Could you give us a sense of CVD in India?
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Dr Dhruv Kazi
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CVD is a threat to the Indian economy as it affects men and women in their 50s, who are at the peak of their economic productivity. This is almost a decade younger than in Western countries, so our age-adjusted rates of CVD are among the highest in the world. As a society, we’ve gotten more overweight and less physically active, and have some of the highest rates of diabetes and high blood pressure in the world. So, we are seeing an epidemic of CVDs of unprecedented proportions.
How does CVD in India compare to a similar nation, China?
China faces similar challenges with CVDs and tobacco use, with some key differences. They have higher rates of strokes than we do – and we have higher rates of heart attacks. It’s not clear why this difference exists. However, China has invested heavily in its public healthcare system over the past decade, so they now are better equipped to handle cardiac emergencies. They are also investing heavily in research, to understand the local needs and opportunities.
Why should we use m-Health for managing diseases?
India has seven doctors per 10,000 population – one fourth of those in Western countries. As you know, this number is only a half-truth – disparities are even more severe in rural areas, where one may not find a trained experienced practitioner for miles. We clearly do not have the resources needed to rely on doctors to manage the national burden of CVDs – we don’t have enough physicians and it would simply be too expensive. We need to find alternative, cost-effective solutions, so that doctors can focus on the most complex cases, while the everyday management of hypertension or uncomplicated CVD can be done by trained healthcare workers empowered by technology. And this is achievable – much of CVD management is algorithmic and therefore amenable to being managed by an app or software. Latest figures suggest we have 900 million mobile subscriptions in a country of 1.2 billion people – practically every adult has one. Over the next decade, we will see increased penetration of low cost smart phones – so every Indian will have the power of a small computer in their pockets, and communication costs will be low. This is a fantastic opportunity to leverage well-designed, well-studied technological solutions to help address the gap in healthcare services and boost the health of our entire population.
Tell us about the study you undertook at Bangalore for managing CVD patients?
The project in Bangalore, with Narayana Hospitals, is an ongoing project. We are currently in pilot stages and are examining whether a well-designed app can help nurses and technicians manage relatively complex patients who need to be on blood thinners after heart surgery. This particular app is designed for use by nurses and technicians rather than the patients themselves, but eventually the goal will be to have the patients enter their own data into the app. It uses a simple algorithm at the back end to make recommendations about how to adjust the dose of the blood thinner and when the patient needs to get checked. In order to teach people about blood thinners, we developed a soap opera (in Kannada) with local TV celebrities. The Center for Chronic Disease Control in New Delhi are also partners in the project and, along with Narayana Hospitals, have been incredibly supportive.
What are the learnings from the pilot project?
Our early field tests have shown some interesting results. Nurses and technicians are excited about the technology, and find it very simple to use. It helps them make better decisions but also improves efficiency – so it’s a win-win for all concerned. We did learn that in this particular patient population, literacy is a real challenge, so patients prefer using phone calls to SMS.
How did the study help in understanding the use of mobile apps for disease management?
Developing technologies for healthcare requires a nuanced understanding of the providers and patients. There is great value to partner with patients, families, and their providers early in the design process – which helps make the product more user friendly and practical. There are many opportunities in our health care system for well-designed and validated applications to address the health needs of our population.
What is the next step?
Our project is ongoing as we continue to refine and deploy the product. We have received an overwhelming response from cardiologists and patients and are looking for technology partners in India to help with the growth. In the long-run, I would like to see dedicated incubators or training programmes that help young software developers or entrepreneurs understand the special needs of developing robust healthcare applications.
Your parting remarks
The epidemic of CVDs in India is a real threat to our future and we will pay an enormous price – in lives and money – if we continue to ignore it. But we have an amazing opportunity to fix this problem in a cost–effective manner. We need to inspire the next generation of young techies and entrepreneurs to partner with doctors and population scientists to tackle this challenge head–on. We can fix this, but the time to act is now.