Project Cardiogram

Cardiovascular diseases accounts for 28.1% of total deaths in the country.
The incidence and prevalence of cardiovascular disease in rural India is comparable to urban India with more than 40% of the cardiac patients being in rural areas. Early detection of Acute Coronary Syndrome (ACS) or Myocardial Infarction (MI) reduces the cardiovascular death rate. The availability of an ECG machine under Project Lifeline in Ahmedabad, Gujarat showed that effective screening in a high-risk population saved 2.90 life years at a cost of 31.07 USD (Approximately 2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The major factors contributing to the problem are lack of resources in the rural and peri-urban belts as well as the skill competency of the staff for precise, accurate and immediate diagnosis followed by time effective treatment. The burden of cardiovascular disease in India is significant, with an estimated prevalence of around 6-10% in rural areas and 12-15% in urban areas, according to a report by the World Health Organization (WHO). The disease also accounts for a large share of Disability-Adjusted Life Years (DALYs) lost in the country, estimated at around 24% of the total burden of disease. The economic burden of cardiovascular disease on the government is also considerable, with a report by the National Health Accounts estimating that it accounted for 5.2% of total government health expenditure in 2017-18. The cost of hospitalization due to cardiovascular disease is also high, with an average cost of around INR 57,000 per hospitalization, as reported by the National Health Profile 2019.

WYHF - India in its endeavors to bridge the gap between urban and rural healthcare has set up a project known as Project Cardiogram. Project Cardiogram has the vision of ensuring access to affordable cardiovascular health to all individuals living in rural India.

Goal-

1. Strengthen the rural healthcare system by improving access to cardiovascular healthcare services.

2.     Establish a scalable and sustainable cardiovascular healthcare referral and treatment service integration with the public sector to improve patient outcomes.

3.     Raise awareness regarding cardiovascular diseases and their risk factors among the general population with the support of ASHA workers.

4. Organize community screening camps to screen patients for cardiovascular diseases and diabetes.

Objectives-

1.     Install ECG machines at 500 PHCs in rural areas in India in next 2 years

2.     Train 1000 staff nurses and medical officers at rural PHCs to use ECG machines, identify a normal ECG and perform cardiopulmonary resuscitation (CPR) in next 2 years

3.     Establish 15 district-level clusters including PHCs and higher referral centers with telemedicine facilities in next 2 years.

4. Screen 30,000 individuals for cardiovascular diseases and diabetes in next 2 years through community-level screening camps.

Technology Stack

We acquire our digital ECGs primarily from two ECG manufacturers : 

- Wellnest

-Kardioscreen : FDA approved clinical grade 12/6 lead digital ECGsolution. It is portable, cloud connected, fully digital.

 AI Integration

iMedrix software performs real-time automatic AI (Artificial Intelligence) data classification and analytical monitoring of heart health parameters. Software support for cohort and deep longitudinal analysis provides assistance for rapid diagnosis. iMedrix works with leading medical device and pharma majors to apply its analytics.

Competency model for Advocacy : 

The Training Camps are to educate the healthcare personnel on various cardiovascular risk factors and  lifestyle modifications.

It will take place in 2 phases.

1. Firstly for medical education :  For the healthcare personnel we would be assessing the Knowledge, attitude and practice study undertaking the training that should be incorporated for better heart health. 

2. The Way Forward : . They would also be trained to use the digital ECG machines, which is an essential key component of our project  to aid the transition of the healthcare curve towards telemedicine in Latin America post pandemic. It will also help  to combat barriers due to social distancing policies in 

Our ultimate goal is to improve the health status and reduction of risk factors across all population groups , one locality at a time which would in turn reduce the cardiovascular burden for the continent over time.

The Screening Camps : 

will be conducted at each PHC where the machine will be deployed. They can be recurrent based on demand. 

• Phase 1: (Till 15 camps)

Conduct NCD screening camp focussing only on cardiovascular diseases.

• Phase 2: (After 15 camps)

Inculcate other NCDs including breast, cervical and oral cancer in the screening camp.

The World Youth Heart Federation (WYHF) aims to serve and provide access to affordable healthcare to the rural population of India with risk factors for cardiovascular health.

1. Firstly, it is the only youth-led NGO in India that focuses exclusively on cardiovascular health. Other youth NGOs in India usually conduct general health screening camps and donation drives, which are not specific to cardiovascular health. Most of the activities of medical student organizations are centered around capacity building of medical students and providing them opportunities and on-field exposure. WYHF on the other hand centers it’s activity around the general population and provides preventive and diagnostic solutions for Cardiovascular health especially in the rural areas.

2. Secondly, larger organizations usually focus on providing guidelines and do large-scale advocacy but lack the manpower and enthusiasm brought in by the youth, which limits their on-ground execution.

