Are we treating heart attacks too late? Detect your risks before symptoms show up

Every day, people walk into hospitals across our country after the chest pain that they initially dismissed as acidity finally becomes unbearable. Patients need prompt diagnosis and treatment, but uncertainty, fear of medical costs and concerns about busy healthcare facilities can often lead to people delaying seeking care.

This is a pattern that quietly plays out again and again — patients losing precious time while their heart muscle quietly collapses. According to the Global Burden of Disease, 2021, heart disease is the most common cause of death in India, accounting for 28.6 lakh deaths annually. Moreover, we Indians develop heart disease almost a decade earlier than the global average, which means working-age adults, the breadwinners of their families, are increasingly the ones affected.

The golden hour we keep missing

In the 1970s, American cardiologist Dr. Eugene Braunwald coined the phrase “time is muscle”. What this means is that a heart attack is not a singular, sudden event — muscle damage slowly spreads over time, and because the damage takes several hours to complete, doctors can save the muscle if they restore blood flow quickly. The first 90 minutes after the heart attack offer the best chance of limiting permanent damage.

Unfortunately, half of all heart attack deaths in India occur before the patient ever reaches a hospital. Guidelines recommend an ECG (electrocardiogram) within 10 minutes of first medical contact, but in practice, many patients travel for hours and often have to visit two or three healthcare centres before that first ECG is even done.

Heart attack symptoms are often mistaken for acidity, fatigue or stress, delaying the urgency this condition truly demands. Misinterpreting symptoms and underestimating personal risk cost the patient time that matters the most.

But improving outcomes cannot depend only on treating patients once a heart attack has occurred. Prevention has an equally important role to play. Understanding risk factors, recognising warning signs early and making healthier choices can help reduce the risk of heart disease before it reaches an emergency.

Why the future cannot look like the past

For decades, cardiology has largely been a reactive specialty. We wait for the chest pain, the ECG, the blocked artery and then we intervene. This cannot remain our working model — recent evidence estimates that cardiovascular disease affects around 11% of India’s adult population, and metabolic risk factors such as high blood pressure, cholesterol and blood sugar are highly prevalent in our country.

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A model built only around emergency response will always be racing against a clock. The answer is to move from treating cardiovascular disease only when it declares itself to identifying and managing risk much earlier. A model of cardiac care that is predictive, preventive and personalised can help us intervene before an emergency begins.

Additionally, metabolic and lifestyle factors together account for the overwhelming majority of India’s cardiovascular risk and nearly all of it is modifiable. This is where preventive healthcare comes into play. The most powerful intervention is not a stent or a bypass. It is controlling blood pressure, cholesterol and blood sugar, staying physically active, eating well and staying away from all forms of tobacco.

Advances in medical technology are changing how we approach prevention. Today, non-invasive tools, including carotid and femoral plaque imaging, CT coronary angiography and coronary calcium scoring, can help detect plaque build-up years before symptoms appear. Wearable sensors and AI-based risk tools add another layer, flagging abnormal heart rhythms or blood pressure trends long before they turn into emergencies.

Furthermore, personalised medicine is important because the risk profile of a 35-year-old professional with a family history of heart disease looks nothing like that of a 60-year-old managing diabetes and hypertension. Some conditions, such as atrial fibrillation (heart rhythm irregularity in the upper chamber) can stay completely silent until a stroke becomes the first symptom. Tailored, risk-based screening, rather than one-size-fits-all check-ups, is how we catch such patients in time.

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What needs to change

We need to close the gap between symptoms and treatment at every level. For that, we need stronger public awareness of heart attack symptoms and about the urgency of the golden hour. Additionally, we need wider availability of diagnostic facilities beyond our metro cities, stronger networks that connect smaller healthcare centres to specialist cardiac care, and routine, risk-based preventive screening rather than screening only after a crisis. For this, the public and private sectors must work hand in hand.

We must build a more predictive, preventive and personalised model of cardiac care. Because with heart disease, every hour of delay is paid for in human lives.