As Ghana joined the global community in commemorating the 25th anniversary of World Heart Day, the powerful theme "Don't Miss a Beat" compels us to listen closely to the rhythm of our nation's heart health.
What we hear is a loud but silent, accelerating crisis: the devastating and growing burden of heart failure, a condition that is crippling our workforce, overwhelming our healthcare system and plunging families into catastrophic health expenditure.
The data paints a stark picture. Cardiovascular diseases (CVDs); Heart Failure and Stroke are the main drivers of CVD mortality and hospitalisation, primarily from undetected and uncontrolled hypertension in Ghana.
A sobering study at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, which serves a population of nearly 10 million, revealed a dramatic 78 per cent increase in the proportion of medical admissions due to cardiac diseases between 2004 and 2014, rising from 4.6 per cent to 8.2 per cent of all medical admissions.
Among these cardiovascular admissions, heart failure (HF) is the predominant culprit, accounting for a staggering 88.3 per cent of cases.
The heavy burden: cost and outcomes
The human cost of this crisis is immense, but the financial burden is equally catastrophic for families and the healthcare system.
A recent study by Appiah et al. in 2023, conducted at a major tertiary hospital in Ghana, provides critical and alarming data on the economic impact of these admissions.
The study, which reviewed admissions between 2018 and 2019, found that heart failure was the third most prevalent CVD among hospitalised patients, accounting for 29.4 per cent of admissions, following stroke (48.5 per cent) and hypertensive emergencies (42.7 per cent).
The financial toll of treating these acute conditions is overwhelming for the average Ghanaian.
The research revealed that the median cost for a CVD hospitalisation was USD $195.29. To put this in perspective, this single hospitalisation cost (for less than a week) is over a hundred times the daily minimum wage in Ghana.
For a condition like heart failure, which often requires repeated hospitalisation, the financial implications are nothing short of catastrophic, pushing families into debt and poverty.
Tragically, the outcomes remain poor. The overall case fatality rate (CFR) across all acute CVD admissions was 21.5 per cent, meaning approximately one in five patients admitted did not survive.
While the CFR for heart failure was slightly lower at 14.1 per cent compared to stroke's 28.9 per cent, it remains unacceptably high.
The KATH study also showed that the proportion of hospital deaths that were cardiovascular in nature more than doubled (a 102 per cent increase) between 2004 and 2014.
Common risk factors and causes
Understanding what drives this heart failure epidemic is key to stopping it.
The same KATH study identified hypertension as the single largest contributor, linked to 52 per cent of all heart failure admissions.
This is particularly alarming given that nearly four out of every 10 Ghanaian adults have high blood pressure, with many unaware of their condition.
Beyond hypertension, the causes of heart failure in Ghana differ from those in Western nations.
The main aetiology includes: Dilated Cardiomyopathy (often from unknown causes or viral infections), Hypertensive Heart Disease (from long-term, uncontrolled high blood pressure), Ischemic Heart Disease (heart attacks and blocked arteries), whose prevalence rose by a worrying 250 per cent between 2005 and 2015 and Valvular Heart Disease (often from untreated rheumatic fever in childhood.
Other significant risk factors exacerbating the crisis include excessive alcohol consumption, diabetes, obesity and physical inactivity.
Prevention: How we can "not miss a beat"
The theme: "Don't Miss a Beat" is a powerful call for awareness, prevention and timely action.
We cannot afford to miss a beat in our own heart health, nor can our healthcare system miss a beat in its response.
Here’s how we can turn the tide:
Know your numbers: Every adult must know their blood pressure, blood sugar, and cholesterol levels.
Regular check-ups are non-negotiable.
This is the first step to catching problems early.
Embrace lifestyle changes: Adopt a heart-healthy diet rich in fruits, vegetables, and whole grains while reducing salt, sugar and unhealthy fats.
Engage in regular physical activity and avoid tobacco and excessive alcohol.
Adhere to medication: For those diagnosed with hypertension or diabetes, strict adherence to prescribed medication is crucial to prevent the devastating complications that lead to heart failure.
Strengthen the healthcare system: Policymakers must prioritise primary health care and preventive strategies.
Increasing investment in public health initiatives, subsidising essential medicines for chronic conditions, and strengthening the National Health Insurance Scheme (NHIS) to better cover long-term CVD management are critical steps to reduce the catastrophic out-of-pocket costs revealed by Appiah et al.
Public awareness: Nationwide campaigns are needed to de-stigmatise CVDs and educate the public on recognising symptoms such as shortness of breath, prolonged chest pain and extreme fatigue early.
A collective call to action
As we mark World Heart Day, the silent crisis of heart failure demands a loud response.
It is a collective responsibility. Individuals must take ownership of their health.
Healthcare providers must advocate and deliver better preventive and chronic care.
The government and policymakers must prioritise cardiovascular health through funding and robust policies aimed at primordial and primary prevention.
Let us honour the 25th anniversary of World Heart Day not just with words, but with action.
Let us commit to listening to our hearts, to supporting one another, and to building a healthcare system where a heart failure diagnosis is not a financial death sentence and where prevention is the cornerstone of our approach.
Together, we can ensure that every Ghanaian heartbeat is strong, healthy and does not miss a beat.
*The writer is the General Secretary, Ghanaian Society of Cardiology.
