Treating cardiovascular disease is both a triumph and a challenge of modern medicine. We know what works to prevent and treat it. We have tests, drugs, and devices that can save lives. We know that too many people still struggle to access it. This World Health Day, I reflect on how human ingenuity continues to transform cardiac care delivery and how this spirit of innovation must drive us to make these advances accessible to everyone.
If progress is measured only by what science and technology produces, then we are moving fast. But if progress is measured by how many people benefit, we are moving rather slowly. The gap between knowledge and delivery is where health systems are failing. Millions still die because health systems have not fully solved three basic problems: affordability, care coordination, and quality.
Access Still Has a Price Tag: Affordability
According to the World Health Organization and the World Bank, around 55 million people worldwide are pushed into poverty each year due to out-of-pocket (OOP) health expenditures. In some countries like Bangladesh, out-of-pocket spending is as high as 74 percent of health expenditure – among the highest in the world – leaving families little choice but to sell assets or borrow for essential care.
Across the world, more patients today can reach proven tests and treatments. But for many families, affordability remains the deciding factor – whether a parent can afford a diagnostic, or whether a child can access a life-saving drug. Families use what little they have to decide who gets care. This is not just an economic gap. It is an equity gap. Who gets to live depends on who can pay.
In my early years as a cardiologist, I witnessed firsthand how out-of-pocket expenses became the greatest barrier to cardiovascular care. For most Indians in need of angioplasty or bypass surgery, the cost of a stent or other essential device was simply out of reach. Families often had to make devastating choices such as selling land, borrowing heavily, or forgoing treatment altogether. Cardiovascular disease, while treatable, was pushing countless households deeper into financial distress. This was not just a medical crisis but a systemic one: life-saving technology existed, but affordability determined who could access it.
In the 1990s, this reality drove a team of us, led by Prof. B. Soma Raju, with former President Dr. A.P.J. Abdul Kalam, Prof. Arun Tiwari, and scientists from India’s Defence Research and Development Organisation (DRDO) and the Council of Scientific and Industrial Research (CSIR), to address the problem head-on. Imported coronary stents then cost between USD 1,700 and 3,000, far beyond the reach of most Indians. Together we developed the Kalam-Raju Stent, India’s first indigenous coronary stent, launched in 1996. Affordable, context-appropriate, and life-saving, it reduced the cost of angioplasty dramatically, bringing the price of a stent below USD 100. Nearly three million stents have since been implanted across more than 30 countries.
The Kalam-Raju Stent did not just represent a device. It represented possibility. It proved that India could design and manufacture advanced medical technologies of international quality and seeded an industry of indigenous innovation that continues to this day. Other Indian companies have since built on this foundation, expanding access to advanced devices. The project was also a lesson in collaboration: Nizam’s Institute of Medical Sciences partnered with DRDO and CSIR, and a Society for Biomedical Technology was formed to coordinate efforts. It was Dr. Kalam’s catalytic vision, asking why a country with such a vast scientific infrastructure still depended on imports, and Prof. Soma Raju’s clinical leadership that made this possible.
The story of the Kalam-Raju Stent also revealed something bigger: the need for an ecosystem that links research, testing, clinical validation, and scale-up. That realization led to new enterprises and institutions that I helped build including the CARE Hospitals, CARE Foundation, Relisys Medical Devices, TRUST Healthcare, IncuMed, ACCESS Health International, and InOrder, each carrying forward the same mission of making high-quality care more accessible. Though the original coil stent was soon replaced by newer technologies, it planted the seed for India’s self-reliance in cardiac devices, resonating strongly with today’s pursuit of Atmanirbharata—a Sanskrit-derived Hindi term that translates to self-reliance or self-sufficiency.
While governments adopt health technology assessment to decide which interventions go into benefit packages of social protection schemes, families in many countries still make the hardest choices about who among their loved ones will access proven tests and treatments. Policy has a role to play here: expanding benefit packages, regulating prices, and incentivizing innovation can all close the gap between science and delivery. Thailand, for example, expanded its Universal Coverage Scheme in 2002 to include cardiac care, shifting costs from households to systems.
Outcomes Need Coordinated Systems
Even when affordability improves, outcomes often do not necessarily follow. Patients are lost in fragmented systems, one doctor for diagnosis, another for treatment, another for follow-up
At CARE Hospitals, and later at TRUST Healthcare, we worked on models that integrated care pathways and measured outcomes, both clinical and patient-reported. The lesson was simple: integration is as important as innovation.
Brazil’s Family Health Strategy is one example of how integrated primary care reduced hospital admissions for cardiovascular conditions by over 40 percent in some regions. These gains underline that systemic coordination, not just specialist care, is critical to achieving better outcomes.
More Care Is Not Always Better Care: Quality
A quieter crisis in many LMICs is inappropriate care: unnecessary tests, unneeded procedures, and over-prescription thriving under weak regulation. The consequences are stark. WHO estimates that at least 10 percent of hospitalized patients in LMICs experience harm due to unsafe care. Inappropriate or unnecessary procedures do not just waste scarce resources, they also erode trust in health systems already under strain.
Solutions are clear: mandate accreditation for all providers, and use value-based financing to pay for outcomes, not volume. Quality cannot be optional.
LMICs offer useful lessons. Mexico’s Seguro Popular linked financing with measurable health outcomes before it was dismantled, and Rwanda’s national accreditation system for health facilities has sharply reduced inappropriate care. ACCESS Health’s work in Indian states (Kerala, Telangana, and Uttar Pradesh) and platforms like APAC CVD Alliance, are part of this larger global movement to align financing, regulation, and service delivery with outcomes that matter. The aim is not more care, but the rightcare that is affordable, integrated, and accountable.
If the 20th century was defined by breakthroughs in cardiac science, the 21st will be defined by whether we build systems that deliver those breakthroughs to every patient who needs them. The science already exists. The question is whether the systems will catch up.