Prof. Khan Shah zaman - NICVD - Interview 2014

Entire health budget may soon be insufficient for curing Heart Diseases alone.
Prof. Khan Shah Zaman – Head of NICVD, reveals alarming facts on heart-health
Medical news recently took the opportunity to discuss some important facts on the nation's heart-health with the leading cardiologist of the country - Dr. Khan Shah Zaman. Here are a few highlights of the advice and statements given by the learned heart-expert:
Q.1. What are the age and gender trends in the incidence of Heart diseases?
National Institute of Cardio-Vascular Diseases (NICVD) receives around 1200 to 1500 patients per day in the OPD. Since there are only 5 major specialized centers in the country which are providing comprehensive facilities in treatment and surgery of heart, including pediatric cardiology and pediatric cardiac surgery. Many of the patients that come to NICVD from outside Karachi, from the cities and towns where they do not have any specialized hospital for heart diseases.
We receive pediatric cardiology patients from all over Baluchistan, Sindh and even from the southern Punjab. This is because, NICVD is the only facility of its kind in the Southern region of the country.
Q.2. Please tell us about the incidence of heart diseases in children.
One kind of pediatric heart problems is the Congenital Heart Diseases which cannot be correlated with the poverty or the other prevailing conditions in the country. It involves genetic composition of the patient. In the developed countries, regular health checkups are done, so Congenital heart diseases in infants and children are usually diagnosed at a very early stage, even during pregnancy, so they are able to cure more of their children. They are able to distinguish between the newborns who need immediate heart treatment, or those whose health will allow them to live till the age of 12 or 15 years before treatment is initiated.
Here in Pakistan, such young patients are not brought to the hospital till the time the disease has progressed significantly, and clear symptoms of heart disease become visible. Due the this delay the treatment often becomes more difficult.
Q.3. What are the common symptoms of heart disease in infants?
Among the common symptoms of heart disease are; that the infant will not take enough milk, or starts crying, or starts to breath heavily while being fed, or the infants facial complexion becomes bluish while feeding. Once an infant becomes a child and starts activities like walking, running and jumping, he will get fatigued very quickly, if his heart is suffering. His level of concentration and attention span would be much lesser than the normal children. Due to lack of pediatric heart treatment facilities in the country, the parents in less developed areas, tend to delay a thorough check up to evaluate the heart health of the child.
Dr. Naeema Patel – a paediatric heart specialist at NICVD, checks and treats around 80 to 100 children with suspected heart ailments, each day. Over the years the number of children coming to the NICVD have increased, primarily due to increased awareness among the parents, about the importance of a heart checkup for their children. Most parents prefer NICVD over other hospitals, because of the affordable treatment and expertise available here. Other private hospitals are much more expensive when it comes to heart treatment.
Another kind of heart ailments found among children are the Rheumatic Heart Diseases. These are found more commonly among the poor segments. These are triggered by serious infections or high fever during childhood. The Streptococci is a micro organism which can damage the heart-valves of the child. These heart-valves, once they get damaged, will gradually create problems, when the child reaches the age of 5 to 15 years or later.
Q.4. Should the children diagnosed with heart disorders continue with their physical activities and sports, or should they be restrained from excessive activities?
Many of the congenital heart diseases allow the child to live normally till the age of 12 or 15, without any restraint or need for regular treatment. Only if he gets excessively tired during play, he should rest a little and then continue with his game. We try our best to avoid surgery on the younger patients, who have a heart problem, but are progressing comfortably in their early life.
There are some cases who are not able to continue their physical activity, such cases do need early surgery or treatment. We have the facility to operate on those very young children.
Q.5. Looking at the population and disease incidence in Pakistan, how many major cardiology institutions would we need all over the country to effectively manage the heart diseases?
Of course, the number of Heart hospitals in Pakistan is not sufficient. If a patient travels all the way from Tharparker to Karachi for a heart checkup and surgery, in many cases,  unfortunately, we are not able to treat him immediately. Many such patients travel back to their villages and then come back to us after several days or even weeks. This creates a lot of inconvenience, health-threats and financial burden on the patients.
Ideally speaking, Pakistan needs a separate tertiary care centre in every division of the country, like Karachi Division, Hyder. These tertiary care centres should be able to provide cardiology facilities, in addition to all the major specialties of medical care. With the rapid population growth and the increasing size of our younger generation, each of these divisional tertiary care centres should also provide pediatric heart care and diagnosis services.
At present, there are one or two basic heart-care and treatment facilities available in most of the major districts of Pakistan. However, most patients and their families have more trust on the expertise, competence and modern facilities being provided at the major urban institutions like NICVD, where we are conducting 8 to 10 surgeries every day.
