Cardiovascular diseases (CVD), including heart diseases and strokes, are accountable for nearly half of all deaths related to non-communicable diseases. Claiming around 18.6 million lives each year, it has become the world’s number one killer. World heart day is celebrated every year on 29 September to raise awareness on CVDs and highlight the actions that individuals can take to prevent and control heart diseases. Through this campaign, the World Heart Federation unites people throughout the globe in the fight against heart diseases and inspires and drives international action to encourage heart-healthy living.
This year on World Heart Day, the World Heart Federation invites the world to “Use heart to connect”; that is to focus on the use of telehealth to improve awareness, prevention, and management of heart diseases during the pandemic situation.
Ministry of Health Non-communicable Diseases (NCD) Director and Community Medicine Specialist Dr. Vindya Kumarapeli, and NCD unit Registrar in Community Medicine Dr. Danushka Abeygunathilaka discussed their views regarding heart diseases in Sri Lanka.
Following are excerpts from the interview.
Heart diseases are the leading cause of death and disability throughout the world. What is the situation in Sri Lanka in this regard?
Similar to the global scenario, heart diseases are the leading cause of deaths in Sri Lanka as well. NCDs were responsible for 83% of the total deaths in the country in 2016, and heart diseases accounted for around 34% of total annual deaths. According to available data up to 2019, heart diseases were the number one cause among deaths reported from government hospitals. A survey was carried out in 2015 among 5188 people, aged 18-69 years, to assess the prevalence of NCDs and their risk factors in Sri Lanka. According to that, 9.1 % of Sri Lankan adults aged 40-69 years had an existing CVD or had ≥ 30% risk to develop a cardiovascular event, such as a heart attack or a stroke, within the next 10 years of their life.
Heart disease carries a wide spectrum of disease conditions. What are the most common conditions we identify in Sri Lanka?
This can be classified in different ways. One way is according to the origin of the heart disease condition. Commonly present due to poor blood supply to heart muscles (ischemic), changes in the heart structure (structural) or due to poor functioning of heart muscles (conduction disorders).
Heart diseases could show a range of symptoms. Angina is commonly experienced as chest pain on exertion (climbing stairs, walking/running to a certain distance).
In a heart attack, symptoms like pain or discomfort in the center of the chest; and/or pain or discomfort in the arms, the left shoulder, elbows, jaw, or back, with sweating are the commonly presented symptoms. Rarely, patients do not have symptoms, and the initial presentation will be an abnormal test finding such as an ECG or echocardiogram ordered for another reason.
Are heart diseases confined to a certain age group?
There is a spectrum of heart diseases that could present even from birth as congenital deformities. Many of these conditions that are identified get medical intervention, and good outcomes are seen on many occasions with advancements of treatment options and the dedication of healthcare teams.
Some acquired conditions among children and young adults could be due to infections like Rheumatic fever, Dengue, and even Covid-19. Heart disease conditions are seen even from the early thirties at present. Hence, there is clearly an advancement of the age of presentation. There is a clear high risk among males compared to females.
What are the risk factors identified to develop heart diseases?
As we mentioned, risk is little less among females during the childbearing age, mainly due to the natural protection by their hormones. Thereafter, risk among females also rises.
Commonly, there are two types of risk factors, called modifiable and non-modifiable.
Non-modifiable risk factors are mainly the inheritance from genetics. Though we cannot modify them, we can delay the onset of disease as well as reduce complications by adhering to proper control measures.
In addition, there are many modifiable risk factors that could lead to other NCDs as well. These are called common/shared NCD risk factors. Unhealthy diet, physical inactivity, use of all forms of tobacco, use of alcohol, and mental stress are the most common. In addition, air pollution also increases the risk.
These factors directly increase the risk for altered blood lipid levels, altering blood vessels (atherosclerosis) and increasing blood pressure. All other risk factors will work synergistically to increase risk for heart diseases and even for other NCDs.
From the Directorate of NCD, Ministry of Health, what are the steps taken to educate the public on preventing heart diseases?
The Directorate of NCD is the technical focal point in the Ministry of Health for prevention and mitigation of identified NCDs, including heart diseases and their risk factors. The policy on NCD and the multi-sectoral action plan has clearly identified health promotion and risk reduction as a main strategy to prevent and control NCDs, including heart diseases.
