Experts explain why heart failure should be a public concern

Agencies
April 8, 2018

New Delhi, Apr 8: Heart Failure is a progressive, debilitating and potentially life-threatening condition, which is responsible for silently killing one-third of patients during hospital admission and one-fourth within 3 months of diagnosis.

On World Health Day 2018, the Cardiological Society of India (CSI) has urged the people to prioritise heart failure as a public health priority. The need of the hour is to develop a comprehensive approach to combat heart diseases in India which is on its way to becoming an epidemic in the country.

Focusing on the 'Health for all' theme of World Health Day 2018, the CSI calls for introducing programmes concentrating on screening and detection of symptoms of heart diseases amongst the rural population as such initiatives need to be scaled up across the country.

It is important that the growing incidence of heart failure should be seen as a public health challenge to further reduce mortality and morbidity due to heart failure.

'Heart failure' doesn't mean that the heart is about to stop working, but it is a potentially life-threatening condition where the heart cannot pump enough blood around the body. This, in most cases, happens because the heart muscle, which is responsible for the pumping action, weakens or stiffens over time.

According to the Non-Communicable Diseases Country Profiles released by the WHO, of the estimated 98.16 lakh deaths in India, NCDs led to nearly 6 million, which is 60 percent of the total mortality reported annually in the country.

Cardiovascular diseases (CVDs) are the leading cause of mortality, accounting for more than half of all deaths resulting from NCDs. The burden of CVDs is rising at a significantly high rate amongst middle-income and lower-income geographies.

According to Dr. K. Sarat Chandra, President, Cardiological Society of India, "Indians have all the reasons to be alarmed over matters of the heart. With the burden of heart failure snowballing in India and the associated high death rates, it is necessary to recognize heart failure as a public health priority in the country. The disease has socio-economic and emotional implications for the patient and his family, impacting the overall quality of life. The need of the hour is for all stakeholders to come together to develop a community-level approach to raise awareness about this condition."

The increased prevalence of heart diseases in India can be attributed mainly to lifestyle factors like tobacco use, unhealthy diet, physical inactivity and psychosocial stress. Heart failure is a global health problem, affecting about 26 million people worldwide. The disease burden of heart failure is around 10 million in India.

Dr Ambuj Roy, Additional Professor of Cardiology, AIIMS, New Delhi, said, "Untreated Heart Failure is a rapidly progressive and potentially fatal condition, so it is important to recognize the symptoms promptly and get treated at the earliest to prevent a rapidly downhill course. This is especially critical, since there is no way to reverse the damage already done, and treatment helps in containing further damage to the heart and other body organs. Simple medicines and in some cases implantable devices are known to benefit these patients and prolong their survival."

Data from low-income and middle-income countries like India suggested that mortality in patients with heart failure in these countries is greater than that in high-income countries. It is estimated to have cost about US$100 billion in 2012. The marked variation in mortality is attributed to low awareness, economic disparity, and ease of access to high-quality healthcare facilities, environmental and genetic factors.

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Agencies
June 24,2020

New Delhi, Jun 24: Expanding the testing criterion for coronavirus, the Indian Council of Medical Research has said it should be made widely available to all symptomatic individuals across the country.

"Since test, track and treat' is the only way to prevent spread of infection and save lives, it is imperative that testing should be made widely available to all symptomatic individuals in every part of the country and contact tracing mechanisms for containment of infection are further strengthened," it said in an advisory on 'Newer Additional Strategies for COVID-19 Testing' on Tuesday.

In its revised testing strategy for COVID-19 issued on May 18, the Indian Council of Medical Research (ICMR) had advised testing for all symptomatic Influenza-like illness (ILI) among returnees and migrants within seven days of illness.

All hospitalised patients who develop ILI symptoms, symptomatic individuals living within hotspots or containment zones and healthcare and frontline workers involved in containment and mitigation of coronavirus were also advised testing.

The apex health research body has also advised authorities to enable all government and private hospitals, offices and public sector units to perform antibody-based COVID-19 testing for surveillance to help allay fears and anxiety of healthcare workers and office employees.

The earlier advisories on rapid antibody testing advisories had focused on areas reporting clusters (containment zones), large migration gatherings/evacuees centers and testing of symptomatic ILI individuals at facility level.

