The Alarming Rise of Heart Failure in India

Heart failure, a condition where the heart muscle weakens and cannot pump blood effectively, has emerged as a major public health challenge in India. Unlike in Western countries where it typically affects the elderly, heart failure here strikes at a younger age, often around the mid-50s, disrupting lives and livelihoods prematurely. Recent estimates suggest that heart failure contributes to approximately 1.8 million hospitalizations annually in the country, with cardiovascular diseases claiming nearly 28.6 lakh lives each year. This progressive ailment demands lifelong management through medications, regular monitoring, lifestyle modifications, and frequent hospital visits, placing immense strain on families already grappling with rising living costs.

The disease's roots in India are multifaceted, primarily driven by ischemic heart disease following heart attacks, which accounts for over 70 percent of cases, alongside dilated cardiomyopathy and rheumatic heart disease—a lingering legacy of untreated infections in underserved areas. Urbanization, sedentary lifestyles, diabetes, hypertension, and tobacco use have fueled a sharp uptick, making heart failure not just a medical crisis but an economic one for millions of households.

A Groundbreaking Multicentre Study Sheds Light

A landmark multicentre cross-sectional survey, published in early 2026 in the journal Global Heart, has quantified this crisis like never before. Led by researchers from the Achutha Menon Centre for Health Science Studies at Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST) in Trivandrum, the study enrolled 1,859 patients across 21 tertiary care hospitals spanning diverse regions of India between 2019 and 2022. This collaborative effort involving institutions like AIIMS Delhi, CMC Vellore, and others provides a robust, nationally representative snapshot of heart failure's real-world impact.

Participants had an average age of 56 years, with women comprising about 30 percent and nearly half hailing from rural backgrounds—mirroring the demographic profile of heart failure patients nationwide. The study's rigorous methodology included detailed assessments of direct medical costs, out-of-pocket expenditures (OOP), indirect costs like lost wages, and coping mechanisms, revealing patterns that underscore systemic gaps in healthcare financing.

Staggering Treatment Costs and Out-of-Pocket Reality

The numbers paint a grim picture. The average cost of a single heart failure hospitalization clocks in at around Rs 1.19 lakh, covering diagnostics, medications, procedures, and inpatient stays. Yet, this is just the tip of the iceberg for a chronic condition requiring ongoing care. Annual OOP spending per patient averages Rs 1,06,566, dominated by outpatient visits (frequent check-ups), medications (lifelong beta-blockers, diuretics, ACE inhibitors), and investigations like echocardiograms.

Over 90 percent of total health spending in India is OOP, and heart failure exemplifies this vulnerability. For uninsured patients, this figure soars to 98 percent of costs, forcing families into impossible choices. Low-income and rural households bear the brunt, with expenditures often exceeding 40 percent of their capacity to pay—a threshold defining catastrophic health expenditure affecting 38 percent of study participants.

Financial Protection Gaps: Only 3 in 10 Covered

Shockingly, 70 percent of heart failure patients lack any form of financial health protection. Among the insured minority, private policies reduce OOP to about 59 percent, while government schemes like Pradhan Mantri Jan Arogya Yojana (PM-JAY or Ayushman Bharat) still leave patients paying 74 percent out-of-pocket. Why? These schemes primarily cover inpatient hospitalizations up to Rs 5 lakh annually per family but exclude outpatient care, diagnostics, and many guideline-directed medical therapies (GDMT)—the gold standard drugs that improve survival and quality of life.

Waiting periods for pre-existing conditions, high premiums for high-risk profiles, and exclusions for chronic management create barriers. The absence of insurance inflates OOP by 28-38 percent, perpetuating a cycle where delayed or suboptimal treatment leads to more frequent, costlier hospitalizations. The full study details highlight how even insured patients face gaps, urging a rethink of coverage models.

