 |
|
The recent media attention surrounding a reported spike in heart attack deaths in Karnataka's Hassan district, with claims of 20 fatalities in a single month, has triggered widespread public concern and prompted government action. However, preliminary data analysis and expert opinions suggest that the situation in Hassan, while undoubtedly tragic, may not be an anomaly when compared to the overall trend of heart attack-related deaths across the state. The Karnataka government, responding to the public outcry, has formed a committee to investigate the incidence in Hassan. But this investigation, based on initial findings and broader statistical analysis, appears to indicate that the number of deaths aligns with the general pattern observed throughout Karnataka. This does not diminish the gravity of the situation, but it does provide a necessary context for understanding the underlying factors contributing to the prevalence of heart disease and mortality in the region.
Data collected from government hospitals between January and May of the current year reveals that Karnataka recorded 6,943 heart attack-related deaths, averaging approximately 1,388 deaths per month. In Hassan, during the same period, the number of recorded heart attack deaths stood at 183, averaging around 36 deaths per month. Dr. K.S. Ravindranath, the director of Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) in Bengaluru and the head of the government-constituted probe panel, emphasized that the incidence in Hassan appears to be consistent with the known incidence across the state. He further cautioned that some of the reported deaths may be unconfirmed, lacking thorough investigation or post-mortem examinations. This lack of conclusive evidence adds another layer of complexity to the situation, making it challenging to accurately assess the true extent and underlying causes of the reported increase in heart attack deaths.
The data from other regions within Karnataka also highlights the widespread prevalence of heart disease. Government hospitals in the Bengaluru city region reported 2,599 heart attack deaths between January and May, averaging around 520 deaths per month. At SJICSR, a leading government heart hospital in Bengaluru, 119 heart attack deaths were recorded between January and June, with 21 deaths reported in June alone. In the Kalaburagi district, where SJICSR operates a facility, 95 deaths were recorded between January and May, with 23 of these reported in May. These figures underscore the significant burden of heart disease across Karnataka, emphasizing the need for comprehensive public health interventions and preventive measures.
Dr. Ravindranath highlighted the challenges in accurately determining the causes of death in Hassan, noting that many cases lacked post-mortem examinations and detailed clinical histories. He stated that the committee has requested detailed information on whether ECGs were performed, whether the deceased had consulted a doctor, the location of death (home, transit, or hospital), and whether the deaths were properly documented. He also expressed concern about the potential for media hype to distort the actual situation. To address these data gaps, the committee has sent a proforma to the district health officer and officials, requesting the collection of data on the deceased, including their medical history for conditions like obesity, cholesterol, diabetes, tobacco and alcohol use, recreational drug use, and genetics and family history. The committee is also investigating lifestyle factors, the use of medications for infections, and engagement in crash diets.
The expert panel intends to conduct a verbal autopsy, relying on information from family and close relatives to determine if the deceased experienced chest pain, the duration of the pain, and the treatment received. This retrospective approach aims to gather indirect evidence to confirm whether the deaths were indeed caused by heart attacks. Dr. P.S. Subramani, a professor of cardiology at SJICSR in Bengaluru, concurred that the incidents in Hassan appear to be coincidental and not unusual, but emphasized the need for further investigation to determine the underlying causes.
The media coverage of the Hassan heart attack deaths, particularly local television channels claiming an unusual phenomenon affecting individuals across age groups, including young people, sparked public anxiety and led to increased hospital check-ups. This prompted Chief Minister Siddaramaiah to establish the expert panel to investigate the deaths and identify potential solutions. He also stated that the committee was already tasked in February with examining the reasons behind sudden deaths among young people in the state and assessing whether COVID-19 vaccines could have any adverse effects.
In a politically charged statement, Siddaramaiah suggested that the hasty approval and distribution of the COVID-19 vaccine could be a contributing factor to the deaths, citing recent studies. However, the Indian government refuted this claim, stating that investigations by the Indian Council of Medical Research and All India Institute of Medical Sciences have conclusively established that there is no direct link between COVID-19 vaccination and the reported sudden deaths.
Dr. Rahul Patil, an interventional cardiologist and head of the Premature Heart Disease Division at SJICSR, who is in charge of a registry for heart attack deaths, reported an increase in deaths among young people due to heart attacks in the post-COVID period in Karnataka. He stated that there has been a 9 to 10 percent increase in heart attacks recorded in the Premature Coronary Artery Disease register compared to pre-COVID and post-COVID periods. Dr. Patil attributes this increase to the natural progression of non-communicable diseases in a large population and emphasized the need to study whether there is a proportionate increase in co-morbidities. He noted that around 27 to 30 percent of heart attacks are occurring in the absence of conventional risk factors.
Dr. Patil also suggested that some heart attacks in very young individuals could be attributed to congenital heart disease, structural heart disease, or congenital rhythm disorders. He proposed a basic heart screening program at the high school level for Class 10 students, including ECG, Echo, sugar, and cholesterol tests, to help reduce sudden deaths among the very young. He also advocated for a national registry for sudden deaths, similar to notifiable diseases, to facilitate comprehensive study and analysis.
According to Dr. Patil, smoking remains a major cause of heart attacks among the young, with nearly 60 percent of heart attack deaths linked to smoking. He also highlighted the prevalence of insulin resistance in the Indian population as a significant risk factor. He suggested the use of coronary calcium scans for individuals from 40 years of age to screen for silent blockages. Dr. Patil theorized that the high incidence of heart disease in India could be linked to genetic predisposition to insulin resistance, potentially stemming from historical famines that led to the development of insulin resistance as a survival mechanism. He also pointed to the reuse of cooking oil, particularly in urban areas, as a contributing factor.
A 2023 Lancet paper on cardiovascular disease in Southeast Asia revealed that heart diseases were responsible for 26.6 percent of total deaths in India in 2017, compared to 15.2 percent in 1990. The paper also reported that the age-standardized death rate for cardiovascular disease in India was higher than global levels and that heart disease-linked deaths occur at a younger average age in India compared to other populations. The paper attributed the increased biological risk among Indians to phenotypic changes caused by early life influences and six major transitions: epidemiological, demographic, nutritional, environmental, social-cultural, and economic.
In conclusion, while the reports of increased heart attack deaths in Hassan have raised valid concerns, the available data and expert opinions suggest that the situation is reflective of a broader trend in Karnataka and potentially across India. The factors driving this trend are complex and multifaceted, ranging from lifestyle choices, genetic predispositions, and environmental factors to the potential impacts of COVID-19 and vaccination efforts. The need for comprehensive public health interventions, preventive measures, and further research to understand the underlying causes of heart disease and sudden deaths in India is paramount. The proposed measures, such as high school screening programs and national registries for sudden deaths, represent important steps towards addressing this critical public health challenge. Furthermore, efforts to promote healthier lifestyles, reduce smoking rates, and address the prevalence of insulin resistance are essential for mitigating the risk of heart disease and improving overall cardiovascular health in the Indian population.
The socio-economic implications of heart disease cannot be overlooked. The economic burden of treating cardiovascular diseases in India is substantial, placing a strain on both individuals and the healthcare system. Moreover, premature mortality due to heart disease results in lost productivity and economic opportunities, further exacerbating the socio-economic challenges faced by many families. Access to quality healthcare and affordable treatment options is crucial for mitigating the socio-economic impact of heart disease and ensuring equitable health outcomes for all segments of the population. Public health policies should prioritize prevention, early detection, and affordable treatment to address the socio-economic dimensions of cardiovascular disease in India.