Despite scientific and technological advances in cardiovascular care, heart diseases are still the leading and most predominant cause of death for non-communicable diseases globally, affecting over 500 million people1. In 2021, about 20.5 million people died from a heart condition2, far outnumbering the death toll from COVID-19. The global economic burden of heart failure alone exceeds USD $100 billion per year, the majority of which is attributable to direct healthcare costs3.
As the population ages and obesity and sedentary lifestyles increase, cardiovascular diseases are rapidly becoming common, especially in high risk groups such as people living with diabetes and high blood pressure. So how can we change this disease landscape? The easy answer is prevention and timely detection. Prevention must be understood as not simply primary prevention – the avoidance of elevated risk – but also as secondary prevention. This entails managing the risk of people living with previous conditions and mitigating the chances of disease progression to provide better care and alleviate burden on health systems.
While timely detection is essential to preventing cardiovascular diseases and their devastating consequences, 47 percent of the global population and 81 percent of people in low- and lower-middle income countries have little or no access to lifesaving diagnostics4. Even in high-income countries diagnostics are underutilised.
Aiste Štaraitė was only 29 when she started feeling the first symptoms of heart failure - shortness of breath, fatigue, fast resting heart rate, dry cough and swelling belly. After several visits to the hospital resulted in incorrect diagnoses and intervention, a terrifying situation made her run into the emergency room. “I was seated while sleeping, because I couldn’t even lay down, and my heart rate was around 160 and stayed that high. I thought my chest was going to split in two because it was beating so strong and often. That’s when I noticed something was definitely wrong.” Aiste had to wait until the following day to see a cardiologist, and an echocardiogram revealed end-stage heart failure.
Now, several years and a pump device and heart transplant later, Aiste devotes her days to educating and advocating for patients as chair of the Heart Failure Patient Council at the Global Heart Hub. She also serves as president of the Lithuanian Heart Failure Association. Similar to Aiste, 80 percent of those with heart failure are only diagnosed after being admitted to an emergency room. “Even among patients seeking help in primary care, far too many are not getting tested with the cardiac tests that can identify developing heart failure weeks, months, or years before it turns acute,” explains Mathias Egermark, Senior Vice President, Cardiometabolic Disease, Roche Diagnostics.
A study in the United Kingdom shows that in primary care, only 25 percent of patients diagnosed with heart failure had access to what are known as natriuretic peptide (e.g. NT-proBNP) tests six months prior to the diagnosis5. These cardiac biomarker tests can help identify first signs of the disease prior to an acute situation, enabling intervention earlier.
When it comes to fighting this silent pandemic, every minute counts. Innovation in cardiac care, both in diagnostics and treatment, has advanced over the years. Innovative diagnostics tools from cardiac biomarkers in labs to near-to-patient solutions such as point of care testing and digital devices are already available and can be integrated into comprehensive disease management programs to support timely detection and decision making. But access to these innovations is still not a reality in most of the world.
Establishing national cardiometabolic plans, focused on integrating diagnostics tools across the care continuum and integrating multidisciplinary care approaches is critical to enabling sustainable and equitable care. Integration of care also means investing in multidisciplinary teams approaches including general practitioners and nurses to facilitate timely detection and decision making and overcome the workforce shortage, which has been an increasing reality worldwide.
Supported by a diagnostics strategy and framework, healthcare professionals and health systems are able to maximise efficiencies needed to address this number one killer in a sustainable and equitable way. Implementing the solutions already available today allow countries to offer better quality care by identifying and intervening earlier, hence preventing premature deaths and reducing direct and indirect costs related to cardiac diseases. This benefits people living with or who are at-risk of cardiovascular diseases as well as health systems, by reducing direct or indirect costs and advancing toward a world with healthy lives for all.
References
Roth GA, Mensah GA, Johnson CO, et al. 2020. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology 76(25): 2982-3021
World Heart Federation (2023). World Heart Report 2023 - Confronting the world’s number one killer, 2023. Accessed on August 14 2023.
Bloom D, Chen S, Kuhn M, et al. 2019. The flip side of “live long and prosper”: Noncommunicable diseases in the OECD and their macroeconomic impact. In: Bloom D, ed. Live long and prosper? The economics of ageing populations. London: Centre for Economic Policy Research Press: 45-47
Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys, Published:October 06, 2021, Accessed on August 14 2023,
European Heart Journal, Volume 43, Issue 9, 1 March 2022, Pages 881–891, Accessed on August 14 2023,
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