World Heart Day: High cost, specialist shortage, weak infrastructure worsen cardiac care - The Guardian Nigeria News

• About 400 cardiologists serve over 220 million Nigerians • Open-heart surgery costs N9.4m to over N40m • Only 10 catheterisation centres available nationwide • 40 per cent of Nigerian adults are hypertensive • Fewer than 5% have controlled blood pressure • High out-of-pocket costs limit access to treatment • Experts seek wider insurance coverage, stronger cardiac care

As Nigerians join the rest of the world to mark World Heart Day today, experts have identified the high cost of care, out-of-pocket spending, dearth of equipment, severe shortage of specialists and poor emergency services as major obstacles to the management and treatment of the increasing burden of heart disease in the country.

They warned that Nigeria is undergoing an epidemiological shift, with the burden moving from predominantly infectious heart diseases towards a rising mix of cardiovascular and metabolic conditions.

The World Heart Federation (WHF) says heart disease and stroke are the world’s leading causes of death, killing more than 20.5 million people yearly. Developing countries account for about 80 per cent of the fatalities and up to 80 per cent of premature cardiovascular disease (CVD) deaths.

According to the Nigeria Heart Foundation (NHF), the burden of heart disease in Nigeria is rising, with hypertension, diabetes, coronary artery disease and changing lifestyles increasingly putting Nigerians at risk.

Recent studies indicate that about 40 per cent of Nigerian adults are hypertensive, while fewer than five per cent have their condition properly controlled.

The crisis is exacerbated by poor awareness, limited health insurance coverage, and the migration of skilled healthcare workers, among other factors.

According to the Nigerian Cardiac Society (NCS), the country has only about 400 cardiologists catering to a population of more than 220 million.

While the cost of care varies according to the condition, hospital, investigations and whether treatment involves medicines or procedures such as coronary angiography, angioplasty, stenting, pacemaker implantation or cardiac surgery, patients paying out of pocket could face substantial cumulative costs for consultations, blood tests, ECGs, echocardiography, imaging, drugs, hospital admissions and interventions.

The Guardian findings showed that the cost of diagnosing and treating worsening heart disease in Nigeria is high, especially in private facilities, averaging over N319,200 and N421,596 for routine outpatient care, while advanced care, such as open-heart surgery, ranges from N9.4 million to over N40 million, depending on the facility and procedural complexity.

Also, diagnostic and routine initial tests, such as ECG, echocardiograms and blood panels, range from N10,000 to N1.7 million per screening session, depending on the hospital and procedure.

The financial burden is further compounded by gaps in cardiac infrastructure, particularly the limited availability of catheterisation laboratories in public hospitals. Investigations revealed that catheterisation services are available in only 10 centres across the country, with most concentrated in urban areas.

Mrs Chika Emenike, who lost her 75-year-old mother to heart disease, lamented that despite spending millions of naira on her diagnosis and treatment, her mother did not survive due to uncontrolled hypertension.

Emenike told The Guardian that treating heart disease was financially draining, adding that her mother’s condition was complicated by blood pressure that remained excessively high for several months.

She said, “My mother really suffered due to this heart problem. We spent over N28 million in the course of trying to save her life. We planned to organise a befitting birthday for her this coming December. We wanted to celebrate her while she was alive, but it is heartbreaking that she died last week.”

PRESIDENT of the Nigeria Heart Foundation (NHF), Prof. Osaretin Odia, said the growing burden of heart disease, including hypertension and coronary artery disease, coupled with poor access to care and high treatment costs, threatens millions of Nigerians.

He observed that the country is witnessing an epidemiological transition from predominantly infectious diseases affecting the heart to a growing combination of cardiovascular and metabolic diseases.

He identified hypertension as one of the country’s major drivers of heart disease, warning that many Nigerians live with elevated blood pressure for years without knowing it because the condition often produces no obvious symptoms.

“Hypertension is a major problem in detection and diagnosis,” Odia said.

Available estimates suggest that about 35 to 40 per cent of Nigerian adults have elevated blood pressure, although reliable nationwide figures for several other forms of heart disease remain limited.

The country’s changing diet, reduced physical activity, increasing obesity, diabetes, cigarette smoking and harmful patterns of alcohol consumption are also contributing to the growing cardiovascular burden.

Odia explained that heart disease is no longer an “old people’s disease” and could affect Nigerians at different stages of life, from childhood to old age. Congenital heart defects remain an important concern among children and could be associated with factors during pregnancy, including infections and inappropriate medication use. He stressed the importance of adequate antenatal care.

One of the most serious challenges in managing heart disease is the cost of diagnosis and treatment. While basic blood pressure checks can be relatively inexpensive, more sophisticated investigations such as electrocardiography, echocardiography and cardiac catheterisation are far less accessible. ECG costs vary widely depending on location and facility, while echocardiography remains limited at the primary healthcare level.

Specialised cardiac catheterisation is available in only 10 centres across the country, most concentrated in urban areas. The procedure can cost between N2 million and N5 million, depending on the treatment required, while stent insertion can cost between N12 million and N15 million.

“These are very expensive,” Odia said, adding that high costs, geographical concentration of facilities and a shortage of specialists combine to restrict access to care.

Many Nigerians continue to pay out of pocket for healthcare, and many have been financially ruined by treatment costs. Odia called for stronger health insurance systems and greater government commitment to universal health coverage, urging federal, state and local governments to expand contributory and social health insurance schemes.

