Evolution of Cardiac Care in India
By Arunima Rajan
India’s cardiac story reads like a tech upgrade,until you zoom out: uneven access beyond cities and missing fundamentals of water, air and food safety.
India’s cardiovascular care has come a long way from months-long waits in the 1990s for bypass surgery, often in hospitals in other cities or states to procedures completed within days today, supported by advanced diagnostic tests. Yet, access remains uneven, with latest advances and specialists still concentrated in major cities.
Dr. G. R. Kane, director of cardiology at Kokilaben Dhirubhai Ambani Hospital, says India has come a long way in cardiac care. He recalls, “In the 1960s, when someone had a heart attack, an ECG was not easily available, so patients were told to rest for 15 days.”
He notes, “In the 1970s, monitors and defibrillators became available and saved many lives. Mortality from heart attacks fell immediately, by about 50%, because most deaths previously occurred within the first 24 hours. The most common mode of death was an arrhythmia, typically ventricular tachycardia or ventricular fibrillation.”
He observes, “When a person has a heart attack, the heart can suddenly start to fibrillate because it senses that blood and oxygen are no longer reaching the muscle; this is why many patients die at home. Another cause of death is a massive myocardial infarction, when a large portion of the heart is affected, though this is less common because the three coronary arteries supply different territories. Patients with apparently normal coronaries can still die if a small MI triggers a fatal arrhythmia.”
He adds, “For many years, the only post-event test was coronary angiography. Even with a single blockage, coronary artery bypass grafting was often the only option in the 1970s and 1980s. The first angioplasty in India was performed in 1987; before that, it was not available locally. The first angioplasty in the world was performed by Dr. Andreas Gruentzig in 1977, while cardiac surgery had been available since the 1950s. Cardiologists therefore had to show outcomes equivalent to surgery before angioplasty was widely adopted, prompting many trials. Both procedures have since evolved.”
He continues, “Initially, angioplasty was simple balloon dilation. Because opening a blockage creates a controlled crack in the plaque to increase flow, arteries could sometimes close acutely due to dissection, and surgeons were required as backup. To address this, cardiologists introduced stents—first bare-metal stents—which prevented recoil and sealed dissections. Results improved, but many patients developed restenosis within three to six months. Drug-eluting stents, which release small amounts of antiproliferative drugs, were then developed and proved a major advance. In many scenarios, outcomes with drug-eluting stents approach those of surgery.”
He stresses, “Coronary disease varies, so surgery and angioplasty are complementary. The responsible clinician must guide each patient on the most appropriate procedure at that point in time. In general, for patients under about 65, angioplasty is often preferred because each intervention has a finite durability, typically 15 to 30 years.”
He concludes, “Today there have been major advances in angioplasty and meaningful improvements in bypass surgery as well. Used judiciously and in combination, they can deliver both better quality and length of life. Patients should understand that, over a lifetime, they may need a sequence of interventions—angioplasty followed by surgery, and sometimes angioplasty again depending on how disease evolves. Each time, the team must determine whether a repeat bypass or another angioplasty is indicated. If a patient has recurrent blockages after one or two stents, the body may be reacting poorly to stents and surgery may be the better option. Recognising this principle helps set realistic expectations; otherwise, it is easy to assume something ‘went wrong’ when, in fact, disease progression and procedural limits are driving the next step.”
Capacity, Cost and Awareness
Dr. V. Surya Prakasa Rao, clinical director and head of cardiology, CARE Hospitals, Banjara Hills, Hyderabad, says, “In practice, the biggest gaps in cardiac care are in capacity, cost and awareness. Smaller towns often lack cath-labs and emergency-ready teams; many patients struggle to afford treatment and medicines; and early symptoms are frequently dismissed. The solution we find most workable is a hub-and-spoke model. Large centres provide specialised care and set protocols; district hospitals handle initial assessment, basic procedures and follow-up. With tele-mentoring, experts can guide local teams in real time from emergencies to complex interpretations. Over time, adding cath-labs, cardiac ICUs and rehab services in these regional hospitals brings lifesaving care closer to home.”
Gender Bias
Access is only one part of the story. Another concern is the bias women face in cardiac care. Dr. Dayanand Yaligar, Consultant Internal medicine, Apollo One, Electronic City, Bangalore points out that heart disease remains significantly under-diagnosed and under-treated in women. “This is due to factors like misperceptions that it is primarily a man's disease, women often presenting with atypical symptoms that are dismissed, and a historical underrepresentation of women in clinical trials. Addressing gender-specific symptoms, risk factors, and improving clinical guidelines are crucial steps to optimize care and reduce the burden of heart disease in women.”
