Heart failure, devices and transplants: Benefits and possibilities

Over the past decade, India's cardiovascular device market has grown into a significant health-tech segment with an estimated value of $1.55 bn and projected to reach $2.34 bn by 2030

India continues to face the ever-rising burden of cardiovascular disease, which is responsible for almost one in three deaths nationally. Coronary artery disease remains the major culprit along with lesser contribution from other conditions such as hypertensive heart disease, rheumatic heart disease, congenital heart disease, and heart rhythm disorders.

 

Compounded by disease progression, the rising incidence of ensuing heart failure is reshaping how clinicians are adopting new, integrated, and personalised therapies. Technological innovations in device therapy, safer surgical interventions, personalised

immunosuppression regimes, improved organ preservation techniques, and a steadily growing nationwide transplantation infrastructure offer new possibilities towards prolonged survivorship for patients with advanced heart failure.

 

 

Over the past decade, India’s cardiovascular device market has grown into a significant health-tech segment with an estimated value of $1.55 billion and projected to reach $2.34 billion by 2030 1 . From pacemakers and implantable automatic cardioverter-defibrillators (AICDs) to ventricular assist devices (VADs) and heart transplantation, an expanding toolkit of advanced therapies has moved from a limited number of specialist centres to become part of mainstream clinical practice.

Better Toolkit for Failing Hearts

Each device serves a distinct clinical need. Pacemakers address electrical disorders such heart block or dangerously slow heart rate; AICDs guard against lethal arrhythmias and prevent sudden cardiac arrest; in advanced coronary artery disease, Coronary Stents implanted percutaneously, and when necessary surgical use of minimal access techniques including robotics are vital in restoring normal blood flow in advanced coronary artery disease; VADs and Total Artificial Hearts augment the pumping capacity of a failing heart; and heart transplantation remains the gold standard therapy for end-stage cardiomyopathies.

 

Once considered largely for the elderly or critically ill, today even younger adults benefit, especially when their conditions are diagnosed early. We have shifted from using technology purely as salvage therapy to a broader application focused on ensuring

survivorship, quality of life, return to work and routine family life.

 

While the volume of application still significantly lags behind clinical need, the year-on-year trajectory signals that transplantation and use of devices including mechanical circulatory support are now part of a maturing ecosystem for the management of advanced heart failure.

Safer, Smarter, and Connected

Reflecting on the growing adoption of novel life-saving technology and devices, my colleague Dr Kumud Kumar Dhital, Sr.Cardiothoracic & Transplant surgeon, and Program & Surgical Director – Institutes of Heart-Lung Transplant & MCS at Apollo Hospitals commented, that technological innovation has been the principle catalyst enabling deeper penetration of emerging platforms such as machine learning, AI, and robotics. He added that therapies based on such advancement, particularly when integrated are not only safer but also designed to deliver better outcomes with fewer complications and save more lives.

 

Leadless pacemakers, for example, eliminate complications arising from pocket and leads; remote monitoring allows clinicians to detect heart rhythm disturbances early and adjust therapy from a distance thereby extending high-quality follow-up beyond major metros. Telemedicine platforms now knit together tertiary centres, secondary hospitals, and rural clinics to reduce the need for repeated long-distance travel after the initial procedures.

 

Artificial intelligence is beginning to impact every stage of the heart failure care pathway. Algorithms trained on large datasets can refine arrhythmia risk stratification, guiding pacemaker and AICD placement with greater precision. In transplantation, AI-assisted donor-recipient matching, and optimisation of immunosuppression protocols aim to not only reduce episodes of acute rejection and infection, but also to limit chronic rejection for better prognosis.

Preserving the Gift of a Donor Heart

In a vast country where geography often stands between uniting the donor heart with a matched recipient, even incremental changes in widening the donor acceptance criteria and in organ preservation technology can be transformative. Research and early clinical adoption of improved cold-storage strategies and normothermic machine perfusion are lengthening the safe transport window, giving surgical teams more time to evaluate grafts and plan complex logistics. Each extra hour can expand the radius for retrieval, increase utilisation of donor organs, and ultimately, save lives that would otherwise be lost on the waitlist to time and distance.

The Access Gap: Cost, Capacity and Continuity

According to my colleague Dr. R Ravikumar Clinical Lead for Heart failure & Transplant Cardiology at Apollo Hospitals, the high cost of devices and complex surgeries remain a major barrier. For patients based rurally and in small-towns, devices such as pacemakers, AICDs, and VADs, are perceived as a burden, particularly when combined with the need for distant follow-up, lifelong surveillance and rehabilitation. The largest barrier however, remains that of affordability.

 

Donor availability is an additional constraint. There is hope that the efforts of the National Organ and Tissue Transplant Organization (NOTTO) 2. and individual state-based transplant regulatory authorities will deliver the necessary uplift in the overall national deceased organ donation rate which currently sits at less than 1 pmp. It is worth noting that if the national donation rate could emulate that seen in Tamil Nadu and Telangana at 3 and 5 per million population (pmp) respectively, we would be seeing thousands of more solid transplants. Finally, measurements matter. National registries for devices and transplants which capture indications, outcomes, complications, and patient-reported quality of life, will drive quality improvement, inform reimbursement, and highlight where investment will deliver the greatest public-health return.

 

India has the expertise, the technology, and the early proof from clinical practice. The next chapter will be written by how effectively the country tackles cost, capacity, and continuity of care. The challenge is not merely of having the devices to enhance your quality of life, but rather of affordability, accessibility, and continuity of care. This calls for public and private players to come together and ensure that these therapies move from being rare lifelines to becoming life-changing standard of care for all who need them. If it succeeds, the story of heart failure in India will change, from inevitable decline to a condition that can be managed, supported, and in many cases, decisively overcome.