Heart care advances, but capacity remains concentrated in Dhaka

Infographic: TBS

Bangladesh has made significant strides in treating heart disease, but its growing cardiac-care capacity remains heavily concentrated in Dhaka, leaving people outside the capital with limited access to advanced treatment, particularly cardiac surgery.

Experts are calling for stronger cardiac services at district and divisional levels as the number of heart disease patients continues to rise.

According to the Directorate General of Health Services (DGHS), 43 facilities across the country provide cardiac treatment, including 34 with surgical facilities. But only eight of those 34 are outside Dhaka.

As a result, Dhaka-based institutions perform about 95% of the country's heart surgeries, despite the capital being home to only around 10% of the population. The remaining 90% have access to just 5% of the surgeries.

The Cardiac Surgeons Society of Bangladesh says only three government hospitals currently perform cardiac surgery – the National Institute of Cardiovascular Diseases, Dhaka Medical College Hospital and Chattogram Medical College Hospital.

Sylhet, Rangpur and Khulna have catheterisation laboratories (cath labs) for angiograms, but do not offer cardiac surgery. Bangladesh performs around 10,000-12,000 cardiac surgeries a year, against an estimated need for about 25,000.

Cath labs are essential for procedures including angiograms, angioplasty, pacemaker and ICD implantation. There are 87 cath labs in public and private hospitals nationwide, 58 of them in Dhaka.

Cardiologists, however, are now available at almost all medical colleges and district hospitals. The Bangladesh Cardiac Society estimates that the country has around 1,400 cardiologists.

The society has proposed that the Health Ministry establish at least five-bed coronary care units (CCUs) at district and upazila hospitals that do not currently have them.

Dr Din-E-Mujahid Mohammad Faruque Osmany, associate professor of cardiology at Bangladesh Medical University, told The Business Standard that bringing a heart attack patient from outside Dhaka to the capital can take up to 24 hours, which can prove fatal in some cases.

"Timely administration of streptokinase to prevent blood clots in the artery can save many lives. But this is not currently possible in many places, resulting in preventable deaths," he said.

Although most complex cardiac treatment remains Dhaka-centric, he said capacity is increasing in divisional cities such as Chattogram, Sylhet and Rajshahi. Heart transplantation, however, is still unavailable in Bangladesh.

Professor Dr Nazmul Hossain, cardiologist and director general of the Directorate General of Medical Education, said the government is working to establish heart care centres in all eight divisional cities alongside cancer and kidney treatment facilities.

BMU plans first cardiopulmonary rehabilitation centre

While Bangladesh has expanded its capacity for heart attack treatment, angioplasty and bypass surgery, specialised services such as heart transplantation, heart failure management and cardiac rehabilitation remain limited.

Bangladesh Medical University (BMU) has therefore taken an initiative to establish a cardiopulmonary rehabilitation centre.

Dr Osmany, head of BMU's Department of Heart Failure and secretary general of the Bangladesh Heart Failure Association, said the biggest gap now is long-term rehabilitation after a heart attack.

"Treatment does not end with a stent or bypass surgery. Patients need guidance on exercise, diet and returning to normal life," he said, adding that such rehabilitation services are yet to be effectively established in Bangladesh.

He said BMU is developing the centre with support from the University of Glasgow and the UK's National Health Service (NHS), which are providing equipment and technical assistance. The university is working on allocating space for the facility.

Two BMU doctors are also scheduled to travel to the University of Cambridge in November for fellowship training in heart transplantation and heart biopsy. Doctors hope the collaboration will help lay the groundwork for advanced heart failure treatment and, eventually, heart transplantation in Bangladesh.

Don't dismiss chest pain as gas

Doctors attribute the rising burden of heart disease to unhealthy diets, obesity, pollution, smoking and physical inactivity.

Dr Amal Kumar Chowdhury, former professor of cardiology at the National Institute of Cardiovascular Diseases, said heart disease is increasingly affecting younger people.

"Maintaining a healthy lifestyle and having regular heart check-ups after 30 are essential," he told TBS.

He urged people with chest pain accompanied by sweating, vomiting, anxiety or shortness of breath to seek immediate medical attention rather than dismissing it as gastric pain.

According to Bangladesh Bureau of Statistics data, heart attacks were responsible for 17.45% of all deaths in Bangladesh in 2022. Including other cardiovascular diseases, which accounted for 3.67%, cardiovascular conditions were linked to 21.12% of all deaths.