Karachi’s chest pain units handle over 900,000 cases in six years

KARACHI: Over 900,000 people sought emergency care at Karachi’s 18 chest pain units (CPUs) over the last six years, with a significant percentage under age 40, a study from the National Institute of Cardiovascular Diseases (NICVD) has revealed.

The study, which was published in the leading global health journal The Lancet, has identified young men in particular as an at-risk demographic for severe heart conditions. Among those evaluated at these CPUs, approximately 24 percent required further medical intervention, with around 9 percent suffering from acute heart attacks.

Launched in 2017, NICVD’s 18 CPUs have transformed emergency cardiac care in Karachi, targeting high-density areas to offer swift diagnosis and timely transfer to primary care centers. The CPUs have not only alleviated pressure on NICVD’s main facility but have also significantly increased early intervention rates for heart attack patients, particularly those with ST-elevation myocardial infarction (STEMI) or serious heart attack.

Data indicate a 17-fold rise in quarterly STEMI cases treated since the CPUs’ inception, demonstrating the effectiveness of this decentralized, community-focused approach. The data emphasize the demographics of those seeking care at these CPUs. Out of all patients screened, 61% were male and 39% female, with 38% of patients aged 40 or younger. Many of these young patients exhibited symptoms indicative of serious cardiac conditions, including heart attacks and unstable angina.

Of the patients requiring further treatment, 9% were diagnosed with STEMI, and 29% with non-ST-elevation acute coronary syndrome (NSTE-ACS) or unstable angina, highlighting a notable prevalence of critical cardiac conditions among Karachi’s youth.

“The youth profile of heart attack patients is troubling,” noted the study’s authors, linking these cases to risk factors prevalent in urban populations, such as stress, poor diet, and limited physical activity. Karachi’s crowded, often resource-limited health infrastructure had previously struggled to provide rapid intervention to heart patients across the sprawling metropolis of over 23 million people.

Each CPU is staffed by a cardiologist and equipped with essential diagnostic tools, including ECG machines and medications for immediate intervention. The CPUs’ strategic locations in congested neighborhoods ensure that patients can access life-saving assessments quickly.

Following an initial evaluation, patients requiring emergency care are transferred via ambulance to the NICVD’s main center for primary percutaneous coronary intervention (PCI), a critical treatment for heart attacks.

For STEMI or heart-attack patients, the CPUs reduced “first medical contact to device time” to a median of 100 minutes, a key metric in preventing long-term damage during heart attacks. Additionally, the median “total ischemic time”—the time from symptom onset to treatment—was 232 minutes.

Despite Karachi’s intense traffic congestion and widespread urban sprawl, these times are within global standards, underscoring the efficiency of the CPUs in facilitating urgent care.

The CPUs also triage non-cardiac cases, with 75.6% of patients eventually discharged after assessment. These units’ ability to handle both cardiac and non-cardiac cases eases the load on emergency rooms across the city, enabling NICVD to prioritize critical cardiac patients.

As a result of the CPU initiative, the NICVD’s primary PCI (Emergency Angioplasty) caseload has steadily increased, with an estimated annual growth of 16–20% in procedures. By 2023, the NICVD performed over 9,000 primary PCIs—a significant increase from previous years.

In-hospital mortality rates for STEMI patients receiving primary PCI have been maintained between 5.1% and 6.9%, aligning with rates observed in developed countries despite Karachi’s unique challenges.

According to the study, the CPUs have contributed to a broader understanding of cardiovascular health trends in Pakistan, as well as the factors that may be accelerating early-onset cardiac issues in younger populations.

The study’s authors recommend expanding this model throughout other cities in Pakistan, where similar challenges exist due to dense populations and limited healthcare access.

The NICVD’s CPU model has been recognized as a potential blueprint for other densely populated low- and middle-income countries (LMICs). It differs from traditional hospital-based chest pain units in that it brings essential cardiac diagnostic and triage services into local neighborhoods. The CPU model’s success underscores the importance of community-based healthcare interventions in regions where transport limitations and financial constraints often hinder timely medical access.

Funded by the government of Sindh, the CPU programme represents a significant public health investment in Karachi’s future, with wider implications for cities grappling with similar urban health challenges.

The NICVD’s network of CPUs and expanding PCI services across Sindh could inspire similar initiatives across South Asia and other parts of the world where urban density complicates access to timely cardiac care.