Confluence of Cultural Context and Technological Innovation to Reduce Cardiovascular Disparities in India.

Abstract

Cardiovascular diseases (CVD) are a source of major morbidity and mortality worldwide, including in several low- to middle-income countries (LMICs). In fact, CVD represents the leading cause of death in India, accounting for a quarter of all mortality.1 CVD in India has quadrupled in the past 40 years, and estimates suggest that, by 2020, almost 60% of CVD patients worldwide will be Indians.2 Thus, India represents an accelerated epidemiological transition model (also observed in LMICs such as Brazil), where patients are living longer with chronic diseases.3 In combination with hypertension and diabetes mellitus as major risk factors for the burgeoning burden of CVD, ST-segment–elevation myocardial infarction (STEMI) carries a grave prognosis in India and other LMICs.3 Moreover, CVD disproportionately affects patients in poor and rural regions in India, and disparities in socioeconomic status accentuate this phenomenon.1 Those from lower socioeconomic status status less frequently receive optimal therapy, fueling adverse outcomes.1 Although cost-effective interventions have been developed for prevention and control of CVD risk factors, barriers to widespread use exist. Low detection rates, inadequate awareness, poor use of evidence-based interventions, and low adherence rates are a few of the challenges. Thus, innovative solutions are needed to surmount these barriers to improve CVD outcomes in India and other LMICs. A compelling opportunity to improve health lies in low-cost, high-impact technologies. India has the optimal milieu to foster technological innovation in reducing CVD disparities—bridging some of the age-old problems of income, caste, culture, and economic status. Importantly, the power of these technologies can be harnessed using a culturally tailored approach, such as pairing trusted community healthcare workers to deliver care to vulnerable, high-risk patients.4,5 We present 3 illustrative examples of healthcare providers using technological innovations—monitoring devices, mobile phone–based clinical decision support systems, and wearable …