Minutes That Count

Ask any emergency cardiologist what decides a heart attack outcome and you’ll hear a version of the same answer. It isn’t the skill in the cath lab, though that matters. It’s how long it took the patient to get there.

The Cost of the Missed Golden Hour

India feels that answer more than most countries. A report by BM Birla Heart Hospital, called Beat by Beat 2025 and covered by Business Standard in February, found that roughly one fifth of heart attack deaths worldwide happen in India. About a quarter of all deaths in the country come from cardiovascular disease. The death rate stands at 272 per 100,000 people, against a global average of 235, and Indians tend to develop heart disease nearly a decade earlier than the global average. Sixty per cent of cardiovascular deaths are premature.

The most striking line in that coverage is a plain one. Half of heart attack deaths happen at home. The report attributes this largely to delays in seeking treatment, and to the fact that the golden hour, the first sixty minutes after symptoms start, is so often missed. Limited access to cath labs and emergency cardiac services in smaller cities and rural areas makes it worse. Underdiagnosis is a concern in some states, where patients tend to turn up with advanced disease.

The Reality of Out-of-Hospital Arrests

Cardiac arrest tells the same story in sharper form. A prospective study at a tertiary hospital in India followed 205 adults who arrived at the emergency department after an out-of-hospital cardiac arrest. It was a single centre and the fieldwork ran from February 2019 to January 2020, so it can’t speak for the whole country. Even so, the numbers are hard to forget. Only 6.8% had received bystander CPR. About 41% reached hospital by some means other than an ambulance. A defibrillator was used in roughly 1% of patients. More than half collapsed at home, and nearly a third collapsed in transit. Median time from a witnessed arrest to hospital arrival was 30 minutes. Of the 205, 1.4% survived to discharge.

Those figures are a reminder of how much happens before a patient reaches a doctor. Survival after a cardiac arrest falls with every minute without circulation. In that study, a shorter arrest and an initial shockable rhythm were linked to a return of circulation. Neither is something a hospital can influence once the patient is in the ambulance bay. They depend on a neighbour who knows how to do compressions, on a phone call made quickly, and on a vehicle that arrives equipped and finds its way.

Networks That Compress Time

The encouraging news is that parts of the system are improving, sometimes quickly. A report published in October described a seven-state heart attack programme using a digital cardiac network, run by a company called Tricog Health. It spans 167 districts in Goa, Telangana, Maharashtra, Odisha, Karnataka, Bihar and Manipur, connecting more than 3,000 health centres and covering more than 305 million people. The model is simple to describe. A patient gets a digital ECG at the first point of care. A cardiologist reads it remotely, around the clock, with AI doing an initial analysis and a doctor signing off each case. The patient is then moved along an agreed treatment pathway.

The reported results are striking, though they come from the programme and its coverage rather than from an independent trial, so they deserve a careful reading. In Karnataka, the time from arrival to opening the blocked artery fell from 170 minutes in March 2023 to 65 minutes in May 2026, and time to clot busting treatment fell from 34.5 to 14.2 minutes. In Maharashtra, in-hospital mortality was 3.9% for patients treated in time against 19.7% for those who weren’t, and overall heart attack mortality in the programme fell from 20% to 15.5%. Goa reports treatment in about 15 minutes, well inside the 90 minute benchmark.

Coordination Over Delay

What these results suggest is that the delay isn’t inevitable. It’s a coordination problem. Expertise exists, in the cities and in some smaller towns. What’s missing is the link that gets the right information to the right specialist, and the right patient to the right facility, in time.

That link has several parts. Patients and families need to recognise the signs, and know that a few minutes of hesitation at home can decide the outcome. Bystanders need basic CPR training, which is cheap to teach and rare in practice. Ambulances need to be properly equipped and reachable. Hospitals need to say clearly what they can treat, so that a patient isn’t taken to the nearest building when the right one is twenty minutes further. And information has to flow, ideally before the patient arrives, so the cath lab team is ready.

Information as Vital Infrastructure

Some of that is infrastructure and some of it is behaviour, but a good part is simply information. If a family at midnight can see which nearby centres have a cath lab, who’s available, and what it’s likely to cost, the next decision gets made faster. Digital platforms that bring those facts together won’t replace clinicians. They may well shave the first, most expensive minutes off a journey that still ends in a human being’s hands.

The evidence so far suggests that a country with enormous clinical talent can do much better on timing, and that the fix is as much about connection as about capacity. For a heart in trouble, minutes aren’t a statistic. They are the whole question.