 3. Thirdly, through Project Cardiogram, WYHF adapts a unique approach of bridging the demand-supply gap by collaborating with ECG manufacturers and supplies portable digital ECGs to government PHCs. These ECGs are easy to use, and results can be remotely interpreted by senior doctors at Tertiary Care Centers, thus facilitating telemedicine in rural areas.

4. Fourthly, WYHF fuels its work through exhaustive research and on-ground baseline assessments to provide specific need-based solutions to each PHC of the district. It also undertakes research projects to assess the diagnostic accuracy of the digital ECG provided by the newer manufactures.

 5. Lastly, WYHF conducts cardiac screening camps, and trains MOs and nurses to use ECG, interpret it, perform CPR and learn basic management of MI. This approach enables WYHF to provide more specific and comprehensive cardiovascular care solutions to the community.

Target Audience for Project Cardiogram: 

1. People who suffer from any kind of cardiovascular disease or its risk factors like diabetes, obesity etc. and seek healthcare from the Primary Health Care Centres (PHCs) of rural districts of India.
2. Medical Officers, Nurses & ASHA working at the Primary Health Care Centres (PHCs) of rural districts of India.
3. Digital ECG manufacturers who could supply ECGs to the Primary Health Care Centres (PHCs) of rural districts of India.

Founder and Past President: Dr. Priyansh Shah

President: Dr. Eesha Shah

Vice President Internal Affairs: Reeti Chauhan

Vice President External Affairs: Sanah Mahajan

Vice President Funding: Ashutosh Modi

Cardiogram Project Head: Shirish Rao

Cardiogram Team: 5 National Coordinators & 2 Recruitment Coordinators

The entire management team receives constant guidance from Senior Doctors who act as mentors for WYHF. The vision of WYHF has been to take on cardiovascular challenges by an interdisciplinary approach . Or organisation comprises of individuals from all sectors, the core team is made up of medical graduates and students ho are passionate for Public Health and cardiovascular diseases having multiple years of experience working in youth led organizations, nationally and internationally for advocacy, leadership and awareness. The benefit of being medical student being we have closely observed and worked the rural ground level to understand the lacunae of care provided and bring forth a solution to amend that on grass root level. he added advantage is communicating with the patient , general population to address the modifiable risk factor and to train the healthcare staff it gives an edge of  advantage to address the communities at large.

https://drive.google.com/file/...

The document is the initial pilot paper on the needs assessment done for the project of Vadodara-Anand. The ECG have been deployed in 4 regional Primary Health centers and community Health centers that caters to a population of approximately 50,000 collectively. There have been Phase 1 screening camps conducted with the following results.

Analysis of the First Pilot Screening Camp:

• 71 patients screened out of which 26 patients had cardiovascular health symptoms.

  • 43 individuals had a normal ECG

  • 2 individuals has anterior wall ischemia

  •  1 individual had Ventricular premature complexes

  • 7 individuals had old infarcts

  • 1 individual had sinus tachycardia

  • 8  individuals had left axis deviation (2 patients referred for further evaluation)

  • 4 patients had right axis deviation and P. pulmonale pattern (referred)

• Referral rate : 8.5%

The Training camps for the healthcare and local workers have been fruitful as well. In explaining them the cardiovascular prevention, initial signs and how to spread awareness among high risk patients regarding the cautionary measures and modifiable risk factors. 

The pilot project in  city of Vadodara is currently under the monitoring and maintenance phase. Meanwhile we have started working on currently for the baseline assessment in various localities of Maharashtra and Rajasthan. The scale up strategy for this project, we aim to steadily put in action the project in various major cities of the country and eventually take the sustainable model on a global scale to foster collaboration among youth and improving the cardiovascular health of the society together. 

In our quest to reduce the burden of cardiovascular disease, we are positive that the Project Cardiogram has a potential to address the high risk population in rural areas to provide and promotes, accessible and affordable healthcare for all. The pilot project done gave us insights on numerous challenges and possible barriers but it also assured that the Project had a huge potential to create change. We intend to tackle cardiovascular burden with a holistic approach of community intervention and digital transformation. The non-profits thus, have an important role in mediating public-private partnership. Thus, it is currently an uphill battle but with perseverance we shall surely be able to conquer it in the upcoming decade and MIT Solve is a platform that can help us navigate and accomplish it in the way we envision it. The challenge is not only funding or financials, but in terms of incorporating a digital solution, addressing public-private partnerships and empowering youth along the way as well. We believe that MIT Solve can help us guide and shape this project to attain the global impact we hope to achieve. The MIT Solve network and resources can help us achieve our goal and accelerate the time line tremendously. At the core of fragile healthcare context , the Project Cardiogram essentially aligns with the SOLVE's mission for social impact to overcome global challenges with a collaborative effort. Solve's mentorship and global cultural diversity in partnerships can be an immense help to navigate the challenges we face and help us together achieve the unified goal.