Chennai: Tamil Nadu’s state-run network for treating STEMI — the most severe form of heart attack, caused by a complete blockage of a coronary artery — handled 19,623 cases in 2025, up from 11,379 in 2019, as the number of hospitals equipped to perform emergency artery-opening procedures grew to 21 hub centres linked with 195 smaller “spoke” hospitals across the state. But even as more patients got care, deaths held nearly steady — 993 (8.73%) in 2019 to 1,773 (9.04%) in 2025.Now, as the network nears full scale, officials say the next fight against heart disease will happen outside the hospital. Treating a rising tide of heart attacks has grown too costly to sustain through hospitals alone. Preventing or managing diabetes, high blood pressure and obesity before they cause a heart attack, they say, is now the cheaper and more urgent priority.The programme, Idhayam Kappom Thittam, or the Tamil Nadu Heart Attack Management Program, was built for patients in rural and semi-urban areas, who often died or suffered lasting heart damage because the nearest hospital had no facilities, such as a cath lab to treat them.Since 2018, the state has linked hospitals into a “hub-and-spoke” network — smaller spoke hospitals, often without heart specialists, stabilize a patient and alert a nearby hub hospital in advance so doctors are ready when the patient arrives. If the patient cannot reach a hub quickly, the spoke hospital gives clot-dissolving drugs on the spot; if a hub is close enough, doctors skip straight to angioplasty, the fastest and most effective way to reopen a blocked artery.Twenty-four cath labs now run around the clock across the state’s medical college hospitals, a structure officials say has closed much of the treatment gap that once left rural patients without timely options. Angiograms, the diagnostic scans that map blockages, climbed from 19,970 in 2021 to 24,761 in 2025, while angioplasties, the artery-opening procedures at the heart of emergency cardiac care, rose from 5,264 to 9,760 over the same period. Primary PCI, the fastest track to angioplasty for patients who reach a hub hospital in time, grew from 563 cases in 2019 to 1,522 in 2025. “More people reached hospital on time and were saved,” said a senior cardiologist.But saving lives at this scale carries a steep price tag, doctors noted during a recent program review. Heart procedures consumed ₹125 crore, nearly a tenth of the state’s flagship health insurance spending in 2025, making cardiac care the second most expensive category of treatment after kidney disease. Interventional cardiology — where stenting is done — alone accounted for 9.62 percent of the Chief Minister’s Comprehensive Health Insurance Scheme outgo, totalling ₹125.35 crore, the second-highest specialty by expenditure after nephrology. For patients seeking treatment at private hospitals with partial or no insurance coverage, the cost could be considerably higher.The answer to both problems — rising deaths and rising costs — lies not in the hospital, but in preventing heart attacks before they happen. “This programme is a short-term policy plan to save lives. Long-term health policy is now focusing on prevention,” said Dr S Uma, project director of the Tamil Nadu Health Systems Project. “We want to prevent diabetes, hypertension, cholesterol and obesity to prevent heart disease and premature deaths, or keep them under control,” she said. “This will not just reduce costs but also deaths,” she said.Idhayam Kappom Thittam: By the NumbersProgramme totals (2021–2025):* Patients undergoing PCI: 44,242* Patients undergoing Angiogram (CAG): 108,691* Total beneficiaries: 152,933*Hub hospitals: 21*Spoke hospitals: 195*Cath labs running 24/7: 24 (across 21 medical colleges)
