When Every Minute Matters: Bangladesh needs a National Heart Care Network

A heart attack does not only test the capability of a hospital. It tests whether a person recognises the warning signs, whether help arrives quickly, whether the first healthcare facility makes the right decision, whether definitive treatment is available in time—and whether the family can afford it.

World Heart Day, observed on September 29, should therefore be more than an occasion for awareness. It should prompt Bangladesh to examine the entire journey of cardiovascular care, from prevention and early diagnosis to emergency treatment, rehabilitation and long-term follow-up.

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The World Heart Federation’s theme, “Use Heart for Action”, offers an appropriate message. Bangladesh now needs to turn cardiovascular awareness into coordinated action.

Cardiovascular diseases remain the world’s leading cause of death. According to the World Health Organization, they caused an estimated 19.8 million deaths in 2022, representing about 32 per cent of all deaths globally. Heart attacks and strokes accounted for around 85 per cent of cardiovascular deaths, while more than three-quarters occurred in low- and middle-income countries.

For Bangladesh, the consequences extend far beyond mortality. A serious cardiac event can remove a breadwinner from work, force relatives to become full-time caregivers and push households into financial hardship.

Prevention must begin in primary care:

Much cardiovascular disease can be prevented or delayed through early detection and treatment of risk factors.

Primary healthcare should routinely identify hypertension, diabetes, high cholesterol, tobacco use, obesity, kidney disease and relevant family history. People should not assume that feeling well means their blood pressure, blood sugar or cholesterol is normal.

Bangladesh already has encouraging evidence that organised primary care works. WHO reported in 2025 that hypertension control increased from 15 per cent to 56 per cent in some programme areas between 2019 and 2025. These figures are not national rates, but they demonstrate what structured screening, treatment and follow-up can achieve.

Healthy living is equally important. Regular physical activity, tobacco cessation, healthier food, adequate sleep and less sedentary behaviour should become part of national cardiovascular prevention.

But personal responsibility alone is not enough. People need safe places to walk, healthier food environments, stronger tobacco control and measures to reduce air pollution. Good health policy should make healthier choices easier.

Recognising a heart attack early:

When a heart attack occurs, time becomes critical.

Chest pressure, heaviness, tightness or discomfort may spread to the arm, jaw or back and may occur with breathlessness, sweating or nausea. Symptoms can sometimes disappear and return.

One dangerous problem in Bangladesh is the tendency to dismiss chest discomfort as “gas” and wait until symptoms become severe. Public education should make it clear that suspicious chest pain requires prompt medical assessment.

Once a patient reaches a healthcare facility, an ECG should be performed and interpreted rapidly. Current international guidance recommends obtaining a 12-lead ECG within 10 minutes in suspected acute coronary syndrome.

Blood testing with high-sensitivity cardiac troponin can assist diagnosis, but neither an ECG nor a single laboratory value should be interpreted in isolation. Symptoms, serial tests and clinical findings need to be considered together.

For a major heart attack caused by complete blockage of a coronary artery—known as STEMI—restoring blood flow quickly can save heart muscle and life.

Primary percutaneous coronary intervention, or PCI, is generally the preferred treatment when it can be delivered rapidly. Where timely PCI is impossible, appropriate clot-dissolving treatment followed by transfer to a PCI-capable centre may be necessary.

The important point is simple: patients should not lose precious time moving aimlessly from one facility to another.

Bangladesh needs a cardiac emergency network:

Bangladesh should establish a national acute coronary care network as part of a broader cardiovascular action plan.

At community level, people need education about symptoms, CPR and emergency activation.

Upazila health complexes should have functioning ECG machines, resuscitation facilities, trained staff and access to specialist advice. District hospitals should be able to assess and stabilise patients rapidly and coordinate referral.

Regional centres should progressively develop round-the-clock PCI and coronary-care capability, backed by tertiary hospitals offering cardiac surgery and other complex services.

Patients should be taken to the appropriate facility as directly as possible rather than being required to pass through every administrative level.

A regional hub model could initially be assessed across the country's historical greater-district areas. Locations, however, should be determined by population needs, travel times, existing facilities and geographical barriers. Coastal, riverine, rural and other difficult-to-reach communities must not be left behind.

A cardiac centre also needs much more than a catheterisation laboratory. Cardiologists, nurses, technologists, medicines, consumables, reliable electricity, maintenance and infection-control systems are essential.

Ambulances should become part of clinical care rather than simply vehicles for transport. They should have trained personnel, monitoring and defibrillation equipment, communication with receiving hospitals and a coordinated dispatch system.

CPR can save lives before hospital arrival:

Cardiac arrest demands another layer of preparedness.

If an adult suddenly becomes unresponsive and is not breathing normally, bystanders should call for emergency assistance, begin cardiopulmonary resuscitation and use an automated external defibrillator when available.

Bangladesh should therefore expand practical CPR training in schools, universities, workplaces and community organisations. Public-access defibrillators can also play an important role, but installing machines without training and maintenance will achieve little.

Treatment cannot depend on ability to pay:

Financial protection should be built into any national cardiac strategy.

A publicly supported emergency cardiac package could cover initial assessment, emergency treatment, transfer and indicated reperfusion. Participating public and private hospitals could operate under clearly defined prices, reimbursement arrangements and accountability mechanisms.

A critically ill patient should not have emergency stabilisation delayed because relatives cannot immediately produce a large deposit.

Digital technology could further improve the system through remote ECG interpretation, referral coordination and real-time information about ambulances, coronary-care beds and catheterisation laboratories.

Care does not end after survival:

Surviving a heart attack is only the beginning of recovery.

Patients need cardiac rehabilitation, appropriate exercise, medication support, cholesterol and blood-pressure control, smoking cessation, follow-up and help returning to normal life.

Bangladesh will need rehabilitation models that connect specialist hospitals with local healthcare facilities and allow home-based or hybrid care where appropriate.

A national cardiovascular registry should also monitor treatment delays, access to reperfusion, complications, survival, readmission and recovery, while examining inequalities related to geography, sex and socioeconomic status.

The national strategy must ultimately extend beyond heart attacks to heart failure, stroke, rheumatic and other valve diseases, congenital heart disease and arrhythmias.

World Heart Day should leave a measurable legacy: more people with controlled blood pressure, fewer missed warning signs, faster referrals, reliable emergency treatment, better rehabilitation and fewer families driven into financial distress by cardiac illness.

Awareness is necessary, but awareness alone will not save enough lives.

Every minute matters to a heart in danger. Bangladesh must build a health system that makes every minute count.

The writer is a Clinical and Interventional Cardiologist, Professor and Head, Department of Cardiology, Popular Medical College & Hospital, Dhaka. E-mail: mbhuiyan14@yahoo.com