Barriers and strategies to manage CVD in India (SPECTRUM): a nationwide survey

Purpose: India has high rates of cardiovascular diseases (CVD). Yet there are no representative data on the barriers and strategies to improve CVD care in India. We aimed to analyse the barriers and elicit strategies, which are important to implement programs and policies. Methods: We conducted a nationwide cross-sectional study among physicians at randomly selected hospitals, stratified by region, population and level of health care. Sample size for hospitals was based on community prevalence of CVD. At each hospital we randomly selected an average of 10 physicians. All self reported questionnaires were anonymously collected between March 2012 and January 2013. The questions included description of physicians, patients seen, risk factors, barriers perceived and strategies suggested to manage CVD. Results: We received completed questionnaires from 1,271 physicians (from 124 hospitals at 75 cities in 22 states that represent 94.1% of the population). Physicians were internists (54.3%), specialists (27.7%) and generalists (18.0%). The median years since qualification were 7 (inter quartile range 3.0 – 16.0) and they practiced for 8.4 (± 3.01) hours a day. Most (70%) used international guidelines for management. The stated barriers for optimal CVD management were cost and access to medication (92.0%), literacy (86.9%), complex regimen (86.1%), lack of family support (79.0%), poor follow up (75.0%), lack of adequate hospital staff (56.6%), complementary and alternative medication (50.0%) and high patient load (49.9%). Strategies suggested to improve CVD management were related to practice (use non physicians 90.4%, additional medical staff 88.6%), patients (more education 93.4%, provide written material 83.6%, mobile text reminder 52.0%), physicians (better access to guidelines and updates 95.3%, compulsory CME 87.0%, better internet access 85.1%, clinical research participation 79.8%) and policy (better infrastructure 94.0%, hospital registries 93.3%, IT infrastructure 88.5%, Government subsidy for treatments 87.5%, universal health insurance 83.3%). Conclusions: This first nationwide survey identified significant barriers and elicited practical strategies for better CVD care. The Government and health care providers must urgently consider these findings to implement policies and programs to reduce the high CVD mortality in India.