55% of cardiac deaths in India caused by delay in seeking care

NEW DELHI: About 55 per cent of the cardiac/stroke deaths reported in India are due to delay in seeking care, according to the first community-based study published in the journal Lancet.

The study, conducted at the All India Institute of Medical Sciences (AIIMS) and Indian Council of Medical Research (ICMR), New Delhi, stated that only a small proportion of patients with cardiac and stroke emergencies reach health facilities early.

"Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies including stroke. We assessed the presence of delay in seeking appropriate care among those who died due to cardiac/stroke emergencies in a community in northern India," said Anand Krishnan, correspondence author, Centre for Community Medicine, AIIMS, in the study.

The findings showed only 10.8 per cent of the deceased reached an appropriate health facility within one hour.

"Delayed presentation leads to delay or failure to provide the most beneficial therapies like thrombolysis for myocardial infarction/ischemic stroke leading to poorer disease outcomes. It is estimated that interventions that reduce delays in care in patients with myocardial infarction (MI) could decrease risk of mortality by 30 per cent," the study showed.

"The inability to recognise the severity of illness and financial constraints were identified as major reasons for the delays in seeking care," Krishnan said.

The study was conducted in two out of three tehsils (Badkhal and Ballabgarh) of Faridabad district of Haryana. The team conducted a social audit among all civil-registered premature deaths among patients aged between 30 and 69 years due to acute cardiac events or stroke in the district.

About half of the deceased did not visit any health facility during their terminal illness and only one in ten subjects reached an appropriate health facility within the first hour after onset of the symptoms.

Those staying closer to a facility or families with higher income were more likely to reach within the first hour. In general, strokes reported greater delays.

The study also identified affordability and accessibility as important factors for delays resulting in mortality and identified better insurance coverage and appropriate equipped ambulance linkages along with programmes to improve recognition of a heart or brain attack among the populace.