Besides, the ICMR on Tuesday also recommended deployment of rapid antigen detection tests for COVID-19 in combination with RT-PCR tests in all containment zones, all central and state government medical colleges and government hospitals, all private hospitals approved by the National Accreditation Board for Hospitals and Healthcare (NABH), all NABL-accredited and ICMR approved private labs, for COVID-19 testing.

All hospitals, laboratories and state governments intending to perform the point-of-care antigen tests need to register with ICMR to obtain the login credentials for data entry.

"ICMR advises all state governments, public and private institutions concerned to take required steps to scale up testing for COVID-19 by deploying combination of various tests as advised," the advisory added.

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Agencies
June 21,2020

Lower neighbourhood socioeconomic status and greater household crowding increase the risk of becoming infected with SARS-CoV-2, the virus that causes COVID-19, warn researchers.

"Our study shows that neighbourhood socioeconomic status and household crowding are strongly associated with risk of infection," said study lead author Alexander Melamed from Columbia University in the US.

"This may explain why Black and Hispanic people living in these neighbourhoods are disproportionately at risk for contracting the virus," Melamed added.

For the findings, published in the journal JAMA, the researchers examined the relationships between COVID-19 infection and neighbourhood characteristics in 396 women who gave birth during the peak of the Covid-19 outbreak in New York City. Since March 22, all women admitted to the hospitals for delivery have been tested for the virus, which gave the researchers the opportunity to detect all infections -- including infections with no symptoms -- in a defined population

The strongest predictor of COVID-19 infection among these women was residence in a neighbourhood where households with many people are common.The findings showed that women who lived in a neighbourhood with high household membership were three times more likely to be infected with the virus. Neighbourhood poverty also appeared to be a factor, the researchers said.Women were twice as likely to get COVID-19 if they lived in neighbourhoods with a high poverty rate, although that relationship was not statistically significant due to the small sample size.

The study revealed that there was no association between infection and population density.

"New York City has the highest population density of any city in the US, but our study found that the risks are related more to density in people's domestic environments rather than density in the city or within neighbourhoods," says co-author Cynthia Gyamfi-Bannerman."

The knowledge that SARS-CoV-2 infection rates are higher in disadvantaged neighbourhoods and among people who live in crowded households could help public health officials target preventive measures," the authors wrote.

Recently, another study published in the Journal of the American Planning Association, showed that dense areas were associated with lower COVID-19 death rates.

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Agencies
July 7,2020

The World Health Organization (WHO) is reviewing a report that suggested its advice on the novel coronavirus needs updating after some scientists told the New York Times there was evidence the virus could be spread by tiny particles in the air.

The WHO says the Covid-19 disease spreads primarily through small droplets, which are expelled from the nose and mouth when an infected person breaths them out in coughs, sneezes, speech or laughter and quickly sink to the ground.

In an open letter to the Geneva-based agency, 239 scientists in 32 countries outlined the evidence they say shows that smaller exhaled particles can infect people who inhale them, the newspaper said on Saturday.

Because those smaller particles can linger in the air longer, the scientists - who plan to publish their findings in a scientific journal this week - are urging WHO to update its guidance, the Times said.

"We are aware of the article and are reviewing its contents with our technical experts," WHO spokesman Tarik Jasarevic said in an email reply on Monday to a Reuters request for comment.

The extent to which the coronavirus can be spread by the so-called airborne or aerosol route - as opposed to by larger droplets in coughs and sneezes - remains disputed.

Any change in the WHO's assessment of the risk of transmission could affect its current advice on keeping one-metre physical distancing. Governments, which also rely on the agency for guidance policy, may also have to adjust public health measures aimed at curbing the spread of the virus.

"Especially in the last couple of months, we have been stating several times that we consider airborne transmission as possible but certainly not supported by solid or even clear evidence," Benedetta Allegranzi, the WHO's technical lead for infection prevention and control, was quoted as saying in the New York Times.

WHO guidance to health workers, dated June 29, says that SARS-CoV-2, the virus that causes Covid-19, is primarily transmitted between people through respiratory droplets and on surfaces.

But airborne transmission via smaller particles is possible in some circumstances, such as when performing intubation and aerosol-generating procedures, it says.

Medical workers performing such procedures should wear heavy-duty N95 respiratory masks and other protective equipment in an adequately ventilated room, the WHO says.

Officials at South Korea's Centers for Disease Control said on Monday they were continuing to discuss various issues about Covid-19, including the possible airborne transmission. They said more investigations and evidence were needed.

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