For Mrs Chika Emenike, the battle to save her mother from heart disease became a painful race against time—and money.
Her 75-year-old mother had lived with poorly controlled hypertension for months before her condition deteriorated. Despite spending millions of naira on consultations, investigations, medication and other treatments, the family was unable to save her.
The loss has left Emenike not only grieving but also questioning the enormous financial burden associated with managing heart disease in Nigeria.
“My mother really suffered due to this heart problem. We spent over N28 million in the course of trying to save her life. We planned to organise a befitting birthday for her this coming December. We wanted to celebrate her while she was alive, but it is heartbreaking that she died last week,” she told The Guardian.
Her experience reflects a wider challenge confronting Nigerians living with cardiovascular diseases as the country marks World Heart Day today.
Health experts say the rising burden of heart disease is being compounded by the high cost of diagnosis and treatment, widespread out-of-pocket spending, inadequate cardiac infrastructure, severe shortages of specialists and weak emergency medical services.
They also warn that Nigeria is undergoing a major epidemiological transition, with the traditional burden of infectious diseases increasingly accompanied by hypertension, diabetes, coronary artery disease and other cardiovascular and metabolic conditions.
The World Heart Federation (WHF) says heart disease and stroke remain the world’s leading causes of death, accounting for more than 20.5 million deaths annually. Developing countries bear about 80 per cent of these fatalities, as well as up to 80 per cent of premature deaths from cardiovascular disease.
In Nigeria, the Nigeria Heart Foundation (NHF) says the cardiovascular disease burden is increasing, driven by hypertension, diabetes, coronary artery disease and changing lifestyles.
Recent studies cited by health experts indicate that about 40 per cent of Nigerian adults are hypertensive, yet fewer than five per cent have their condition properly controlled.
For many patients, the danger is compounded by the fact that hypertension can remain undetected for years.
President of the NHF, Prof Osaretin Odia, said hypertension remains one of the country’s major cardiovascular health challenges.
“Hypertension is a major problem in detection and diagnosis,” Odia said.
He noted that available estimates put the proportion of Nigerian adults with elevated blood pressure at between 35 and 40 per cent, although reliable nationwide data on several other forms of heart disease remain limited.
According to him, Nigeria’s cardiovascular disease profile is changing rapidly.
He said the country was moving from a situation in which infectious diseases dominated the health burden to one where cardiovascular and metabolic diseases are increasingly prevalent.
Odia explained that heart disease should no longer be regarded as a condition associated exclusively with old age.
He said Nigerians could develop cardiovascular problems at different stages of life, including childhood, while congenital heart defects remain an important concern among children.
Such defects, he noted, could be associated with factors during pregnancy, including infections and inappropriate medication use, making adequate antenatal care important.
Cost of care puts treatment out of reach
One of the most significant barriers to cardiac care is the cost of diagnosis and treatment.
While a basic blood pressure check may be relatively inexpensive, more sophisticated investigations—including electrocardiography, echocardiography and cardiac catheterisation—can impose substantial costs on patients.
The Guardian’s findings showed that the cost of diagnosing and treating worsening heart disease is particularly high in private hospitals. Routine outpatient care can average more than N319,200 to N421,596, while advanced treatment such as open-heart surgery may cost between N9.4 million and more than N40 million, depending on the facility and complexity of the procedure.
Diagnostic and initial routine tests, including ECGs, echocardiograms and blood panels, can also range from about N10,000 to N1.7 million per screening session, depending on the hospital and the procedures involved.
For patients who require specialised interventions, the financial burden can become overwhelming.
Odia said cardiac catheterisation, available in only about 10 centres nationwide, could cost between N2 million and N5 million, depending on the treatment required. Stent insertion could cost between N12 million and N15 million.
“These are very expensive,” he said.
He noted that the high cost of treatment, the geographical concentration of cardiac facilities and the shortage of specialists were combining to limit access to care.
The problem is particularly severe for Nigerians who have no health insurance and must pay directly for consultations, investigations, medication, hospitalisation and procedures.
Many patients, experts said, are forced to delay treatment or abandon prescribed care when they can no longer afford it.
Odia called for stronger health insurance systems and greater commitment by governments at the federal, state and local levels to universal health coverage.
He urged authorities to expand contributory and social health insurance schemes so that patients would not have to bear the full cost of increasingly expensive cardiovascular treatment.
Cardiac infrastructure stretched
Beyond cost, Nigeria's cardiac healthcare system is also struggling with inadequate infrastructure.
Investigations showed that catheterisation services are available in only about 10 centres across the country, with most concentrated in urban areas.
The limited availability of catheterisation laboratories in public hospitals means that patients requiring specialised diagnosis and treatment of blocked arteries are frequently referred to private facilities.
Consultant cardiologist at the University of Nigeria Teaching Hospital (UNTH), Prof Emmanuel Ejim, said the cost of care becomes particularly burdensome when patients require advanced cardiac interventions.
He said many government hospitals do not have functional catheterisation laboratories, commonly known as cath labs, where specialised procedures for diagnosing and treating blocked heart arteries are carried out.
