Govt moves to curb cardiac deaths by expanding care, cutting treatment costs

Infographic: TBS

With heart disease being one of the leading causes of death in the country, the government is taking steps to reduce preventable mortality by lowering treatment costs and expanding cardiac care beyond Dhaka to several districts, where such facilities face a severe shortage of specialists and infrastructure.

For this, the health ministry has initiated plans to reduce the price of stents, increasing the number of functional catheterisation labs (cath labs), and establishing Coronary Care Units (CCUs) in several hospitals.

In addition, new positions for cardiologists are being created in various hospitals, while the Directorate General of Drug Administration is working to simplify and expedite the registration process for cardiac treatment devices.

The decisions were taken at a meeting chaired by Dr Md Sayedur Rahman, special assistant to the chief adviser for the health ministry, on 19 March.

"For several months, cardiac patients have not been travelling to India for treatment, and hospitals here are able to cope with the influx of cardiac patients. No cardiac patient has been deprived of treatment. Now, the price of stents will be rationalised," Sayedur told TBS on 21 June.

He further said, "We have identified the issues in cardiac treatment. We will prioritise increasing healthcare services outside Dhaka so that patients don't have to come to Dhaka."

According to the meeting minutes, an additional cath lab will be established at the National Institute of Cardiovascular Diseases and Hospital, which currently has seven cath labs – though not all are operational at all times.

Although cath labs have been set up in Faridpur, Tangail, and Manikganj hospitals, they have yet to become operational. The government aims to activate these labs as soon as possible.

A Coronary Care Unit (CCU) will be urgently established at Shaheed Suhrawardy Medical College Hospital. Meanwhile, efforts will be made to expand cardiac treatment services at Bogura, Rajshahi, and Dinajpur Medical College Hospitals.

The meeting also decided to review the average stent prices in India, Pakistan, Sri Lanka, and Nepal, along with Bangladesh's tax structure, to set new stent prices domestically.

According to the World Health Organisation, non-communicable diseases account for 67% of all deaths in Bangladesh, with cardiovascular diseases responsible for an estimated 30% of total mortality.

The latest data from the Bangladesh Bureau of Statistics (BBS) shows that in 2022, heart attacks alone caused 17.45% of all deaths in the country.

In 2024, a total of 98,909 coronary angiograms, 35,730 coronary angioplasties, 3,896 permanent pacemaker implantations, and 14,554 cardiac surgeries were performed nationwide.

"Tobacco use, obesity, trans fats, high salt intake, and air pollution are major contributors to the rising incidence of heart disease and related deaths," Professor Dr Sohel Reza Choudhury, head of the Department of Epidemiology and Research at the National Heart Foundation Hospital and Research Institute, told TBS.

Shortage of specialists, infrastructure hinders cardiac treatment

Due to a lack of adequate infrastructure and specialist doctors, a large number of cardiac patients in the country are unable to receive the treatment they need, experts say.

According to the Cardiac Surgeon Society of Bangladesh, there are 42 cardiac care units in both public and private hospitals nationwide, with 32 of them equipped to perform cardiovascular surgeries. However, only three government hospitals – the National Institute of Cardiovascular Diseases, Dhaka Medical College Hospital, and Chattogram Medical College Hospital – currently offer cardiac surgery.

While cath labs exist in Sylhet, Rangpur, and Khulna, only diagnostic procedures like angiograms are performed there – no surgeries are conducted. On average, around 10,000 to 12,000 cardiac surgeries are performed annually in the country, whereas the actual need is estimated at around 25,000 surgeries per year.

Cath labs are critical for cardiac care, enabling procedures such as angiograms, angioplasties, and pacemaker or ICD implantations. There are 87 cath labs in public and private hospitals across the country, with 58 located in Dhaka alone. However, due to a shortage of trained personnel, eight cath labs across the country remain non-operational.

Even in Dhaka, many cath lab machines are out of order. The National Heart Institute, for instance, has three non-functional machines. Additionally, eight cath lab machines supplied to hospitals such as Dhaka Shishu Hospital and medical colleges in Mymensingh, Chattogram, Rangpur, Khulna, and Rajshahi are currently inoperative.

Dr D M M Faruq Osmani, Assistant Professor in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, said the Bangladesh Cardiac Society has around 3,000 registered members, but many of them are either no longer in active practice or are living abroad. "Given the size of our population, the number of practicing cardiologists is extremely low," he said.

Experts note that pediatric cardiac care in the country remains significantly underdeveloped, with nearly one-third of child heart patients traveling abroad for treatment.

The Paediatric Cardiac Society of Bangladesh (PCSB) reports that nearly 4 lakh children suffer from various types of heart disease, with around 50,000 newborns diagnosed with congenital heart defects each year.

According to PCSB, around 40% of children affected by heart disease die annually due to lack of proper treatment.

Professor Dr A B M Abdus Salam, vice president of the PCSB and former head of the Department of Child Cardiology at the National Institute of Cardiovascular Diseases, said there are no more than 30 pediatric cardiologists in the country – and nearly all of them practice exclusively in Dhaka.

Lack of emergency cardiac care raises mortality risk

Experts say immediate treatment is critical in heart disease, especially during heart attacks, but emergency cardiac care remains inadequate across the country – particularly outside Dhaka. As a result, many patients face life-threatening delays in receiving timely treatment.

According to the Directorate General of Health Services, 43 healthcare institutions in Bangladesh provide cardiac treatment, of which 34 offer surgical services. However, only eight of these are located outside Dhaka.

While just 10% of the population lives in the capital, Dhaka-based hospitals perform 95% of all heart surgeries, leaving only 5% for the remaining 90% of the population.

Dr D M M Faruq Osmani said heart attacks can be diagnosed quickly and affordably through ECG and serum troponin tests. He suggested linking union and upazila health centres with major hospitals via an online system to transmit test results to central servers, allowing specialists to provide remote consultation in real time.

Plans to cut high stent prices

Stents used in cardiac treatment are significantly more expensive in Bangladesh than in neighbouring countries – especially high-end models priced over Tk1 lakh.

Currently, 26 types of stents are used in Bangladesh. In April 2024, the Directorate General of Drug Administration set price caps ranging from Tk20,000 to Tk140,500. However, the use of lower-priced stents is limited, with most patients receiving those priced above Tk1 lakh.

Stents – commonly known as "rings" – are used in angioplasty procedures to keep blocked arteries open and maintain normal heart function.

According to meeting documents from the Ministry of Health, the government is considering reducing stent prices by at least Tk5,000 and taking steps to lower cost disparities caused by delivery system inefficiencies.