Advancements
Dr. Rushikesh Patil, associate director, cardiology, Dr L H Hiranandani Hospital, Powai, says advancements in cardiology services in India are dramatic. “Over the last two decades, diagnostics, pharmacology and surgical methods have advanced dramatically improving detection and management and giving patients tools to manage their own health. Cardiac MRI and CT coronary angiography now offer detailed, non-invasive views of structure and function. High-sensitivity troponin assays enable earlier, more accurate identification of myocardial injury. And wearables including smartwatches with ECG allow continuous rhythm monitoring and earlier intervention for arrhythmias, often reducing hospital time.”
Less Invasive Treatments
Dr. Madhukara H. M., interventional cardiologist, Kauvery Hospital, Bengaluru, adds that cardiac treatment has become far less invasive. “Bypass surgery has moved from open-chest to keyhole and robotic techniques across many corporate and multi-speciality hospitals. For valve disease, transcatheter approaches have been a breakthrough: TAVI replaces a narrowed aortic valve through the leg or neck without opening the chest, and TMVR extends similar benefits to the mitral valve.”
He cautions: “Whatever the tool AI included the conversation with a doctor comes first. If we treat only the report, we miss the person. Patients often mislabel chest pain as gastritis or muscle strain; even if it is, they should still get an ECG and see a doctor. Young adults may believe they are ‘too young’ for a heart attack, but lifestyle can age arteries fast. Tests exist to protect you, not burden you; prevention remains better than cure.”
He also points out that he recently performed TAVI on a 92-year-old who remained remarkably active. “Families accept TAVI because it avoids open surgery, is done through the leg, often allows next-day discharge and provides excellent relief,” he explains.
Although there has been lot of buzz about new tools like AI, many remain cautious. Dr. P. R. L. N. Prasad, interventional cardiologist and consultant, Gleneagles BGS Hospital, Kengeri, adds, “We will pick an instant-ECG and risk-scoring platform on practical grounds: clinical proof, regulatory clearance, integration, security and data control, and vendor risk. We look for evidence of better outcomes fewer missed diagnoses, fewer emergency visits, better triage. CDSCO approval or comparable backing is essential. The platform must plug into our workflows without long downtime or heavy customisation. Patient records must be secure, auditable and transferable; we avoid closed systems that trap data. We also prefer solutions that allow export and sensible licensing to avoid lock-in. If no external product meets our clinical, regulatory or cost needs, we will build modules in-house. We will start with proven external platforms for speed and validation and prototype internal dashboards or scoring modules within 12 to 24 months, provided they can be clinically validated and cleared by regulators.”
Remote Monitoring and Wearables
Dr. Madhukara H. M., interventional cardiologist, Kauvery Hospital, Bengaluru, adds that cardiac treatment has become far less invasive. “Bypass surgery has moved from open-chest to keyhole and robotic techniques across many corporate and multi-speciality hospitals. For valve disease, transcatheter approaches have been a breakthrough: TAVI replaces a narrowed aortic valve through the leg or neck without opening the chest, and TMVR extends similar benefits to the mitral valve.”
He cautions: “Whatever the tool AI included the conversation with a doctor comes first. If we treat only the report, we miss the person. Patients often mislabel chest pain as gastritis or muscle strain; even if it is, they should still get an ECG and see a doctor. Young adults may believe they are ‘too young’ for a heart attack, but lifestyle can age arteries fast. Tests exist to protect you, not burden you; prevention remains better than cure.”
He also points out that he recently performed TAVI on a 92-year-old who remained remarkably active. “Families accept TAVI because it avoids open surgery, is done through the leg, often allows next-day discharge and provides excellent relief,” he explains.
Although there has been lot of buzz about new tools like AI, many remain cautious. Dr. P. R. L. N. Prasad, interventional cardiologist and consultant, Gleneagles BGS Hospital, Kengeri, adds, “We will pick an instant-ECG and risk-scoring platform on practical grounds: clinical proof, regulatory clearance, integration, security and data control, and vendor risk. We look for evidence of better outcomes fewer missed diagnoses, fewer emergency visits, better triage. CDSCO approval or comparable backing is essential. The platform must plug into our workflows without long downtime or heavy customisation. Patient records must be secure, auditable and transferable; we avoid closed systems that trap data. We also prefer solutions that allow export and sensible licensing to avoid lock-in. If no external product meets our clinical, regulatory or cost needs, we will build modules in-house. We will start with proven external platforms for speed and validation and prototype internal dashboards or scoring modules within 12 to 24 months, provided they can be clinically validated and cleared by regulators.”
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