Promoting physical activity, healthy food habits, and combating all forms of tobacco are in the mandate of the Directorate of NCD. We are following the life cycle approach in combating NCDs. The Directorate focuses on adults for lifestyle modification in reducing all above-mentioned risk factors, working and co-ordinating with many non-health related stakeholders, NGOs, civil society organisations, and the Provincial Health Ministries. We create awareness among the public through many modes, including social media, printed media, and electronic media on healthy lifestyle for prevention of NCDs, including heart diseases. The latest is the social media campaign for a positive behavioural change for the public to become responsible consumers. The campaign is focused on colour coding, or the traffic light system, to indicate the salt, sugar, and fat levels in solid and semi-solid food packets.
Further, we promote a healthy diet, physical activity, and tobacco cessation at community level through trained staff at Healthy Lifestyle Clinics established at primary health care level hospitals (more than 1,000 in number) and by training peer leaders and community support groups.
Detection of NCDs, including heart diseases among people of 35 years and above, are carried out through HLCs. Clients diagnosed with heart diseases or its risk factors are either referred for specialised care, or followed up at the HLC with counselling for lifestyle modification.
Days identified internationally and nationally for the promotion of specific health-related activities are commemorated with relevant professional organisations to create continuous awareness among the public. “World heart day” is one of such days we mark annually.
The theme for the world heart day this year is ‘Use heart to connect’. How do you explain the use of digital technology to enhance connectivity, improve awareness, and assist in the prevention and management of heart diseases among the public globally and nationally?
The current Covid-19 pandemic has led to the isolation of people due to restricted physical and social interactions. The main objective is to use modern technology to connect patients with their families and healthcare workers. It will ensure continued care for people with heart diseases regarding their monitoring and advising on treatments.
Additionally, digital devices and user-friendly mobile health applications are used to raise public awareness on risk factors for heart diseases and how to modify them. These applications can further help promote a healthy diet, increased physical activity, maintaining healthy body weight, improving mental wellbeing, and cessation of alcohol and tobacco consumption, which in turn will minimise the risks for heart diseases.
Smartphone applications, telephone helplines, telemedicine, remote monitoring, and communication devices through the internet, wireless communication modes (including e-mail), and the media – including social media – are numerous aspects of digital technology that can be utilised effectively for the purpose.
Amidst the pandemic, promoting telemedicine helps to ensure continuous care for the patients. Further, connecting and communicating with loved ones using technology improves psychological wellbeing and reduces stress.
With the current pandemic situation do you see any increase in heart diseases? If so, what could be the causative factors?
Out of the total of over 12,000 Covid deaths reported by the Epidemiology Unit, around 77% are of people over 60 years of age. Furthermore, nearly 60% of them have had multiple co-morbidities and 24% had heart diseases as a comorbidity.
It is clearly seen that in people with poorly controlled heart diseases, there is a higher risk to develop complications alongside Covid-19 infection and thereby, increase risk of death. We have noticed two major factors that could contribute to escalation of cases; one reason is the deficiencies in continuing routine heart disease treatments. Secondly, there is a delayed presentation due to the travel restrictions, financial hardships, and also Covid infection in patients and family members. Psychological wellbeing of patients, especially among senior citizens, has been affected due to travel restrictions and social isolation. Unhealthy food habits and sedentary life-styles during the pandemic have also contributed to this.
During the pandemic situation, what are the steps taken by the Ministry of Health to ensure regular medical check-ups and supply of medicines for the patients with heart diseases?
The Ministry of Health has foreseen most of these risks, and has planned and launched many services to get people safe and timely treatments. We are maintaining all the treatment services in the same capacity through the hospital system, including emergency care in the midst of high incidences of Covid-19.
Hospitals are conducting clinics for people who can travel to them safely. To provide drugs to patients who cannot come to hospitals, postal delivery is arranged with the assistance of the postal department. These services are co-ordinated by medical officers in NCD at district levels along with respective hospitals at community level.
In addition, we provide a hotline service for people who need assistance to get drugs from clinics or even from a pharmacy nearby, and also provide updated information to the public on preventing and controlling heart diseases by the NCD unit and Health Promotion Bureau through social media groups.
What are the helplines established for the patients?
There are a number of helplines that cater for different needs of patients conducted by the NCD unit and other stakeholders.
- 0720 720720 and 0720 606060 are tri-lingual hotlines established for co-ordination, communication, and delivery of clinic medication, done in collaboration with the national postal service and dedicated to cardiology patients registered at government hospital clinics
- 1999 hotline is established by the Health promotion Bureau for responding to any health-related questions from the public
- 1990 “Suwasariya” ambulance service is available for emergency hospital admissions
- 247 is established by the Sri Lanka Medical Association for addressing Covid-19-related health issues