![]() In such circumstances, healthcare rationing becomes inevitable. ![]() ![]() 7 A study on microeconomics of cardiovascular disease (CVD) in India showed that 79% people have to resort to “distress financing” forcing them to borrow or sell assets when faced with an acute episode of acute coronary syndrome (ACS) or stroke. As high as 86% of rural population and 82% of urban population are not covered under any insurance scheme whether public or private, to support health expenditure. 6 Private health care runs parallel with government funded health service, but is expensive and therefore affordability is an issue. 5 This is still lower than the government spending in countries such as UK (7.9%), US (8.2%) and Japan (9.6%). Government of India has cleared the National Health Policy 2017, which promises to increase public health spending to 2.5% of GDP. This inequality in healthcare distribution is a major impediment for implementation of universal health care in India. Most of the tertiary healthcare resources are concentrated in the large cities and that too mostly in the big Metropolis. Only basic health care facilities are available at most of the primary health centres, which are often understaffed and their services overstretched. At the 2001 census, 72% of the population lives in villages which are poorly accessible by roads, making delivery of healthcare difficult. The challenge is to make quality healthcare services accessible and affordable to a socioeconomically and linguistically diverse population of more than 1.3 billion 4 spread over 3.287 million km 2, with inadequate infrastructure to deliver services and lack of strict quality control measures. Challenges of management of heart failure in India This position statement is recommendatory in nature and carries no statutory status.ġ.1.2. We also have tried to gather data on conditions specific and relevant to the Indian context like rheumatic heart disease, aortoarteritis and endomyocardial fibrosis. The purpose of this statement is to provide a single document for the whole country which provides the latest available data both from India and the rest of the world. ![]() It is in this context that Cardiological Society of India (CSI) decided to bring together a group of experts in HF in India, to develop and publish the ‘Position Statement on management of HF in India’. Since our resources are limited and the vast majority of the population spend out-of-pocket for treatment, it is an important responsibility of the cardiologists and all concerned stakeholders to provide the best available therapeutic options in an affordable manner, based on the latest available medical knowledge and practice. Also the varying geographic and ethnic diversity poses a great challenge to the management of HF in our country. With the dual burden of traditional diseases like rheumatic heart diseases and the rising burden of new-age diseases like coronary artery disease, the burden of HF in India, is likely to be enormous. Heart failure (HF) is emerging as an important public health problem in India. The very essence of cardiovascular medicine is the recognition of early heart failure. Narain, d Vimal Raj, af and Yash Lokhandwala ag Sanjay, b Satyendra Tewari, j Sengottuvelu G., Y Soumitra Kumar, c Soura Mookerjee, a Tiny Nair, ab Trinath Mishra, ac U.C. Yadava, U Prashant Bhardwaj, V Pravesh Vishwakarma, d Rajeeve Kumar Rajput, W Rakesh Gupta, X S. Hiremath, P Milind Hot, Q Mrinal Kanti Das, R Neil Bardolui, S Niteen V. Sawhney, J Jayanta Saha, a Johann Christopher, K K.K. Lanjewar, A Dharmendra Jain, B Dipak Sarma, C G. Pancholia, o Ajay Sinha, p Akshyaya Pradhan, q R Alagesan, r Ambuj Roy, e Amit Vora, s Anita Saxena, e Arup Dasbiswas, t B.C. ![]() Kerkar, i Sandeep Seth, e Rakesh Yadav, e Aditya Kapoor, j Ajaykumar U. Harikrishnan, b, ⁎ Saumitra Ray, c Rishi Sethi, d S. ![]()
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