Rising heart attack rate outpaces surgery facilities in Bangladesh

Highlights:

• Heart attacks claims the highest 17.45% of Bangladeshi lives in 2022
• Bangladesh has has 42 cardiac care units in public and private facilities
• 32 hospitals are equipped to conduct cardiovascular surgery
• 50% succumb to heart attacks before reaching medical facilities
• 30,000 heart surgeries needed in Bangladesh every year
• But only 12,000 are surgeries performed

Despite heart attacks consistently ranking as the leading cause of death in Bangladesh, the country's medical infrastructure remains insufficient to effectively address this critical health concern.

According to medical professionals, while there has been an improvement in the quality of heart disease treatment, the quantity of services provided falls significantly short, with only one-third of the necessary heart surgeries performed annually.

Moreover, heart disease treatment is mostly centred in Dhaka city, leading to increased rates of premature death across the country.

Continuing a trend for years, heart attacks claimed the highest 17.45% of Bangladeshi lives in 2022, according to the latest data from the Bangladesh Bureau of Statistics (BBS). Combined with heart disease (3.67%), cardiovascular issues account for a significant 21.12% of all deaths in the country.

According to the Cardiac Surgeons Society of Bangladesh, the country has 42 cardiac care units in both public and private facilities, of which 32 hospitals are equipped to conduct cardiovascular surgery.

The latest Health Bulletin released by the Health Directorate shows the bed occupancy rate at the National Institute of Cardiovascular Diseases (NICVD) is 191.5%.

Dr Asraful Hoque Sium, the society's general secretary, told The Business Standard that only three government facilities – National Institute of Cardiovascular Diseases, Dhaka Medical College Hospital, and Chittagong Medical College Hospital – conduct cardiac surgeries.

He added, "Although Mitford Hospital once offered surgery, it is now closed. While angiogram facilities exist in Sylhet, Rangpur, and Khulna, they do not perform surgeries. The majority of private centres with cardiac surgery facilities are situated in Dhaka."

Professor Dr Nazmul Hosain, head of cardiac surgery at Chittagong Medical College Hospital, told TBS that cardiac surgery and heart treatment have improved in Bangladesh since 2000, but there are not enough surgeries.

"Around 25,000-30,000 surgeries are needed in Bangladesh every year, but only 10,000-12,000 are performed, leaving many patients untreated or going abroad for treatment," he added.

Citing a journal published in the Japan Medical Association last year, Dr Hosain said only 80-90 surgeries per million population are performed in Bangladesh, compared to 1,500 in the US and 1,200 in Germany.

Even in India and Pakistan, there are over 100 surgeries per million. Sri Lanka has the highest number of surgeries in this region, with 250 cardiac surgeries per million, according to the journal titled "Four Decades of Cardiac Surgery in Bangladesh: A Noble Journey That Started with the Help of Japan."

Dr Sohel Reza Choudhury, professor and head of the Department of Epidemiology and Research at the National Heart Foundation Hospital and Research Institute, said tobacco use, obesity, trans fat, high salt intake, lack of physical activity, and air pollution are contributing to the rise in heart disease and deaths.

"In Bangladesh, a major issue with heart disease is premature death. While in many other countries people over 70 are more affected, here, death under 70 is common, posing a significant challenge," he added.

Cardiac treatment in divisional cities

Dr Sium of the Cardiac Surgeons Society said many patients die before receiving hospital treatment, with 50% succumbing to heart attacks before reaching medical facilities.

He said self-sufficiency in heart treatment should be done in eight divisional cities so that no patient from the divisional city has to come to Dhaka. "Specific plans should be made to reduce heart disease deaths."

Dr Choudhury from the National Heart Foundation suggested prompt treatment within two to three hours of a heart attack, either through angioplasty or blood-thinning injections at district-level hospitals. 

He added, "Coronary care units (CCU) cannot be established everywhere, but medical colleges must provide adequate treatment to prevent premature death." 

Dr Robed Amin, director at the Non-Communicable Disease Control (NCDC), mentioned that the ongoing projects to establish cancer hospitals in eight divisional cities will also include kidney and cardiac units. 

"This will reduce the number of patients going to Dhaka for treatment. Additionally, ICUs are being established in all district hospitals, and medical college hospitals already offer treatment for heart disease," he added.

He further said NCD corners are set up at upazila hospitals to control diabetes and high blood pressure, offering free medicines along with awareness programmes.