Written by Olivia Kim, BA candidate in Anthropology: Global Health and Environment, Washington University in St. Louis; and Little Medical School Scholar in the 2023 Institute for Public Health Research Program
During my participation in the Institute for Public Health Summer Research Program – Public and Global Health track, I had the opportunity to attend a seminar by Anubha Agarwal, MD, MSc, an assistant professor and co-director of the Program in Global Cardiovascular Health at the Washington University School of Medicine. While leading a seminar about clinical trials, Agarwal also delved into her research developing a polypill to treat systolic heart failure, or heart failure with reduced ejection fraction (HFrEF).
Heart failure is a leading global public health concern, with more than 26 million cases around the world. HFrEF occurs when the left side of the heart can’t pump blood out to the body as well as it should. In order to treat the condition, doctors prescribe their patients a combination of medications, collectively known as guideline-directed medical therapy (GDMT). GDMT can effectively manage symptoms and critically reduce mortality for patients. However, it also requires patients to take multiple medications at a time. An HFrEF polypill combines these multiple medications into a single pill, offering patients an easy and cost-effective way of taking their medication and empowering them to adhere to their treatment and improve their health outcomes in the long run.
In her presentation, Agarwal talked about the process of examining the HFrEF polypill as a viable treatment to deliver GDMT. The work began with interviews with stakeholders in Kerala, India and a systematic review to understand how patients with HFrEF utilize GDMT. The systematic review notably showed a historical lack of attention to low and middle-income countries. However, the HFrEF polypill also emerged as a promising treatment method. Agarwal began the clinical trial phase with 80 patients at a single hospital in Kerala, later expanding to 900 patients throughout India when the polypill proved to be safe and successful in increasing participants’ adherence to GDMT. At this broader scope, polypill use led to reductions in heart failure hospitalization and cardiovascular disease mortality. Following its success in India, the HFrEF polypill research program is moving to the global stage with its expansion to Sri Lanka, Australia, and the United States.
I was struck by this case study as an example where a health intervention was developed in India and is now expanding to countries like the United States and Australia. To me, it is a case that subverts the dominant narrative that medical knowledge is produced in the West and disseminated to the rest of the world. It is an undeniable truth that the field of global health emerged from a history of colonization and imperialism, and this legacy is still evident in the field today. Developments like the HFrEF polypill show that the future of global health will involve important contributions and collaborations from all over the world. When asked about the challenges of adopting the HFrEF polypill to new places, Agarwal mentioned the hurdles involved when navigating different healthcare systems (ex. dealing with private insurance in the United States). Health interventions will have to be adapted to their specific contexts. However, we will all benefit from the equitable collaboration of researchers around the world.