Better heart health depends on what happens between hospital visits

For decades, our understanding of cardiovascular care has been shaped by the moments of crisis: a heart attack, a hospitalisation, an emergency intervention, or a specialist consultation. While these events/episodes are undoubtedly important, better cardiovascular outcomes are shaped as much by what happens outside the hospital as by the treatment delivered within it.

The reason is simple: cardiovascular disease does not develop overnight, nor can it be managed through episodic care alone. It is a lifelong condition shaped by daily choices, treatment adherence, regular monitoring, and ongoing engagement between patients, caregivers, and healthcare providers.

Advances in diagnostics, therapies, and clinical interventions have undoubtedly improved survival and treatment outcomes. Yet as the burden of heart disease continues to rise, India has an opportunity to reimagine cardiovascular care not as a series of isolated clinical encounters, but as a continuous journey that begins before a cardiac event and continues long after discharge.

The Unfinished Cardiovascular Care Continuum

Cardiovascular diseases remain the leading cause of mortality in India, causing nearly 31% of deaths. Rapid urbanisation, increasingly sedentary lifestyles, changing dietary habits, rising stress levels, and the growing prevalence of obesity, diabetes, and hypertension have significantly heightened cardiovascular risk across populations.

This challenge becomes particularly evident following an acute cardiac event. As symptoms improve and daily routines resume, the urgency associated with a cardiac event often fades. Patients may miss follow-up appointments, discontinue medications, or struggle to sustain lifestyle modifications, especially in the absence of ongoing support and engagement. Over time, the gains achieved through successful clinical interventions can begin to erode.

A prospective Indian study of 716 patients with acute coronary syndrome found that the use of several recommended secondary-prevention medications declined by 16% to 42% within six months, while only 42.7% of patients assessed at follow-up demonstrated good treatment adherence. Rather than being viewed solely as a question of patient discipline, these findings underscore a broader reality: sustaining treatment often becomes far more difficult once patients leave the structured environment of the hospital.

This gap highlights one of the most important yet underappreciated challenges in cardiovascular care. We have become increasingly effective at treating cardiac events, but we are often less successful at ensuring patients stay on the path to recovery once they leave the hospital.

A strong healthcare ecosystem must therefore do more than diagnose, prescribe and discharge. It must make staying in care easier.

Cardiovascular Health and India’s Productive Years

Cardiovascular disease in India is more than a public health challenge; it impacts the most productive years of a person’s life. Heart disease often strikes at a younger age, when careers are being built, and financial responsibilities are at their highest.

The consequences of a cardiac event therefore extend far beyond the hospital, affecting productivity, quality of life, and long-term economic well-being. Returning home does not always mean returning to normal. Patients may need time to rebuild strength, regain confidence and feel comfortable resuming work or physical activity. Families often become part of that recovery as well.

For a country with one of the world's largest working-age populations, protecting heart health is also about protecting economic potential. This is why cardiovascular health deserves to be viewed not only as a clinical priority, but as a national development imperative.

Recovery Is More Than Discharge

Discharge may mark the end of a hospital stay, but it does not mark the end of recovery. For many patients, the more difficult phase begins at home, when they have to rebuild strength, regain confidence and understand how much activity is safe. Cardiac rehabilitation can provide that structure through exercise, education, risk-factor management and psychological support. Yet access remains limited in India, with only around one in four cardiologists in a survey reporting an established cardiac rehabilitation program at their institution.

India cannot rely only on center-based rehabilitation, particularly when distance, work commitments and practical constraints make repeated visits difficult. Recovery should not depend on how easily a patient can reach a specialized program. It should be built into the care pathway itself, so that returning to everyday life does not mean losing access to support.

From Episodic Treatment to Connected Care

The challenge is not that patients lack medical advice, but that much of cardiovascular care depends on what they can manage on their own between visits.

Connected care can make a practical difference. Teleconsultation can reduce the burden of travel. Remote monitoring can help clinicians track changes in blood pressure, symptoms or activity. Medication reminders and structured education can reinforce what was discussed during a consultation. Home-based rehabilitation can extend recovery support to patients who cannot return to a center regularly.

Growing evidence suggests these approaches can support recovery. Mobile health-enabled home-based cardiac rehabilitation has been shown to improve exercise capacity compared with usual care, while offering outcomes broadly comparable with center-based rehabilitation for some measures. Digital tools earn their place when they keep patients connected to their treatment plan, give clinicians visibility between visits and reduce the chances of patients drifting out of care.

Making Continuity of Care a Priority

Over the past decade, India has significantly strengthened its cardiovascular care ecosystem, expanding access to screening, advanced cardiac interventions, and effective treatments. The next step is to ensure these gains are not lost once patients leave the healthcare setting.

As we observe World Heart Day, the conversation must move beyond awareness alone. The challenge before us is not simply to help people survive a cardiac event, but to help them live well after it. Achieving that will require a collective commitment to making continuity of care integral to cardiovascular care delivery. Clinicians remain central, but health systems, policymakers, payers and industry all have a role in making long-term care easier to sustain.

Saving a life may begin in the hospital. Protecting that life happens every day thereafter, in homes, workplaces, communities, and through a healthcare system designed to care for people long after the crisis.

(The author is, President, India Regional Formulations, Lupin. Views are personal.)