Distress Financing: Assets Sold Every 8 Minutes

Perhaps the most heartbreaking revelation is the human cost: every 8 minutes, an Indian family sells assets—land, gold, livestock—to fund heart failure treatment. Nearly 18 percent resorted to distress financing, including borrowing at exorbitant interest or liquidating productive assets essential for livelihoods, especially in agrarian rural areas.

Coping strategies reveal desperation: 68 percent dipped into savings, 54 percent sought family aid, and 15 percent borrowed informally. One-third of patients and over one-third of households reported income declines post-diagnosis, as breadwinners reduced work or quit entirely due to fatigue and breathlessness. Cutting basic necessities like food or education for children becomes inevitable, pushing families toward poverty.

Photo by Tapan Kumar Choudhury on Unsplash

Demographics and Disease Etiologies Exposed

The study cohort reflected India's heart failure landscape: predominantly male (70 percent), middle-aged, with ischemic heart disease (74.3 percent) as the leading cause, followed by dilated cardiomyopathy and rheumatic heart disease. Rural patients (49 percent) faced higher OOP due to travel costs and limited local facilities, while women encountered additional barriers like lower insurance penetration.

• Ischemic heart disease: 74.3% (post-heart attack scarring)
• Dilated cardiomyopathy: Common in younger patients
• Rheumatic heart disease: Preventable via better childhood care
• Hypertension/diabetes-related: Rising with lifestyle shifts

These etiologies demand tailored prevention, yet economic barriers hinder early intervention.

Insurance vs. Uninsured: A Stark Contrast

Protected patients fared better, but gaps persist. Private insurance halved OOP shares, yet premiums deter uptake. PM-JAY shines for acute care but falters on chronic needs—medications like sacubitril-valsartan (costly GDMT) remain uncovered. Experts note that expanding outpatient coverage could slash OOP by 30-40 percent, boosting adherence and outcomes.

Read more on PM-JAY's role in cardiac coverage expansions.

Researcher Insights: Voices from the Frontlines

Lead author Dr. Panniyammakal Jeemon calls heart failure a 'household impoverisher,' emphasizing OOP's role in economic distress. Principal investigator Prof. S. Harikrishnan advocates including GDMT in the Essential Medicines List and extending PM-JAY to outpatient care: 'Free drugs at primary centers could save lives.' Cardiologists like Dr. Mohit Gupta highlight tailoring treatments to affordability, while Dr. Ambuj Roy from AIIMS stresses sustained therapy over procedures.

This SCTIMST-led effort, involving premier institutions, underscores academia's role in policy advocacy.

Broader Context: Heart Failure's National Toll

India bears 20 percent of global heart attack deaths, with heart failure hospitalizations surging amid urbanization and metabolic epidemics. Younger onset (vs. 70+ in West) amplifies productivity losses—patients lose work years, families fragment. Rural-urban disparities exacerbate: limited specialists, poor diagnostics push costs higher.

National programs like NPCDCS screen for risk factors, but implementation lags. Private sector dominates advanced care, pricing out the poor.

Policy Pathways and Solutions Ahead

Addressing this requires multifaceted action:

• Expand PM-JAY to outpatient/GDMT coverage.
• Subsidize generics, include HF drugs in EML.
• Strengthen primary care for early detection/prevention.
• Promote insurance uptake via incentives, portable policies.
• Task-shifting: nurses/pharmacists for follow-ups.

Community models like heart failure clinics cut readmissions 30 percent. Digital telemonitoring reduces visits. For details on evolving schemes, see National Health Mission updates.

Photo by Anik Mandal on Unsplash

Future Outlook: Hope Through Innovation

With GDMT adherence, survival improves dramatically—yet affordability blocks it. Biosimilars, AI-driven risk prediction (pilots at IITs/AIIMS), and wearable monitors promise cost savings. Academia-industry ties (e.g., generics via Jan Aushadhi) and research like this study pave the way. By 2030, targeted policies could halve OOP, preventing impoverishment for millions.

Stakeholders—government, insurers, hospitals—must prioritize chronic care equity to turn the tide on heart failure's economic burden in India.