According to Ejim, the absence of adequate facilities in public hospitals often leaves patients with little choice but to seek treatment in private centres, where they are required to bear substantial out-of-pocket expenses.
He called for increased government investment in cardiac infrastructure, arguing that equipping public hospitals with functional facilities and specialised services would improve access while reducing the financial burden on patients.
Shortage of specialists, ‘Japa’ worsen crisis
The shortage of specialised personnel is another major concern.
The Nigerian Cardiac Society estimates that the country has only about 400 cardiologists serving a population of more than 220 million people.
Odia also estimated that Nigeria has fewer than 10 interventional cardiologists, while shortages of functional heart-lung machines have constrained the country’s capacity to provide open-heart surgery.
Consultant cardiologist at Lagos State University Teaching Hospital (LASUTH), Ikeja, Dr Ehimen Okogun, said the shortage of specialist manpower had been worsened by the migration of Nigerian healthcare professionals abroad, popularly known as “Japa”.
“The Japa syndrome is a nightmare for healthcare in Nigeria. In the whole of Nigeria, we have not up to 300 cardiac surgeons, in a country of over 200 million people,” he said.
He said patients from different parts of the country were sometimes referred to Lagos for specialised procedures because of the limited availability of tertiary cardiac services elsewhere.
The consequences, he said, could be particularly serious for patients requiring urgent interventions.
Okogun recalled the case of a patient who needed an aortic valve operation estimated at N10 million but died before he could raise even N2 million.
Coronary artery bypass surgery, he added, could cost between N20 million and N40 million, depending on the circumstances.
Lifestyle changes fuel rising risk
Experts say Nigeria's changing lifestyles are also contributing to the cardiovascular disease burden.
Odia identified reduced physical activity, increasing obesity, diabetes, cigarette smoking, harmful alcohol consumption and changing diets among factors driving the problem.
Okogun similarly identified smoking, obesity, hypertension, diabetes, physical inactivity, chronic stress and unhealthy diets as major modifiable risk factors.
He said the growing adoption of sedentary lifestyles and high-calorie, high-fat diets, particularly in Nigerian cities, was exposing more people to cardiovascular disease.
He also expressed concern about the increasing incidence of cardiovascular problems among younger people.
According to him, many of the factors responsible for heart disease can be prevented, but misconceptions about hypertension, poor health-seeking behaviour, rising treatment costs and inadequate specialist infrastructure continue to undermine prevention and treatment.
A major concern, he said, is the misunderstanding surrounding hypertension and its treatment.
He explained that antihypertensive medicines need to be taken consistently as prescribed and should not be discontinued simply because a patient feels better.
Heart disease warning signs often ignored
Consultant interventional cardiologist at LASUTH, Dr Ramon Moronkola, urged Nigerians to take cardiovascular risk factors seriously from an early age.
He advised people to know their blood pressure, blood sugar and cholesterol levels and to take appropriate action when results are abnormal.
Moronkola also warned against assuming that chest pain is the only warning sign of heart disease.
He identified unexplained breathlessness, persistent fatigue, reduced exercise tolerance, palpitations, dizziness, fainting, swollen feet or ankles and difficulty breathing when lying down as symptoms that should not be ignored.
He also advised men not to dismiss new or persistent erectile dysfunction, noting that it shares risk factors with cardiovascular disease and can sometimes be an early indicator of underlying vascular disease.
Emergency response remains critical
Experts also stressed the importance of rapid emergency response for patients suffering acute cardiovascular events.
Odia said ischaemic heart disease, also known as coronary artery disease, was becoming increasingly prevalent.
When coronary arteries become severely blocked, he explained, patients can suffer heart attacks requiring immediate access to specialised care.
Poorly controlled cardiovascular conditions can also eventually result in heart failure, making early diagnosis and intervention crucial.
Odia said an effective ambulance network capable of responding rapidly to medical emergencies could save lives, particularly when patients require urgent cardiac treatment.
Prevention remains cheaper than treatment
Despite the growing challenges, the experts stressed that a significant proportion of cardiovascular disease can be prevented or controlled through early detection and lifestyle changes.
Odia urged Nigerians to make routine health checks, particularly blood pressure monitoring, part of their regular healthcare habits.
He also advised people to monitor their weight and blood sugar and pay closer attention to their diets.
Okogun similarly called for greater emphasis on preventive healthcare, including regular screening and early treatment of hypertension and diabetes.
Moronkola said prevention and early treatment were generally less costly than treating heart attacks, strokes or advanced heart failure.
He called for improved health insurance coverage, affordable essential medicines and greater investment in preventive cardiovascular care.
The experts also urged government to increase funding for healthcare, expand insurance coverage and strengthen public hospitals with functional cardiac equipment and specialised personnel.
For families such as Emenike’s, however, the cost of delayed diagnosis and inadequate access to care is measured not merely in naira but in lives lost.
As Nigeria observes World Heart Day, health experts say reducing that toll will require more than public awareness. It will require affordable treatment, stronger health insurance, better-equipped hospitals, more specialists, effective emergency services and sustained investment in cardiovascular care.