidemia to specific ‘targets’. Hence, these guidelines removed specific targets or goals for LDL- or non-HDL-cholesterol … a change from the ATP III recommendations in 2001, which advised determination of risk category and set goals according to the risk category.

The 2017 AACE/ACE guidelines have categorized patients into five atherosclerotic cardiovascular disease (ASCVD) risk categories – low risk, moderate risk, high risk, very high and extreme risk – and now recommend lipid goals for all the five categories.

Low risk: Individuals with no risk factors: LDL < 130 mg/dL, non-HDL < 160 mg/dL, apoB not relevant is recommended.
Moderate risk: Individuals with 2 or fewer risk factors and a calculated 10-year risk < 10%: LDL < 100 mg/dL, non-HDL < 130 mg/dL, apoB < 90 mg/dL is recommended.
High risk: Individuals with an ASCVD equivalent including diabetes or stage 3/4 CKD with no other risk factors, or individuals with ≥2 risk factors and a 10-year risk of 10%- 20%: LDL < 100 mg/dL, non-HDL < 130 mg/dL, apoB < 90 mg/dL is recommended.
Very high risk: Individuals with established or recent hospitalization for acute coronary syndrome (ACS); coronary, carotid or peripheral vascular disease; diabetes or stage 3/4 CKD with ≥1 risk factors; a calculated 10-year risk > 20%; or heterozygous familial hypercholesterolemia [HeFH]): LDL < 70 mg/dL, non-HDL < 80 mg/dL, apoB < 80 mg/dL is recommended.
Extreme risk: Individuals with progressive ASCVD, including unstable angina that persists after achieving an LDL <70 or established clinical ASCVD in individuals with diabetes, stage 3/4 CKD, and/or HeFH, or in individuals with a history of premature ASCVD (males <55 years; females <65 years): LDL < 55 mg/dL, non-HDL < 80 mg/dL, apolipoprotein B (apoB) < 70 mg/dL is recommended.

Lowering cholesterol is important for all age groups, both men and women, regardless of the presence of absence of heart disease. A 1% rise in cholesterol level can raise the chances of heart attack by 2%. 1% reduction of “good” HDL cholesterol increases the chances of suffering from a heart attack by 3%.

However, it is important to keep in mind that every patient is different; hence, treatment, including lipid goals should be individualized according to that particular patient.