Bangladesh needs to strengthen primary and community healthcare to detect coronary artery disease earlier, as many patients reach tertiary hospitals only after the disease has advanced, Professor Dr MA Muqueet, chairman of cardiology at Bangladesh Medical University, has said.
He called for a national programme on cardiac disease prevention under the Ministry of Health, including dedicated heart clinics at district sadar hospitals for screening, identifying patients who need treatment and increasing public awareness.
In an interview with Md Al Amin Sadman of TIMES ahead of World Heart Day, Dr Muqueet also said coronary artery disease is being detected at a younger age in Bangladesh.
“The average age in the Western world is 55 to 65, whereas in Bangladesh it is around 45 to 60,” he said. “So, broadly speaking, coronary artery disease appears to be developing about 10 years earlier in our country than in developed countries.”
He said the age pattern was only one part of the concern. A major challenge is that patients are often not identified while risk factors can still be addressed.
Weak primary care contributing to late detection
Dr Muqueet said developed countries are able to detect coronary artery disease earlier partly because of stronger primary and community healthcare systems.
According to him, local doctors regularly see patients and arrange blood tests and other investigations. This allows risk factors to be identified earlier and preventive measures to be taken.
“Whereas in our country, this primary healthcare or community healthcare system is not as strong,” he said.
He said patients in Bangladesh may continue to have coronary artery disease without knowing it until symptoms become more noticeable.
Chest pain after walking for five minutes or becoming breathless after walking for five to 10 minutes can occur when the disease has reached a more advanced stage, he said.
Earlier check-ups, meanwhile, could identify some risk factors or abnormalities, according to Dr Muqueet.
“A patient may have elevated cholesterol, or something may be detected through an ECG or echocardiogram,” he said.
However, he said such assessments are not being conducted systematically at the primary healthcare level. Patients may therefore eventually seek treatment at tertiary facilities such as Bangladesh Medical University or Ibrahim Cardiac Hospital.
“By then, the blockage may be around 90%,” he said.
A district-level prevention network
Dr Muqueet said the response should begin much closer to where people first access healthcare.
“We need to start from the upazila level,” he said.
He proposed establishing a heart clinic at every district sadar hospital where patients could be examined and screened, while those requiring treatment could be identified.
“If a heart clinic can be established at every district sadar hospital, we can examine patients, identify those who need treatment and screen people who may be at risk,” he said.
He said such clinics could also help increase social awareness about cardiovascular disease.
His proposal would extend beyond district hospitals. He said every medical college should have a heart clinic and that preventive cardiology should be practised systematically there.
“The Ministry of Health should have a national programme focused on the prevention of cardiac disease,” he said.
Under such a programme, he said, designated doctors at district hospitals should be given responsibility for preventive work.
Prevention begins with risk-factor control
Dr Muqueet said prevention also requires greater public awareness about the factors associated with coronary artery disease.
He identified lifestyle and food habits as important factors, along with personal habits such as smoking and alcohol consumption. Pollution, socioeconomic factors and stressful conditions can also contribute, he said.
A sedentary lifestyle is another risk factor. He encouraged regular walking, running and participation in sports such as badminton, tennis and football.
Dietary habits also require attention, he said. Excessive carbohydrate intake should be avoided and rice consumed in moderation. He recommended a balanced food plate containing appropriate amounts of protein, carbohydrates, fat, vegetables and fruits.
He advised limiting saturated fats, including those found in fatty red meat such as beef and mutton. Foods such as biryani should be consumed only occasionally and in moderation, he said.
He also encouraged adequate water intake and consumption of fruits and vegetables, which he said provide essential nutrients and minerals including magnesium, calcium and iron.
Managing hypertension and diabetes
A prevention strategy should also address people who already have risk factors such as high blood pressure and diabetes, Dr Muqueet said.
“Blood pressure and diabetes need to be properly controlled,” he said.
He described blood pressure and diabetes control, healthy food habits, avoiding unhealthy habits and maintaining physical activity as part of “total lifestyle modification”.
He said physicians need to monitor patients’ blood pressure and diabetes, along with their food habits, unhealthy habits and physical activity.
Patients also have a responsibility to follow the recommended lifestyle changes, he said.
“This is both the doctor’s responsibility and the patient’s responsibility,” he said.
Don’t Miss a Beat
Dr Muqueet said the message of World Heart Day, “Don’t Miss a Beat”, highlights the need to recognise the silent progression of cardiovascular disease and its risk factors.
“We should not miss changes such as increasing cholesterol or weight gain,” he said.
World Heart Day is observed every year on 29 September. Dr Muqueet said the World Heart Federation initiated the campaign to raise awareness about heart disease and that its slogan changes from time to time.
He said this year’s theme focuses on hidden or overlooked cardiovascular disease signs and symptoms.
For Bangladesh, he said, the message should be reflected in the organisation of preventive cardiac care, with screening and awareness strengthened at the primary and district levels.
A national cardiac disease prevention programme, he said, could provide the framework for district-level heart clinics, preventive work at medical colleges and earlier identification of people at risk before they require advanced cardiac care.
