Advanced subspecialty cardiology training in India in 2022: challenges and future directions

South Asia, which includes India and neighbouring countries, constitutes nearly a quarter of the world's population, but around 60% of the global cardiovascular disease (CVD) burden.¹ With a current prevalence of almost 25 million individuals, India has become a new epicentre of ischemic heart disease (IHD). Its CVD burden, contributing currently to almost 30% of all deaths nationally, has only worsened, given the country's sociodemographic transition, along with the persistently high burden of classical maladies such as rheumatic heart disease.¹ Coupled with the rise in IHD has been the increasing prevalence of heart failure (HF), which serves as a noteworthy example.²

India has somewhere between 1.3 and 4.6 million prevalent cases of HF, and an incidence of 0.5 and 1.8 million cases per year.² IHD is one of the largest risk factors for the development of HF, yet due to infrastructural challenges and inequitable access to quality healthcare, IHD is undertreated for many Indians. Increasing rates of IHD in India will likely contribute to a significant surge of HF in the coming years. This is further compounded by the high prevalence and poor control of diabetes mellitus in India, along with cardiac dysfunction secondary to tobacco use and air pollutants.²

Despite the heavy and increasing burden of CVDs, there is a significant dearth of trained cardiologists in India. Currently, there are only about 4000 cardiologists in the country—1 for every 300 000 Indians.³