World Heart Day, marked on September 29, on the theme “Don’t Miss a Beat”, challenges Ghana to prevent heart failure before symptoms appear.
Cardiovascular disease is placing growing demands on hospitals and families.
Behind every admission is someone whose illness might have been prevented or delayed.
Many people recognise heart failure only when breathlessness, swollen feet or repeated hospital admissions interrupt daily life.
Yet, damage often begins silently years earlier.
This year’s heart failure prevention programme urges us to act during that silent period.
Heart failure is not the same as a heart attack
Heart failure means the heart cannot pump adequately or does so only under abnormally high pressure.
A heart attack can cause it, but uncontrolled hypertension is a major pathway in Ghana.
Other causes include heart muscle and valve disease, diabetes, kidney disease, coronary disease, congenital conditions and certain infections or toxic exposures.
The heart may initially compensate by thickening or enlarging.
Feeling well, therefore, does not guarantee a healthy heart.
Understanding the stages of heart failure
Stage A means being at risk without symptoms or detectable structural damage.
Hypertension, diabetes, obesity, kidney disease, high cholesterol, smoking, harmful alcohol use, coronary disease, cardiotoxic medicines and family history can increase risk.
This is the best opportunity for prevention.
Stage B, or pre-heart failure, means no symptoms but evidence of heart damage or strain.
ECG, echocardiography or selected blood tests may reveal abnormalities.
These findings require treatment and follow-up even when the person feels well.
Stage C means structural heart disease with current or previous symptoms: breathlessness, difficulty lying flat, waking gasping, swollen legs or abdomen, fatigue, rapid fluid-related weight gain, coughing, palpitations, dizziness or fainting.
These deserve medical assessment, rather than being dismissed as ageing, stress or spiritual problems.
Stage D is advanced disease with persistent symptoms despite treatment, repeated admissions and severe limitations.
Specialist medicines, devices or surgery may be needed, creating substantial financial and emotional burdens. Preventing progression is essential.
Prevention begins with knowing your numbers
Know your blood pressure, blood sugar, cholesterol, weight and waist circumference. Hypertension can damage the heart, brain and kidneys without symptoms.
Take prescribed medicines consistently.
A normal pressure reading may show that treatment is working; it does not mean treatment should stop.
Reduce salt, including stock cubes, salty sauces, processed foods and added table salt. Use herbs and spices for flavour.
Stay physically active, maintain a healthy weight, avoid tobacco, limit alcohol, sleep adequately and manage stress.
People with hypertension, diabetes, kidney or heart disease need regular follow-up. ECG or echocardiography should follow clinical assessment when indicated.
Free primary healthcare
Ghana’s Free Primary Healthcare Programme offers an opportunity to identify hypertension and diabetes through Community-based Health Planning and Services (CHPS) compounds, health centres, polyclinics and community outreach.
Its value depends on what follows screening: confirmation, counselling, treatment and reliable follow-up.
Suspected heart damage needs clear referral for appropriate tests or specialist review.
Trained staff, dependable medicines, accurate records and effective links with the National Health Insurance Scheme are essential.
Screening must lead to sustained care.
Ghana’s pathway remains incomplete
Ghana’s NCD policy and 2022–2026 strategy, the STEPS survey, Ghana Heart Initiative, primary-care cardiovascular guidelines and growing specialist services provide important foundations.
The Heart Failure Registry can strengthen information and quality improvement.
Yet the STEPS survey found hypertension in 21.7 per cent of adults aged 18–69; 51.1 per cent of those with elevated pressure were previously undiagnosed, while only 9.5 per cent were diagnosed, treated and controlled.
Diagnostics, medicines, specialist review, rehabilitation and follow-up remain unevenly accessible.
Referral and counter-referral need stronger links.
Ghana must connect these promising foundations into a financed national pathway from community care to teaching hospitals.
What Ghana should do next
Adopt a national heart failure roadmap covering Stages A–D, with accountable leaders, referral standards and measurable outcomes.
Convert screening into control through treatment protocols, reliable medicines, trained teams and patient recall systems.
Build district diagnostic networks with ECG and laboratory services, regional echocardiography, telecardiology and outreach.
Protect access to essential medicines and safe laboratory monitoring through insurance coverage and dependable procurement.
Create hospital-to-home standards: identify the cause, optimise treatment, provide education and an emergency plan, arrange follow-up within one to two weeks, and reconnect patients with primary care.
Make rehabilitation and supportive care routine, including psychological support, caregiver education and palliative care for advanced disease.
Train the multidisciplinary workforce and use a national dataset and registry to track treatment, survival, readmissions and inequities.
Prevent disease beyond clinics through action on salt, tobacco, alcohol, unhealthy food marketing and opportunities for physical activity. Schools, employers, faith organisations, traditional leaders and the media should participate.
Cardiac rehabilitation
Rehabilitation combines safe exercise, nutrition, education, medication support, psychological care and risk-factor control. It helps patients regain confidence and function while recognising deterioration early.
Affordable community, home-based and digital programmes can extend multidisciplinary care beyond specialist hospitals.
Do not wait for a crisis
Severe or worsening breathlessness, chest pain, fainting, confusion or sudden marked weakness require urgent medical attention. Do not delay care while relying on unverified remedies.
Do not miss an abnormal pressure reading, a clinic appointment or declining exercise tolerance. Heart failure begins long before the emergency admission. That is where Ghana must intervene.
* The writer is an Associate Professor of Medicine and Cardiology, General Secretary of the Ghanaian Society of Cardiology and Fellow of the Ghana College of Physicians, West African College of Physicians and European Society of Cardiology
