In conversation with Payal Agrawal- GM and Country Head India & subcontinent, Structural Heart, Abbott

Q1. There has been an increasing burden of heart diseases since the pandemic hit last year. How has the COVID 19 scenario affected the treatment for heart conditions? Are people coming to hospitals? Many patients and doctors have adopted a new method of tele- consultation. Is that helpful?

Ans. The pandemic saw unprecedented effects on healthcare. Specific to cardiovascular disease, in 2020, we saw a decline in the number of patients seeking treatment. People were not comfortable going to a hospital or calling an ambulance. While people’s fears amid the pandemic are understandable, it is important for patients with cardiac issues or other chronic conditions to seek timely and periodic treatment. Delaying medical intervention can lead to complications and further damage to the heart.

A survey by the European Society of Cardiology, published in the European Heart Journal, Quality of Care and Clinical Outcomes, states that while global healthcare delivery and policy are currently focused on the COVID-19 pandemic, we must not forget other serious conditions. For example, acute coronary syndromes (ACS), for which physicians can deploy life-saving evidence-based treatments continue to exist and may even increase in prevalence during an infectious disease pandemic. 1 While healthcare systems are stretched even now, there is increased preparedness in the hospitals to treat patients who need other treatment. In fact, the ICMR (Indian Council of Medical Research) has formulated and issued treatment protocols to manage cardiac cases during the pandemic.

Virtual interactions between patients and doctors have increased. Some of our cardiac devices also have remote monitoring options enabling doctors and patients to stay connected. Technology plays a significant role in enhancing patient and physician engagement.

Q2. The burden of cardiovascular disease has almost doubled in the past 25 years and mitral regurgitation (MR) characterised by irregular heartbeat is emerging as a common heart valve problem. Could you elaborate more about this defect? Is there a minimally invasive treatment option available for patients who do not want to go for open heart surgery?

Ans. The heart is a pump, sending oxygenated blood throughout the body. Each valve has a purpose to keep blood moving to or from the heart, so the body can operate as intended. Mitral regurgitation occurs when blood backs up in the heart, from either a leaky mitral valve or from valve leaflets that cannot close if the left chamber of the heart is enlarged from advanced heart failure or a heart defect. This results in breathlessness, cough, heart palpitations, fatigue and swollen legs. MR can be related to age, a birth defect, or a history of heart disease. Significant leakage can form blood clots. If left untreated, the condition can lead to several cardiac problems such as heart failure, atrial fibrillation, and pulmonary hypertension.

Advanced medical technology has resulted in minimally invasive procedures such as transcatheter mitral valve repair, offering an effective alternative option for MR patients who are at prohibitive risk for conventional mitral valve surgery. Such procedures using a clip device can restore normal functioning of the leaflets of the mitral valve by clipping them together. This clip-based device is delivered to the heart through a small incision in the leg and does not require opening of the chest. It enables faster recovery; reduction of hospital stays and improves symptoms.

Q3. How do such innovative treatments ensure better quality of life for patients compared to open-heart surgeries?

Ans. One important advantage of a minimally invasive procedure is that it avoids the requirement for an open-heart surgery and associated risks. The procedure helps patients with faster recovery, less complications, and can be used for older patients who suffer from mitral regurgitation and are at high-risk for an invasive surgery. This therapy has been used in over 100,000 patients across the world, improving clinical outcomes and quality of life

Q4. What kind of heart defects are seen in the new-borns? What is Abbott's contribution in dealing with these rising incidences of congenital heart defects among children

Ans. Cardiac conditions are normally associated with adults. However, it is estimated that more than 200,000 children are born with congenital heart defects in India every year2. Amongst these, at least 20 per cent have critical issues and need intervention within the first month, while others may be treated in the first year or later as required. These issues vary from small defects to more complex and serious conditions. Common defects include Atrial Septal Defects (ASD or a hole between the left and right atria), Ventricular Septal Defect (VSD or a hole between the left and right ventricles), Patent Ductus Arteriosus (a persistent opening between the two major blood vessels leading from the heart which ideally should close after birth) and Coarctation of Aorta (narrowing of the aorta). Some of these defects can be treated without surgery, while others require open heart surgery. The important thing is that early intervention and awareness can help ease some of these problems.

Our innovative devices aim to help young children who require advanced medical attention. Our minimally invasive closure device specifically designed for preemies and new-borns to correct PDA without the need for open heart surgery is one such example. We also have the smallest mechanical heart valve that can be used in paediatric patients 5 years of age or younger. We hope to continue fulfilling the needs of our young patients so that they can live healthier, better lives.

Q5. Please tell us if there is any upcoming innovation from Abbott's structural heart division and how do you aim to strengthen the portfolio in the coming years?

Ans. With dynamic healthcare needs, we are fostering life-changing technologies and will keep finding solutions to address heart problems at every stage in a patient’s life. A few examples of our expanding portfolio include:

- Last year, we launched the clip delivery system, a minimally invasive mitral valve repair device to treat mitral regurgitation in India. This product puts new technology into the hands of physicians by giving them a life-saving treatment option that may be used for people suffering from mitral regurgitation due to a heart defect or because of heart failure.

- We have a range of devices for all ages. We are a leader in occlusion devices that can help to prevent stroke. These are minimally invasive closure devices specifically designed to stop blood flow through all types of patent foramen ovale (PFO) or a hole in the heart. To elaborate, an occluder is an implant that is used to cover or close a hole in the heart. The occluder, which looks like a sort of miniature three-tiered umbrella, is placed through a catheter-based procedure.

- We have recently launched a special occluder, that helps in treatment of a life-threatening congenital heart defect called a patent ductus arteriosus or PDA. This is an opening between two blood vessels leading from the heart that, for most babies seals itself shortly after birth. When it doesn’t, the smaller-than-a-pea occluder can offer life-saving treatment for the smallest patients. An industry first, this device can be implanted in children whose weight is as little as 700 gms.

Abbott’s cardiovascular devices extend beyond structural heart solutions with innovative technologies that improve the way doctors treat people with vascular diseases, heart arrhythmias and heart failure.