Renowned cardiologist and recipient of Padma Bhushan award, Dr TS Kler, recently took charge as the Chairman of the PSRI Heart Institute and heads its Electrophysiology Programme. In a candid chat, he divulges his plans to transform PSRI Institute into a centre of excellence for cardiac care
PSRI super speciality hospital is already known for its medical and surgical management of liver, renal and digestive diseases. What are your plans to turn it into a notable heart institute?
There are many heart institutes and hospitals in Delhi, but we lack a centre of excellence in cardiology and my mission is to make PSRI Heart Institute a state-of-the-art institute. I also want to carry out some specific cardiology research, which is relevant for Indian patients, particularly on refractory heart failure. In refractory heart failure, a patient undergoes all the cardiac surgeries like angioplasty, bypass surgery etc and yet he/ she has cardiac decompensation and the heart fails to respond satisfactorily to routine therapeutic measures. Globally, there are 25 million with such a condition, about four million in India are suffering with refractory heart failure. So, I want to develop a dedicated heart failure programme for such cases. Also, there is an increased risk of coronary disease in India. In Western countries, people aged 55 and above suffer from cardiac diseases, whereas in India, people aged 40 and above have cardiac issues. Also, there is an increase in incidence of cardiovascular disease (CVD) among women, which can be related to high-level of stress. These factors need study and we need to act upon it. The first step is to conduct a research on such observations and I plan to conduct multi-centre trials.
What will be PSRI’s take on the cost front?
Awareness among people on the various cardiac issues is very less in our country. Main issue is the dearth of cardiologists. We have thousands of cardiologists available but patients with CVDs are in millions and are increasing year-on-year. 70 per cent of the population cannot afford the cost of procedures involved in CVDs. We at PSRI are trying to create a category for those who are less privileged and those who don’t fall under BPL category and charge them a little low than private hospitals. For example; on an average, private hospitals in Delhi charges Rs 2 to 2.5 lakh for an angioplasty. We want to reduce it to at least Rs 75,000.
Rapid rise of CVDs have increased the need for more electrophysiologists. Can you share the benefits offered by an electrophysiologist. Do we have enough number of electrophysiologists in the country?
Many are not aware of what is electrophysiology. It is a branch of cardiology which deals specifically with rhythm problems of the heart. If one has palpitation and syncopy (transitory loss of consciousness) they should go and meet preferably cardiac electrophysiologist for checkup. As the public is not aware of which specialist to meet, many end up not receiving the right therapy at the right time. Right now the members enrolled in Indian Heart Rhythm Society (IHRS) are approximately 150, and among them those who are well trained in electrophysiology are around 40. The number is definitely very less compared to what is actually required in our country. Building awareness of different kind of heart disorder & referring them to the right specialist is the need of the hour. There should be a structured awareness programme for CVDs by the government. There should be lessons on CVDs at the school level. I hope these small changes will have larger impact.
What role should genomics play in CVDs?
As far as genomics in CVD is concerned, there are no therapeutic models. The research is still going on and it can be a revolution in future. I want to inform that at present, stem cell therapy in heart diseases doesn’t work.
What are the five rules to avoid CVDs?
Keep your weight and tummy girth in order. Tummy circumference should be below 95 cm in men and 85 cm in women measured at the level of umbilicus in quite respiration. Check your BP and blood sugars every six months, blood level of bad (LDL) cholesterol once a year, any form of exercise test once in two years. Exercise test should be conducted every year in high risk individuals like diabetics, strong history of heart disease, smokers etc. If you have blood pressure, it should be properly controlled, which means keeping the BP below 140/90 in adults. If you have diabetes, good control of diabetes is must and good control means keeping HbA1c between 6-7. Keep your LDL (bad cholesterol) below 100 if you do not have CAD, but below 70 if you have already established coronary artery disease. Regular exercise of 45 minutes should be undertaken at least five days a week and one should learn and handle stress.
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