Bangladesh making strides in cardiac care, but gaps remain; prevention key, say experts

The number of cardiac patients in Bangladesh is increasing due to rapid urbanisation, changing lifestyles, and unhealthy diets. While advanced medical technologies and services are expanding, health experts warn that without stronger prevention measures, awareness campaigns, and a cultural shift towards healthier living, tackling heart disease will remain a major challenge.

At a roundtable at The Business Standard office in the capital's Eskaton on Saturday, experts highlighted serious limitations in cardiac care, including shortages of cardiologists, surgeons, nurses, and technicians, as well as Dhaka-centric services and weak facilities at upazila level. They also cited gaps in advanced procedures such as aortic surgery, complex valve operations, and paediatric treatment, alongside unreliable medicine supplies at NCD corners.

Sharier Khan, senior executive editor of TBS, moderated the event titled "World Heart Day 2025: Don't Miss a Beat," jointly organised with United Healthcare.

Dr Azharul Islam Khan

Director, Medical Services, United Medical College Hospital

United Healthcare operates under one umbrella. On the clinical wing, it includes United Medical College Hospital at Satarkul, Madani Avenue, M A Rashid Hospital in Jamalpur, and Medix in Dhanmondi. Within this ecosystem, there are healthcare education institutions such as United Medical College and United College of Nursing, along with a pharmacy chain: Well-being Pharmacy. To strengthen the country's healthcare equipment sector, TechVital Systems and Medipac are contributing on a national scale. The goal of the hospitals is to make healthcare accessible, available, and affordable, while ensuring quality and specialized care—all of which can be found at the central hub, United Medical College Hospital. Due to rapid urbanisation, reduced physical activity, pollution and changing food habits, cardiac problems are increasing. However, technology has developed significantly. The private sector provides 80% of healthcare in Bangladesh. The country has many skilled cardiologists and cardiac surgeons, yet patients still go abroad. Those treated here should act as ambassadors, promoting that quality treatment is available in Bangladesh.

Prof Dr Mohsin Ahmed

Chief Consultant & Director, Cath Lab, Department of Cardiology, United Medical College Hospital

Cardiac treatment began in Bangladesh in 1978 at the National Institute of Cardiovascular Diseases. The Heart Foundation was established in 1979. Outside Dhaka, treatment is now available in Chattogram, Sylhet, Khulna, Jamalpur, Sirajganj, Rajshahi, and Dinajpur.

For 18 crore people, there are only 1,200 cardiologists, 200 cardiac surgeons, 40 paediatric cardiologists, and 15 paediatric cardiac surgeons. The shortage of cardiac nurses, anaesthesiologists, and technicians prevents further progress. 

In four decades, we have advanced, particularly in heart attack treatment and coronary care. Yet sudden heart attacks or heart failure cases are still not adequately treated. Complex paediatric heart disease treatment is limited to a few centres. Minimally invasive valve surgeries lag behind, and many patients still go abroad. Required devices are expensive, so both private and government sectors must step in.

United Healthcare has contributed to the country's cardiac requirement for 18 years. They have catered thousands of patients through cardiology and cardiac surgeries, at United Medical College Hospital in Satarkul. We have built a comprehensive cardiac ecosystem, ranging from cardiac surgery, paediatric cardiology and cath labs. 

A significant gap in cardiac issues is prevention. We need to investigate why young people suffer heart attacks, including high-cost genetic research. Recovery takes about six months, causing economic losses and risks of repeat attacks. Rehabilitation is essential but almost non-existent in Bangladesh.

The World Heart Day slogan "Don't Miss a Beat" stresses the importance of every heartbeat. To achieve this, we must work together, expand the number of doctors, nurses, technicians, and allied health workers, provide international training, and cut costs by making devices tax-free. Infrastructure can be developed through the private sector, especially who has the healthcare ecosystem like United Healthcare, and local manufacturing will help cardiac care advance.

Prof Fazila-Tun-Nesa Malik

Professor and Chief Consultant, Cardiology, National Heart Foundation

I am optimistic about our healthcare system and see enormous potential. Government and private sectors must work collaboratively. Only by fully developing both can we meet people's needs. Prevention is most important. Without prevention, nothing can be achieved, and everyone has a role.

