Ischemic Heart Disease Management in India for International Patients

Ischemic heart disease management in India

Ischemic heart disease (IHD), or coronary artery disease (CAD) occurs when blood flow to the heart is slowed down (typically by atherosclerosis of coronary arteries) thus resulting to chest pain, myocardial infarction or other alleged conditions. The aims of management are the alleviation of symptoms, an enhancement of the quality of life, prevention of progression, and a decreased risk of heart attacks and death.

The following is an organization summary:

Treatment based on Lifestyle Modifications (Foundation)

Diet:

• Low content of saturated fats, transfat, cholesterol, and refined sugar.
• A balance that is rich in fruits, vegetables, whole grains, legumes, lean protein, and omega-3 fatty acids.
• Exercise: Moderate aerobic exercises like brisk walking should be done 30-45 minutes at a time at least 5 days a week, which should be tolerated.
• Control the weight: keep BMI < 25.
• Quitting smoking: The stoppage of smoking is a must to reduce the risk of cardiovascular disease.
• Restrict alcohol: or do not have it at all.
• Stress: Yoga or meditation or counselling.

Medical Therapy

Symptom Relief

• Nitrates (sublingual nitroglycerin to angina attacks; long-acting to prevention).
• Beta-blockers (e.g., metoprolol, atenolol) -slows the heart rate and cut the oxygen requirement.
• Calcium channel blockers (diltiazem, amlodipine) -perfective in case of contraindications of beta-blockers.
• Ranolazine or ivabradine -- in refractory angina.

Secondary Prevention 

• Antiplatelet therapy: Aspirin (75 to 150 mg daily); clopidogrel in case of intolerance to aspirin.
• Statins: To lower the levels of LDL cholesterol (aiming to achieve the level below 70 mg/dL in patients who are at risk).
• ACE/ARB: In particular when a patient has hypertension, diabetes, or LV dysfunction.
• BP medication beta-blockers: Prevents death.
• SGLT2 inhibitors/GAIN-1: SGLT2 inhibitors/ GLP-1 agonists can be utilized as cardiovascular protective agents in diabetic patients.

Revascularization (when it is required)

• Percutaneous Coronary Intervention (PCI): The placement of stents by balloon angioplasty. In symptomatic significant stenosis that cannot be managed with medications.
• Coronary Artery Bypass Grafting (CABG): in multivessel disease, in left main disease, or diabetics with substantial amounts of CAD.

Monitoring & Follow-up

• Frequent-follow-up to measure symptoms, medication, and lifestyle compliance.
• Controlling blood pressure, blood cholesterol, HbA1c (in diabetics), and kidney performance.
• Imaging or stress test in case of symptoms deteriorating.

Patient Education

• Differential diagnosing of angina symptoms with that of heart attack (continuous chest pains >20min, sweating, nausea -> invoke emergency care).
• Significance of compliance to therapy throughout the life.

Best hospitals for ischemic heart disease in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Factors Affecting Ischemic heart disease treatment cost in India

A detailed explanation of the determinants of the cost of treatment of ischemic heart disease (IHD) in India, more specifically of some of the procedures when it comes to the treatment of this condition, such as the example of angioplasty, and the coronary artery bypass grafting (CABG) is provided below:

Cost Factors with IHD Treatment:

Type and Complexity of Treatment

• Angioplasty/ stenting are generally more expensive, based on complexity and the type of stent. 
• Costs of CABG (bypass surgery) have a wide range or higher in the case of the private hospital. 

Type and location of Hospital 

• Private hospitals (especially in metros (Delhi, Mumbai, Bangalore), are quite expensive.

Hospital Accreditation & Expertise of Surgeon

• Certified doctors and big surgeons charge a premium price. 
• Hospitals accredited by NABH or JCI or of better brand name are also more expensive. 

Expenses Incurred before Procedures and after Procedures

• Diagnostics: labs and imaging before the operation may be more expensive. 
• Inpatient Oh, the costs of general ward stay, private situations and staying in ICU increase the bill.
• Surgery related expenses: Surgeon cost, anaesthesia cost and OT expense. 
• Post op: Drugs, physiotherapy, and follow-up are also added to the tally. 

Underlying Complexity of Medicine

• Diabetes patients, patients with immunodeficiencies or other comorbidities may need someone to take special care of them long, which increases their cost of staying in the hospital. 

Technological Methods Used

• More complicated methods such as laser angioplasty or robotic bypass mean more expense.