Nigeria’s cardiovascular care system also faces shortages of specialised personnel and functional equipment. Odia estimated that the country has fewer than 10 interventional cardiologists, while shortages of functional heart-lung machines affect its capacity to provide open-heart surgery.

Odia said ischaemic heart disease, also known as coronary artery disease, is becoming increasingly prevalent. When coronary arteries become severely blocked, patients can suffer heart attacks requiring rapid access to specialised care, and poorly controlled cardiovascular conditions could eventually lead to heart failure. An effective ambulance network capable of responding rapidly to medical emergencies would save lives, particularly in such cases.

Despite these challenges, Odia stressed that many cardiovascular diseases can be prevented. He urged Nigerians to make regular health checks, particularly blood pressure monitoring, part of their routine, and to watch their weight, blood sugar and diet. He called on the government to make cardiovascular care affordable and accessible through expanded health insurance coverage.

ALSO speaking with The Guardian, a consultant cardiologist at Lagos State University Teaching Hospital (LASUTH), Ikeja, Dr Ehimen Okogun, observed that Nigeria is facing a growing cardiovascular health crisis, with hypertension, obesity, diabetes, smoking, stress and unhealthy diets increasingly putting younger people at risk of heart disease and sudden death.

Okogun said many of the factors responsible for heart disease are preventable, but widespread misconceptions, poor health-seeking behaviour, rising treatment costs and inadequate specialist healthcare infrastructure continue to undermine efforts to reduce deaths.

According to him, recent studies indicate that about 40 per cent of Nigerian adults are hypertensive, while fewer than five per cent have their condition properly controlled.

The cardiologist also raised concerns about the cost of treating cardiovascular disease in Nigeria, particularly as patients largely pay out of pocket.

He emphasised that the rising cost of medicines, driven in part by economic pressures and foreign exchange fluctuations, is making it increasingly difficult for patients to maintain their treatment.

Even potentially life-saving cardiac surgery remains beyond the reach of many Nigerians, he said.

He recalled the case of a patient who required an aortic valve operation estimated at N10 million but died before he could raise even N2 million.

Coronary artery bypass surgery could cost between N20 million and N40 million, depending on the circumstances, he added.

Okogun also identified inadequate specialist manpower and healthcare infrastructure as major obstacles to effective cardiac care, adding that patients from different parts of Nigeria are sometimes referred to Lagos for specialised procedures because of the limited availability of tertiary cardiac services elsewhere.

He noted that the country has a severe shortage of cardiac specialists relative to its population and healthcare needs, adding that the migration of Nigerian doctors abroad, popularly known as “Japa”, has further worsened the situation.

“The Japa syndrome is a nightmare for healthcare in Nigeria. In the whole of Nigeria, we have not up to 300 cardiac surgeons, in a country of over 200 million people,” he added.

Okogun identified smoking, obesity, hypertension, diabetes, physical inactivity, chronic stress and unhealthy diets among the major modifiable risk factors for cardiovascular disease.

He said the increasing adoption of sedentary lifestyles and high-calorie, high-fat diets in Nigerian cities is contributing to the problem.

One of the biggest challenges in tackling cardiovascular disease in Nigeria, he said, is the misunderstanding surrounding hypertension and its treatment.

He explained that antihypertensive drugs work for a limited period and therefore need to be taken consistently as prescribed.

The cardiologist urged Nigerians to take preventive healthcare more seriously, including regular health checks and early treatment of conditions such as hypertension and diabetes.

He also called on the government to increase investment in healthcare and expand health insurance coverage to reduce Nigerians’ dependence on out-of-pocket payments.

FOR his part, consultant cardiologist at the University of Nigeria Teaching Hospital (UNTH), Prof Emmanuel Ejim, warned that the cost of care remains a major barrier, particularly for patients paying out of pocket, with some unable to afford essential investigations and prescribed medicines.

The professor said the financial burden becomes even heavier when patients require advanced cardiac interventions, noting that the absence of adequate facilities in many public hospitals often pushes them towards private centres.

Most government hospitals lack catheterisation laboratories, or cath labs, where specialised procedures for diagnosing and treating blocked heart arteries are performed, leaving many patients dependent on private facilities, he said.

He added that the concentration of advanced cardiac services in private hospitals means patients are often required to bear substantial out-of-pocket costs, even when they need urgent or life-saving interventions.

The cardiologist, therefore, called for increased government investment in cardiac infrastructure, arguing that strengthening public hospitals with functional equipment and specialised services would help reduce the financial burden on patients and improve access to treatment.

ALSO, consultant interventional cardiologist at Lagos State University Teaching Hospital (LASUTH), Dr Ramon Moronkola, told The Guardian that cardiovascular disease is not restricted to older people, noting that risk factors can begin much earlier in life.

He urged Nigerians to know their blood pressure, blood sugar and cholesterol levels, as well as other cardiovascular risk factors, and to take appropriate action when results are abnormal.

He also advised Nigerians not to ignore warning signs beyond chest pain, including unexplained breathlessness, persistent fatigue, reduced exercise tolerance, palpitations, dizziness, fainting, swollen feet or ankles, and difficulty breathing when lying down.

The cardiologist further advised men not to dismiss new or persistent erectile dysfunction, noting that it shares risk factors with cardiovascular disease and can sometimes be an early marker of underlying vascular disease.

Moronkola called for improved health insurance coverage, affordable essential medicines, early screening and preventive cardiovascular care, noting that prevention and early treatment are generally less costly than treating heart attacks, strokes or advanced heart failure.