Diseases such as diabetes, hypertension, and cardiac problems are rising due to modern lifestyles. But one issue we must address is pollution. Children should learn in schools about controlling pollution, and the government also has a role. Pollution not only increases cardiac risk but can also cause cancer and lung disease. Much more must be done in prevention.

Some work is being done in rehabilitation, but not enough. At our hospital, we have a rehab centre where we conduct seminars for every PCI patient. For heart failure patients, we provide membership cards, offering medicines at subsidised rates. This remains rare in the country.

In 446 upazilas and districts, hypertension and diabetes medicines are provided free at Non-Communicable Disease (NCD) corners. The outcome is significant: blood pressure control has improved from 13% to nearly 56%. But the main challenge remains a continuous supply of medicines.

Prof Dr Mofassel Uddin Ahmed

Consultant, Department of Cardiac Surgery, United Medical College Hospital

A single disease often has two treatment options—open-heart surgery or stenting. The cardiologist recommends based on the patient's condition. A main challenge here is propaganda. Strategy kills culture. We do not conduct post-mortems for every patient due to cultural norms—we are not allowed to handle dead bodies. If a patient suffers a massive MI, we cannot always assess clinically if it was the direct cause. Autopsy to determine pathology is not feasible here.

Abroad, politicians engage to address such issues. They act as a bridge between the public and service providers, while businessmen facilitate service delivery in organised chains. Doctors primarily work in laboratories under microscopes, making direct communication with patients difficult. Our work is mostly behind the scenes.

In our country, tertiary care hospitals are putting their best effort to deliver comprehensive services to patients. It is always best to work with an ecosystem so that any patients starting from primary healthcare to tertiary healthcare gets equal service.

Dr Mohammad Rafiur Rahman

Consultant, Department of Cardiac Surgery, United Medical College Hospital

Every year, nearly 20 million people worldwide die from cardiovascular disease, one in five at a younger age than expected. Globally, research is ongoing on these deaths and risks.

In 2010, the American Heart Association emphasised that focusing only on people already undergoing treatment in cath labs or surgery will never eliminate heart disease. They promoted primary prevention through "Life's Simple Seven." By 2022, this became "Life's Essential 8," adding sleep habits.

These eight parameters—healthy diet, daily activity, no tobacco, healthy weight, controlled blood pressure, regulated blood lipids, managed blood sugar, and proper sleep—are measurable. Integrating them into culture is difficult but essential. Prevention requires systemic thinking and cannot be done by individual doctors alone. Public health experts, dieticians, physiotherapists, and policymakers must play key roles.

Working with industry experts in cardiac surgery, I firmly believe that education gets fulfilment only through experience. While the books are important, but learning from the best will help the glory of Bangladeshi cardiac surgery take forward. Which is why, my experience will not only help patients coming to United Medical College Hospital, but also build fresh hands into experienced ones, working alongside me.

Prof Dr Muzaherul Huq

Founder Chairman, Public Health, Foundation of Bangladesh

CPR is a life-saving skill anyone can use if trained. Training should extend beyond doctors to nurses, paramedics, medical students, fire-fighters, Scouts, Guides, and the public.

In Bangladesh, the new Emergency Medicine Department is insufficient. Rapid manpower development, effective infrastructure, and expert teams are urgently needed. Continuous medical education is essential to keep doctors' skills updated, but this is almost non-existent. Regular international training for cardiologists and surgeons, plus coordinated efforts, is necessary. Success requires government, cardiac societies, and professional organisations. With proper planning and large-scale training, life-saving services can reach every level.

Dr Mohammad Mosaddek Hossain Biswas Dambel

President, Bangladesh Private Hospital Clinic and Diagnostic Association

Bangladeshi doctors have treated patients like Tamim Iqbal—has this been properly promoted? Officials are eager to develop infrastructure, but care at sub-centres is not guaranteed. There are enough experienced doctors, and while patients once went abroad, treatment is possible locally.