Top cardiologists for ischemic heart disease in India

• Dr. Kuldeep Arora
• Dr. Amit Kumar Chaurasia
• Dr. Naresh Trehan
• Dr. Anil Bhan
• Dr. Praveen Chandra
• Dr. (Col) Manjinder Sandhu
• Dr. Balbir Singh

Advanced ischemic heart disease management India

Advanced Heart Failure Management

Other than regular anti-anginals and secondary prevention:

• DAPT: Aspirin + P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) - particularly after PCI or ACS.
• Intensive statins: Atorvastatin 40-80 mg or rosuvastatin 20-40 mg; can combine ezetimibe and PCSK9 inhibitors when LDL persists to be elevated.

New Anti-Diabetics (in diabetic patients IHD):

• SGLT2 inhibitors (dapagliflozin, empagliflozin) CV benefit has been confirmed.
• Receptor agonists of GLP-1 (liraglutide, semaglutide).
• Ivabradine: In patients in whom heart rate >70 bpm heart rate despite beta-blockers.
• Ranolazine: In cases of refractory treatment of the angina which is not controlled by other medications.

Revascularization Strategies

In patients who have severe blockage of the coronary arteries:

The Percutaneous Coronary Intervention (PCI)

• Gold standard is drug-eluting stents (DES).
• Complicated PCI procedures: bifurcation stenting, interventions on chronic total occlusions (CTO).
• Intravascular image (IVUS, OCT) and FFR/iFR to accurately assess lesions.

CABG

• Off-pump CABG (OPCAB) to create less morbidity.
• Minimally invasive CABG or robot- assisted CABG select centers.
• Hybrid surgery coronary revascularization (cabg LAD to PCI/other vessels).

Refractory Angina Management (No Option patients)

In patients who have symptoms such as persistent angina despite optimal therapy and the unavailability to be revascularised:

• Enhanced External Counterpulsation (EECP): Non invasive treatment which enhances coronary perfusion.
• SCS: Neuromodulation to lessen the perception of angina.
• Coronary Sinus Reducer (CSR): The implanted device that is used to augment perfusion pressure in an ischemic myocardium.
• Cell Therapy / Stem Cell Therapy: It is under study to facilitate angiogenesis.

Post-IHD-Advanced Heart Failure Management (Post-IHD)

In case of the development of ischemic cardiomyopathy:

The best guideline-directed medical therapy (GDMT):

• ARNI (sacubitril/valsartan), beta-blocker, MRA (spironolactone/eplerenone), SGLT2i.

Device therapy:

• ICD (Implantable cardioverter-defibrillator) to avoid cardiac sudden death.
• CRT (Cardiac resynchronization therapy) of LV dysfunction + conduction delay.
• Mechanical: LV assist (LVAD) as bridge to transplant.
• Heart Transplantation: With terminal, intractable, ischemic cardiomyopathy.

Lifestyle & Digital Health Progress

• Supervised exercise, diet and psychological treatments in a cardiac rehabilitation program.
• Telecardiology / Telemonitoring (watching-wearables to detect arrhythmias, BP, glucose).
• Individualised treatment based on AI-based risk stratification in select tertiary facilities.

Factors Affecting Affordable ischemic heart disease treatment in India

This is a logical view of the elements which influence the affordability of ischemic heart disease (IHD) treatment in India. Procedures such as angioplasty (stenting) or coronary artery bypass grafting (CABG) or long term medication, IHD is often expensive; therefore, its affordability is affected by both direct and indirect factors:

• Type of Treatment Required
• Hospital Category & Location
• Surgeon/Team Expertise
• Technology & Procedure Type
• Comorbidities & Patient Condition
• Pre- & Post-Treatment Expenses

Ischemic heart disease management India by GetWellGo

GetWellGo is one of the medical tourism facilitators that operate through its headquarters Gurgaon, India, which connects in the organization of world-class medical care to the international patient. They provide end-to-end support, i.e., recommending the best hospitals and doctors, assisting with medical visas, transparency of the costs, booking a treatment appointment, and managing after-treatment care.

Services offered for Ischemic Heart Disease through GetWellGo

Advanced Treatment of the Heart

GetWellGo management will provide a variety of cardiology interventions directly IHD including:

• Coronary Angiogram as diagnostic test
• Percutaneous Coronary Intervention (PCI) (the so-called angioplasty with stenting)
• Coronary Artery Bypass Grafting (CABG)
• Therapy on refractory angina cases with External Counterpulsation therapy (ECP)

These are only provided with their vetted network of accredited hospitals with a reputation of cardiac care.

Why Choose GetWellGo for Ischemic Heart Disease Treatment?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Ischemic Heart Disease treatment.
• Expert cardiologist with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food