Matters of the heart

The human heart is at the centre of our circulatory system. Blood must keep on flowing and that’s why if there’s blockage in an artery, a stent is inserted to keep the passage open for blood to flow.

As such, when a news item titled ‘Expired stents — FIA finds glaring irregularities and grave negligence’ was published recently in a local English-language daily, the patients with coronary stenting were shocked.

According to a report filed by the Federal Investigation Agency (FIA), 38 patients had as many as 39 expired stents inserted at the Punjab Institute of Cardiology (PIC) last year. Nobody knows about the unreported cases in other parts of the country.

Responding to the report Pakistan Society of Interventional Cardiology (PSIC) stated that the story created a false impression of involvement of “our members in unethical practices.”

The society argues that doctors are not mandated legally or otherwise to check the expiry date or quality of the equipment, drugs, devices or consumables provided to them by the hospital.

Irrespective of whether ensuring the validity of the stent is the responsibility of the hospitals or the doctors, the matter requires immediate attention of the health authorities concerned.

More so because the FIA also reported that 500 stents were bought from a private company in 2019, which were supposed to be inserted in 2020.

But these stents reportedly had not been used even after 19 months of their expiry date.

Commenting on this report, Dr Faisal Ahmed, an eminent consultant cardiologist and head of the department, Liaquat National Hospital (Karachi) told Bol News that at times you procure certain items in bulk, expecting to consume the whole lot in a year. “But then at times due to various reasons, you may not be able to do that. In that case, the unused items should not be used after the expiry date. So there must have been some confusion in this matter.”

The cardiologist, however, confirmed that the doctors only provide specifications for the stents but procurement is the responsibility of the administrator. Moreover, he is also duty-bound to ensure that all what is required for a heart surgery or angioplasty is given to the surgeon as per specifications provided to him.

For some heart patients, surgery is recommended to open the blocked arteries that supply blood to the heart. One such option is cardiac angioplasty in which a tiny balloon on the end of a catheter threaded into the blocked coronary artery is inflated to stretch open the blockage.

In about 70 per cent to 80pc of these procedures, a stent is inserted to keep the blood vessel from closing up again.

The current statistics revealed that over 40,000 stents are implanted each year in Pakistan.

The price of imported bare metal and drug-eluting stents in the market ranges from Rs35,000 to Rs55,000, and Rs75,000 to Rs125,000, respectively.

He further said that there are two types of stents: bare-metal stents and drug-eluting stents. “The latter are used more frequently and are coated with medication that helps keep a blocked artery open longer. A drug-eluting stent is also the most common type of stent used to treat a blockage of the heart arteries. Many people with heart problems have been successfully treated with drug-eluting stents, preventing the need for more-invasive procedures, such as coronary artery bypass surgery.”

But then it goes without saying that expired items and medicines should not be used, he remarked.

Dr Ahmed also said that normally, the stents are made to be permanent and will continue to keep your artery open once they’ve been placed. “However, stents don’t cure the underlying condition that caused the build-up in your artery (atherosclerosis). You’ll still need treatment to prevent future artery narrowing.”

Good heart health

He added that the patients after insertion of stent may come for a check-up after a week followed by a visit after six months and then only if they develop some problems relating to the heart.

“But then they must continue following the health tips given by the doctor which include walking and quitting smoking. Other suggestions include increasing activity by limiting the time spent watching TV or using the computer, and getting involved in outdoor activities such as cycling, gardening, or walking and above all a calm sleep for at least eight hours,” elaborated the cardiologist.

His recommendations also included limiting the intake of readymade snacks which are often high in sugar, fat and salt, ensuring the intake of at least five servings of fresh fruits and vegetables a day, reducing salt consumption to one teaspoon a day and preparing meals at home for school or work.

Speaking about the causes of heart disease, he explained that smoking in all forms, including the fastest growing shisha, is the main cause of this disease. “And surprisingly enough, during a survey, it was revealed that people in rural areas outnumbered urban residents in smoking, especially women in villages. As such the perception that heart disease is not common in rural areas has been proved wrong.”

Dr Ahmed warns that heart disease is the world’s number one killer and is responsible for 19 million premature deaths: more than 80pc of these deaths occur in low-income and middle-income developing countries. Moreover, heart-related diseases also result in 31pc of all global deaths. The incidence of heart diseases is steadily rising, so much so that 23.6m people are predicted to die from cardiovascular diseases by 2030.

Therefore, Dr Ahmed argues that prevention is better than cure. “But we do not pay attention to it.”

He pointed out that cardiovascular disease in Pakistan and across the world is on the rise, and although it can often be treated, primary prevention is the best way to reverse this trend.

He urged the federal and provincial health authorities to set up preventive cardiology units at district levels. “Preventive cardiology units should focus on lowering patients’ risk of developing heart disease. These units may also help those having a first heart attack or stroke.”

After a first heart attack, most people go on to live a long, productive life, he highlighted. “However, around 20pc of patients aged 45 and older will have another heart attack within five years of their first one.”