Heart attacks are killing more Indians than ever, and do not treat most times. Over the years, news headlines and viral videos have repeatedly told the same sad story: A man collapses mid-workout in a gym, a young professional faintly dancing in a wedding, a office-goer falls on his desk-and never arises. Throughout India, a sudden heart attack is claiming life in homes, gym, offices and even cricket fields.

Heart disease is now the number one killer in the country. The number is shocking: About three to four million people in India have a type of serious heart attack every year called ST-Elavesation Myocardial Information (Stemi). This is a condition where a major artery in the heart is completely blocked, cuts the blood flow and threatens the existence of the heart muscle.

According to the Global Burden of Disease Study, 28.1% of all deaths in India in 2016, heart diseases in 1990 calculated deaths of more than 15.2%.

But despite the scale of crisis, there are not enough cardiologists, hospitals, or emergency systems to save life, especially outside big cities in India.

What happens in a heart attack that a artery in the heart gets blocked. A clot is suddenly formed, such as clotting into a wound, and prevents blood flow. To save the heart muscle, we must immediately restore a drug (thrombolisis) or emergency angioplasty (primary PCI), either blood flow immediately.

Primary PCI is the best option, but it is not available everywhere and definitely not 24/7 in India. The most effective window to save life is known as “Golden Hour” – ideally within the first hour of symptoms.

But in India, patients often take hours, days to treat properly.

A model that works and saves life

To deal with this crisis, the Stemi Act project led by the Indian Council of Medical Research (ICMR) in collaboration with AIIMS is constructing a hub-end-spoke network in states across India.

The model is simple: Small “Bole” hospitals give doctors and paramedics to quickly diagnose Stami using train doctors and ECG and give immediate clot-busting drugs during contact with cardiologists in large “hub” hospitals via telemedicine.

In their pilot, the rate of thrombolisis increased from 30% to 75%, and in more than 90% of cases drugs were given within 40 minutes of the first contact – well within the golden hours.

“If a pizza can be given in 30 minutes, we can give life saving treatment even in 30 minutes,” Dr. S Ramakrishnan, AIIMS Delhi’s Cardiologist and ICMR STEMI Act Project National Head Investigator.

“In a country like India, a pharmaco-invasive approach, thrombolisis first, after angioplasty, is often the best option. The important message is that ‘time is life’ and ‘time is muscles’. Opening the artery quickly saves more from the heart. Unfortunately, the average time to reach a hospital in India is a golden hour.

System problem: It’s not just patient

One of the biggest causes of delay is wrong diagnosis and poor emergency response system.

“The delay is not only due to patients. People do not know that it is a heart attack, they go to the same clinic for chest pain that they will do for fever or headache. These small hospitals are often not equipped for heart attacks,” Dr. Ramakrishnan says.

He said that the treatment of a heart attack is not only about good doctors or cath lab: “You need a whole series that works: from first medical contact to treatment.”

The result of these delays is fatal. “The mortality rate from a heart attack is about 10%, compared to 3-3.5% in the west. Most angioplasty here occur more than 24 hours after the attack, when most of the heart muscle is already dead,” he says.

Training paramedics to defeat the clock

Globally, paramedics are often trained to start treatment and treatment for a heart attack in ambulances. In India, recently it was not allowed due to rules that prevent nurses and paramedics from giving medicines without a doctor’s order.

Dr. Ramakrishnan’s team found a workaround: “We made an ambulance a detailed AIMS – so when I, as a doctor, give the order remotely, it seems as if it is happening in AIIMS itself. If anything goes wrong, I take responsibility.”

This allowed paramedics to be given life -saving thrombolisis on the spot, cut through traffic delays and hospital bottlenecks.

State success stories

Some states have already adopted this model with remarkable success. Tamil Nadu offers free primary PCI 24/7 for eligible patients, Kerala has highly skilled district-level systems, and Goa runs a strong STEMI program.

Under the Stemi Act, Andhra Pradesh treated 4,500 patients in a year, Thromboli is ready for Stami patients in Punjab Primary Health Centers, and expanding the expansion programs of states like Himachal Pradesh, Rajasthan and Uttar Pradesh.

By May 2025, about 6,000 stemi patients were registered under the project.

Public health vision

“Stemi Act aligns with India’s extensive heart disease management goals and the public health strategy of ICMR, which focuses on the timely and effective treatment of the significant form of heart attack, Stemi,” Program Officer in ICMR (cardiovascular disease and neurology) says Meenakshi Sharma.

The project throws light on reducing the burden of non-communicable diseases such as CVD through evidence-based intervention and timely action.

“In particular, the Stemi Act addresses the important ‘Golden Hour’ for treatment, reduces mortality and reduces long -term sickness associated with heart attack, contributing to the national effort to reduce CVD -related deaths,” she says.

By improving care routes, the project also strengthens the ability of the overall healthcare system to handle heart disease – an important part of ICMR’s national strategy.

Why Indians are at high risk, and are small

South Asian, including Indians, suffer a heart attack 5–10 years ago compared to the Western population. Causes are a fatal mixture of high cholesterol, diabetes, high blood pressure, abdominal obesity, smoking, stress, poor diet and lack of exercise.

The 2018 Lancet Global Health Study found that in 2015, India had over 2.1 million deaths in heart disease, including 1.3 million deaths between the age of 30–69 years. Dangerous, heart disease mortality in rural India has now crossed those people in cities.

But even with the system, a major challenge remains, the frontline doctors in rural and semi-urban areas are confidently getting to free thrombolytic drugs from cost.

Meenakshi Sharma said, “Administrating thrombolisis for STEMI within the recommended window, ideally challenging in rural and urban settings, especially within 30 minutes of first medical contact.”

However, there are many obstacles:

• Many MBBS doctors are afraid of complications such as bleeding or arrhythmia.
• Some believe that thrombolisis should be performed only in high centers.
• Health workers worry about legal liability or backlash from the community if something goes wrong.
• It will be important to overcome this fear to save more lives.

It matters every minute

India’s heart attack crisis is not unacceptable, but it demands urgency, awareness and investment.

The Stemi Act project suggests that life-saving treatment can be given in remote areas, along with training, technology and teamwork, within 30 minutes.

But to be everywhere, experts say that states should ensure uninterrupted supply of clot-busting drugs, ambulances and hospitals to ensure ECG machines and defibrillars, train paramedics and medical officials to rapid diagnosis and treat and run public awareness campaigns, so that people identify the symptoms of heart attack and seek immediate help.

Because in a heart attack, time is not just money – time is life.