Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry

Abstract

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.

A year in heart failure: updates of clinical and preclinical findings

“…Coronary artery disease (53%) and VHD (28%) were the most common HF aetiologies in a retrospective European single‐centre study of patients admitted for acute HF during a period of 1 year 17 . A larger cohort from the Indian National Heart Failure Registry determined the cause of the full spectrum of HF being mainly coronary artery disease (71%) and dilated cardiomyopathy (DCM; 18%), whereas VHD represented only 8% of HF causes 18 . It is however notable that rheumatic VHD was the second most common aetiology for HFpEF in India (24%) 18 .…”

“…A larger cohort from the Indian National Heart Failure Registry determined the cause of the full spectrum of HF being mainly coronary artery disease (71%) and dilated cardiomyopathy (DCM; 18%), whereas VHD represented only 8% of HF causes 18 . It is however notable that rheumatic VHD was the second most common aetiology for HFpEF in India (24%) 18 . The Japanese community‐based, prospective, observational KUNIUMI registry cohort with a mean age of 79 years found that VHD was the most common cause of chronic symptomatic HF (50%) 19 .…”

“…18 It is however notable that rheumatic VHD was the second most common aetiology for HFpEF in India (24%). 18 The Japanese community-based, prospective, observational KUNIUMI registry cohort with a mean age of 79 years found that VHD was the most common cause of chronic symptomatic HF (50%). 19 The VHD prevalence increased in higher age groups for tricuspid and mitral regurgitation as well as aortic stenosis (AS), whereas mitral stenosis was less common in older chronic HF cases.…”