We have proposed allocating part of the government budget to private hospitals so patients receive care at subsidised rates. The Bangladesh Private Hospital Association has created four wings, including research and administrative. Many organisations are not run properly, and we are working to set standards—it will take time. The private sector provides 73% of services.

Bangladesh currently has 115 private medical colleges and 37 government hospitals. Standards are inconsistent. Doctors often cannot confidently administer basic procedures such as IV therapy. The current licensing system sometimes allows unsafe practices. We have proposed a pre-registration exam to ensure competency.

Dr Mohammad Suman Sikder

Consultant, Department of Cardiac Anaesthesia and CICU, United Medical College Hospital

Bangladesh's health system includes community clinics, upazila complexes, district hospitals, and tertiary medical colleges, yet cardiac care remains limited. At upazila level, patients with chest pain often lack ECG or Troponin-I tests, and many district hospitals have no CCUs. In some medical colleges, cardiology departments and cath labs exist but are not fully functional due to missing technicians or logistics.

About 21% of deaths are due to cardiac disease, yet the health budget does not reflect this. Advanced treatment is concentrated in Dhaka, with limited services in Chattogram and Sylhet. Basic cardiac facilities are available in less than half of primary centres, limiting initial care.

CPR training is important, but ensuring basic cardiac services is more urgent. Infrastructure, workforce, training, and social awareness must be developed in a coordinated way from primary to tertiary levels.

Prof Dr Syed Zakir Hossain

Professor of Medicine & Former Line Director Non Communicable Disease Control Programme Directorate General of Health Services

To combat non-communicable diseases (NCD), the government has set up NCD corners at the upazila level, linked with community clinics. Patients with hypertension and diabetes are digitally registered, receive free medicines, lifestyle advice, and protocol-based treatment. Monitoring tracks registrations, service use, and dropouts. Around 17 lakh patients are currently on record.

The main gap is prevention. Salt intake is double WHO's recommendation, physical activity is insufficient, and fruit and vegetable intake is low. Premature mortality exceeds 50%, compared to the global 41%. With proper lifestyle and treatment adherence, 80% of premature deaths could be avoided.

Awareness is low, many patients do not know they have hypertension, and only half of that aware take medication regularly. Just 4.2% of the health budget is allocated to NCDs, mostly for curative services. Continuous medicine supply is crucial, and co-payment systems like Korea's could ensure sustainability. Preventive programmes should target schools and workplaces, while low-cost or non-profit cardiac care centres can extend services to rural populations.

Dr Syed Mohammed Atique

Senior Consultant, Deparment of Cardiology, United Medical College Hospital

From my work in Australia, I saw a systematic healthcare model where patients from remote areas were referred efficiently, with outreach services like mobile MRI and heart buses. Cardiac services followed strict standards, with investment boosting both health and productivity.

Bangladesh, though a late starter, can learn from such models and advance quickly. Digital health, app-based follow-up, research, and registries are essential for evidence-based planning. With integrated systems, Bangladesh can provide world-class cardiac care in a short time.

Working in foreign landscape has always enabled me to access the best equipments and resources, which most doctors aspire. But I have always carried my motherland in my heart, for which have brought back all my experiences to my homeland. After returning, my goals to serve my people as well as not compromise the access I used to get abroad, I joined United Medical College Hospital to yield both the benefits which doctors like me always aspire after. 

Dr Abu Muhammad Zakir Hussain

Chairman, Community Clinic Health Support Trust and Member, Health Sector Reform Commission

The Health Sector Reform Commission stresses prevention, especially primary and secondary. Public awareness should focus on sleep, diet, stress, family history, and infections. Counselling is a major gap, as there are no counsellors or training in government hospitals, though lifestyle change depends on it.

The commission recommends strengthening prevention and referral systems at union and upazila levels, and establishing world-class hospitals at districts. Proposals include lowering medicine and device costs, tax incentives, and co-payment systems.

Mandatory CPR training is advised for police, teachers, factory workers, and health staff. School carnivals could build awareness among children and parents. Online prescription systems would help monitor drug use. Severe shortages in human resources—about 800,000 nurses and paramedics—highlight the urgent need for need-based workforce
development.