Aims Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India.
Methods and resultsThe NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. Conclusion One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
This paper first analyzed the trend of annual sediment flux time series from seven major basin outlet stations in India using the non-parametric Mann-Kendall (MK) method. Then the non-linear trends in these series were extracted using the empirical mode decomposition (EMD) method. Similar procedure is followed upon annual rainfall of the basin and a comparison of trend is made with that of sediment load. Results of trend analysis study showed a reduction in sediment flux in five out of seven tropical river basins in India despite the increase in rainfall in three among them. Despite the significant reduction in rainfall, the sediment flux from Chennur station in Pennar basin showed an increasing trend, which is attributed to large flow diversion in the upper reaches of the station. The application of continuous wavelet transform (CWT) analysis confirmed that anthropogenic impact is the major driver behind the sediment flux variability of tropical river basins in India. Then for a microscopic examination of trend in monthly sediment flux data from different stations, first the change points in them were identified by the Hubert's segmentation procedure. For each of the identified segments, the trend is examined using the MK test and EMD method. The nature of trend captured by both methods is similar for most of the cases with discrepancies for few cases. The discrete wavelet transform (DWT) analysis is applied for such segments with discrepancies following extensive sensitivity analysis on mother wavelet type and decomposition levels. The similar nature of trend by DWT as that of EMD confirmed that EMD method is successful in capturing the 'true' inherent non-linear trend in sediment flux series.
Tropical endomyocardial fibrosis (EMF) is endemic in southern districts of Kerala state in India, and sporadic cases are reported from other parts of Kerala. Transthoracic echocardiogram (TTE) is the initial imaging tool and is diagnostic for this condition. The inherent limitation of TTE is its limited sensitivity in the detection of intracardiac thrombus. Transthoracic echocardiography, contrast-enhanced cardiac computed tomography, and cardiac magnetic resonance imaging (CMR) are the imaging modalities for the detection of intracardiac thrombus. This report describes a 46-year-old male with right ventricular EMF (RVEMF) who presented with right heart failure. The TTE diagnosed RVEMF but failed to demonstrate the right atrial thrombus which was clearly seen on CMR. The merits of different imaging modalities for the detection of intracardiac thrombus are discussed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.