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Research showed that Indians were particularly at risk of heart disease, with the Indian subcontinent contributing 45% of the global burden of coronary artery disease. Dr. Shetty said: “Indian genes are three times more vulnerable to heart disease. The average age for heart attacks in the West, for instance, is 65 years, whereas in India, it is 45. When I was a student in London, it was normally a young son who brought his elderly father in for bypass surgery. In my practice in India it is more often the elderly father who brings his son in.”
The most common heart diseases occurred when the supply of blood to the heart was blocked. This typically happened when the coronary arteries (the vessels that supplied the heart muscle with oxygen and nutrients) were clogged by fat and cholesterol. When one or more of the coronary arteries became partially or completely blocked, the heart was starved of its blood supply—the patient then experienced a recurring pain or discomfort in the chest (angina), and this condition was termed coronary heart disease. When the blood supply was cut off, a part of the heart muscle died and the patient was said to have had a heart attack.
Besides good medical therapy, there were two common methods of treating coronary heart disease—angioplasty and CABG. In angioplasty (a form of catheterization), X-rays and dyes were used to visualize the arteries that supplied the heart. [5] A balloon catheter was then inserted in or near the blockage and inflated, thus widening or opening the blocked vessel and restoring adequate blood flow to the heart muscle. In most cases, a device called a stent was also placed at the site of the narrowing or blockage to keep the artery open. The whole procedure was performed from a small hole in the artery of the leg or arm under local anesthesia and took approximately one or two hours.
CABG, on the other hand, was a form of OHS and involved creating a detour (“bypass”) around the blocked part of the coronary artery. Veins (typically, from the patient’s leg) and/or arteries were used as grafts and sewn from the aorta (the main blood vessel going from the heart to the rest of the body) to a point below the blockage, thereby creating an alternative pathway for blood to the heart. The operation took between three and six hours (depending on the number of blockages present), and CABG was usually recommended over angioplasty when there were multiple blood vessels with narrowing or when angioplasty was not technically feasible.
The operations strategy at NH followed the dual principle of highest quality at the lowest cost consistent with that quality. There were absolutely no compromises when it came to the quality of the hospital’s facilities, equipment, and support services. The 500-bed hospital was housed in a modern setting with spacious areas for all amenities, beginning with the check-in counter, to surgical and treatment wards. Equipment costing Rs. 35 crores (US$7.8 million) was imported, and all supplies were obtained from vendors that provided the highest quality. Simultaneously, since Dr. Shetty’s vision was to provide health care at an affordable price to the masses, the operations attempted to drive unit costs lower through a high level of capacity utilization and productivity.
[5] The procedure of injecting dyes into the coronary arteries to look for any blockages was termed “angiogram.”
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