Q.6. After some new legislations, health-care is now a provincial subject, do you feel that it will bring some positive changes in this sector?
I think it is too early to judge whether it will actually transform the sector. But we do expect some positive changes to occur. The provincial health ministries will need to collaborate with the Medical Universities and large institutions to compile nationwide data and prepare elaborate guidelines for better performance and restructuring of healthcare systems.
WHO and UNO should be consulted to draw meaningful conclusions and recommendations from the data and make realistic estimates for funding healthcare in Pakistan. Large Post-graduate institutions like Jinnah Post-graduate Medical Center, Pakistan Institute of Medical Sciences, Punjab Institute of Cardiology, etc. should be engaged to thoroughly analyze the healthcare system's performance and suggest improvements. Since these institutions are catering to patients from every corner of the country,  so they can better identify which diseases are more common in which parts of Pakistan. For Example; KPK certainly has a lower incidence of heart diseases, due to the healthy environment, fresh air, clean water, nutritious food intake and routine walking on hilly terrains.
Q.6. What are the common heart complaints in adult cardiology?
In adult cardiology, there are many acquired diseases, like Coronary Artery Diseases, that have high prevalence in the country. So far, the burden of Rhumatic Heart Disease has not been controlled in Pakistan, while the Coronary Artery Disease (CAD) has also increased rapidly. The hospital are being occupied by CAD patients. Today, 60% of our patients are suffering from CAD. 40% patients have already suffered from a heart-attack, 30% are facing the threat of a heart-attack, 25% of the patients have their hearts damaged to an extent, that they are on the verge of cardiac-failure.
There are various manifestations of heart disease including; chest pains, shortness of breath or palpitations with an accelerated heart-beat. The rise in the incidence of heart disease needs to be addressed urgently in Pakistan, otherwise it may soon consume the entire healthcare budget of the country. Three major diseases; Diabetes, Hypertension and heart diseases are spreading like an epidemic. Diabetic patients, Hypertensive patients and Obesity patients are highly likely to get a CAD within 5 to 10 years.
Obesity has been formally declared as a disease by the World Health Organization, and official guidelines have been developed to control obesity among the masses. Due to lack of awareness in Pakistan, most people still consider obesity as a sign of good health, whereas it is a serious cause of concern and a long-term health-threat for the children and adults.
Q.7. What is the patient turnout observed at NICVD?
The daily turnout of patients at NICVD is around 80 to a 100 people. Out of these, more than 70% people suffer from CAD. Over the past 3 decades, cardiology has changed drastically, as cardiologists are now performing numerous tasks which previously required a cardiac surgeon. With the advent of Coronary Angioplasty, the role of cardiac surgery has become very limited across the globe.
The need for surgeries has now been reduced to only some specific cases of Congenital Heart Disease, or those with multiple coronary artery diseases, where Angioplasty is too expensive or not solving the problem fully. Cardiologists are now able to conduct angio-plasty and even surgeries to open the heart-valves or curing the patients with a hole in the heart.
Q.8. What are the recommendations for changes in diet and lifestyle, to control the incidence of heart-diseases among the masses?
An active lifestyle with regular exercises and healthy food intake is critical for avoiding heart diseases. In developed countries like England, the governments are taking large scale initiatives to promote physical activities like; cycling, walking and exercising among the masses. Very few people in Pakistan take exercise as a pleasure activity. The favorite social activity or celebratory enjoyment seen in Pakistan is dining-out, which brings no health benefits. Infact the commercially prepared food is primarily unhealthy and high in calories. Even the children are now more inclined to play indoor or digital games, rather than indulging in outdoor sports. This trend must change, and people should adopt sports and exercise as their social retreat and pleasure.
The basic schooling curriculum should include guidelines for a healthy diet and ways to lead an active healthy life. This will develop the habit of healthy living and healthy eating among children at a young age and they will grow up to be health-conscious citizens.
As a cardiologist I recommend that an average family should restrict their meat intake to only twice a week, and eat Chicken or Fish (white meat). Throughout the week a healthy family should consume vegetables, beans, pulses and fruits. Red meat (mutton and beef) should be avoided. However, if a family carries out regular exercise and fitness practices, only then they may be allowed to eat red meat twice a month. If the family is burning lots of calories throughout the day, through active laborious exertion, only then you can have the privilege of eating whatever you like.
As a precautionary measure for early diagnosis of heart ailments, after reaching the age of 50 years, even healthy individuals should get an ETT test done once every year. Other kinds of tests are also recommended for healthy persons, once they cross the age of 50 years. Regular monitoring of your health condition can help you in living and enjoying a longer, healthier life.