Heart disease treatment unavailable outside divisional cities

Amina Begum from Feni Sadar Upazila developed chest pain on Sunday night. She was taken to a private hospital the following morning. Doctors there advised her to go to Chattogram Medical College (CMCH). She was admitted to the Coronary Care Unit (CCU) of the cardiology department at CMCH in the afternoon.

Amina’s husband Abu Ahmed said, “We brought her to Chattogram by ambulance after she developed chest pain. She had previously received treatment from a doctor in Dhaka.”

As district level healthcare facilities lack the desired standard of treatment, patients with heart disease from across the country are often forced to travel either to Dhaka or Chattogram.

Advanced heart care is available at many private hospitals in Dhaka and Chattogram alongside government facilities. Most cardiologists in the country practice in these two cities. The main reason is that they have adequate medical infrastructure including catheterization laboratories. Stakeholders believe that if modern heart care facilities are established at both government and private hospitals in other divisional cities, the shortage of cardiologists at district hospitals could also be addressed.

According to the Bangladesh Bureau of Statistics’ Health and Morbidity Status Survey, 31 people per 1,000 in the country suffer from heart disease. The number of people with high blood pressure is 78 per 1,000. According to World Health Organization data, nearly 300,000 people die from heart disease in Bangladesh every year.

Specialist doctors emphasize the importance of providing heart patients with treatment as quickly as possible. However, patients suffering from heart disease at the upazila and district levels have to face considerable difficulties in reaching doctors. This results in unnecessary loss of both money and time. In this way, patients die due to the lack of timely treatment. Today is World Heart Day. Its theme is “Don’t Miss a Beat.” This picture emerged from discussions with doctors ahead of the observance.

Professor Ibrahim Chowdhury of the National Institute of Cardiovascular Diseases told Agamir Somoy, “Every minute is important for heart attack patients. A delay of one minute means serious harm to the patient. If heart care can be expanded to the district level, deaths will decrease significantly.”

Mahbubul Alam, director of the Divisional Health Office in Sylhet, said, “I believe there should be doctors at the upazila level who can provide thrombolysis for heart patients along with ECG and monitoring facilities. But despite our willingness, we cannot do this because of a shortage of manpower and other facilities.”

Chattogram and Barishal have more heart patients: According to the Health and Morbidity Status Survey published last year, the number of heart patients is higher in Chattogram and Barishal divisions. There are around 34 to 36 heart patients per 1,000 people. Among the other divisions, Khulna and Rajshahi have 31 heart patients per 1,000 people, Sylhet has 30, Mymensingh has 29, while Dhaka and Rangpur have 26. The figures were calculated from health information covering the 90 days preceding the survey of 189,986 people across eight divisions. The rate of heart disease is almost equal among men and women.

No catheterization laboratories in Barishal, Rangpur and Khulna: Although Barishal has a higher number of heart patients, there is no catheterization laboratory for heart patients anywhere in the division at either government or private facilities. A few hospitals have CCUs, but the quality of their services is not satisfactory. Barishal Sher e Bangla Medical College is the largest hospital in the division. It has CCU facilities. ECG and echocardiography are also performed there. However, patients have to travel to Dhaka for catheterization laboratory services.

A catheterization laboratory is used to identify blockages or obstructions in the arteries of the heart. This procedure is called an angiogram. Angioplasty and stent placement as well as pacemaker implantation are also performed through catheterization laboratories.

Six district hospitals have ECG facilities. However, not all district hospitals have cardiologists. Barishal Divisional Health Director Mohammad Refayatul Haider told Agamir Somoy, “The catheterization laboratory-based services required by heart patients in Barishal are entirely dependent on Dhaka. There is no catheterization laboratory service at Sher e Bangla Medical College Hospital or in the private sector. Basic heart tests such as ECG are performed at district hospitals.”

All heart patients in Rangpur division have to look toward Dhaka for treatment. Limited catheterization laboratory services are available at Rangpur Medical College Hospital. However, the service sometimes remains suspended. At district hospitals, heart care is essentially limited to ECG, said Divisional Health Director Wazed Ali. No hospital has a cardiologist.

There are no catheterization laboratory facilities at the medical colleges in Jashore, Satkhira, Kushtia and Magura in Khulna division. Of these, only Satkhira and Kushtia have CCUs. Khulna Divisional Health Director Sheikh Mohammad Abu Mosharraf Hossain said, “Khulna Sheikh Abu Naser Hospital and Khulna Medical College have catheterization laboratories. However, heart care at the district level is inadequate.”

Crowds at Chattogram Medical: Chattogram division has six medical college hospitals among its 11 districts. Apart from Chattogram Medical College, none has a catheterization laboratory. Cumilla Medical College only has a CCU. As a result, patients from across the division crowd Chattogram Medical College.

The 100-bed cardiology ward at Chattogram Medical College has around twice as many patients as its capacity. From August last year to August this year, the cardiology department of CMCH treated 58,298 patients.

There is also a long queue of patients at the catheterization laboratory in the same ward for angiograms and angioplasty. Patients have to wait for up to one month after receiving a serial. In 2026, 25,000 patients underwent angiograms at CMCH. The number was 23,000 last year. Hospital Director Brigadier General Mohammad Taslim Uddin said, “There is no alternative to waiting for an angiogram in the cardiology department because of the huge number of patients.”

This year, 5,627 patients underwent angioplasty. The figure was 4,743 last year. Temporary pacemakers were implanted in 1,813 patients this year. A total of 1,273 permanent pacemakers were implanted.

Chattogram Divisional Health Director Sheikh Fazle Rabbi said, “Apart from Chattogram Medical College, there is no government catheterization laboratory elsewhere. There is also no heart care infrastructure outside the divisional city in the private sector. ECG and in some cases, echocardiography are performed at district hospitals. Consultants are also not available in every district.”

Nonfunctional catheterization laboratories: Dhaka division has medical college hospitals in Gopalganj, Faridpur, Manikganj, Kishoreganj, Gazipur and Tangail. A catheterization laboratory was installed at Faridpur Medical College Hospital in 2016 but is currently not operational. The hospital has CCU beds.

The catheterization laboratory at Manikganj Medical College was transferred to Chattogram Medical College about a year ago. As a result, the service has now stopped. CCU services are currently available there.

Dhaka Divisional Health Director Mohammad Jahangir Alam said, “There are medical college hospitals in six districts of the division outside Dhaka. But none provides comprehensive heart care. Even where catheterization laboratories are available, there are shortages of doctors and proper setup in many cases.”

Rajshahi division has eight districts and five medical colleges. Apart from Rajshahi and Bogura Medical College hospitals, there are no catheterization laboratory facilities along with CCUs elsewhere. Sirajganj Medical College Hospital only has a CCU. Divisional Health Director Habibur Rahman said, “There are catheterization laboratory facilities in Rajshahi and Bogura. ECG and echocardiography are available at the others. Consultants are not available at every hospital.”

Other divisions: Apart from Mymensingh Medical College Hospital, there are no other catheterization laboratory or CCU facilities in the division. Jamalpur and Netrokona Medical College hospitals only provide ECG services.

Sylhet MAG Osmani Medical College Hospital has a catheterization laboratory along with a CCU. Apart from this, catheterization laboratory facilities are available at a few private facilities including Heart Foundation. Heart care at district hospitals in Sunamganj, Moulvibazar and Habiganj relies on echocardiography and ECG.

Divisional Health Director Mahbubul Alam said, “It is very important to have heart care services at the district level. If someone has a heart attack in Zakiganj, they need immediate treatment. But by the time they are brought to the division, their life is at risk.”