Profiling cardiac arrhythmia and heart failure patients in India: The Pan-arrhythmia and Heart Failure Observational Study

Vora, Amit; Naik, Ajay; Lokhandwala, Yash; Varma, Jagmohan; Wander, Gurpreet Singh; Jaswal, Aparna; Srikanthan, V. S.; Kahali, Dhiman; Gupta, Anoop K.; Mantri, R.R.; Mishra, Anil; Pandurangi, Ulhas; Ghosh, Debashis; Makkar, Jitendra Singh; Sahu, S.; Radhakrishnan, Rajesh

doi:10.1016/j.ihj.2016.11.329

Cited by 14 publications

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“…This supports the concept that cardiovascular disease affects patients in India at a younger age than the Western HF cohorts, that typically range from 65 to 73 years 2 . Our data confirm the previous findings of the panarrhythmia and heart failure (PANARM HF) registry 10 about the imbalance between males and females among recipients of implantable devices or interventional therapies. This result could be because of a combination of factors such as reduced cardiovascular disease prevalence among females, reluctance to seek health care and, more likely, a lower priority and willingness to finance female health in Indians.…”

Section: Discussionsupporting

confidence: 90%

“…HF is a major component of the noncommunicable disease burden in the Indian population 10 . In India, using calculations based on morbidity and mortality profiles and prevalence of risk factors such as CHD, hypertension, RHD, and increasing aging, there would be at least 1 million patients with HF at any time 2 .…”

Section: Discussionmentioning

confidence: 99%

“…This trend appears to be quite common across India. The PANARM HF registry 10 showed that of the 1011 screened patients who needed to be referred to an interventional cardiologist (IC), only ∼25% of them consulted the IC. Moreover, half the HF patients who consulted the IC, and were indicated for a CRT device, were in HF stage C or D. This finding is a clear reflection of the lack of health awareness and low priority to proactively seek out health care in the Indian community.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac resynchronization therapy is associated with improvement in clinical outcomes in Indian heart failure patients: Results of a large, long-term observational study

Naik

Yadav

Pandurangi

et al. 2018

Indian Heart Journal

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BackgroundHeart failure (HF) is a common health problem in South Asia, and its incidence and prevalence are projected to rise. Cardiac resynchronization therapy (CRT) has been shown to improve mortality, reduce hospitalizations, and improve symptoms in selected patients with HF. The South Asian Systolic Heart Failure Registry (SASHFR) was designed to be a large and comprehensive registry of Indian HF patients with the purpose of enhancing the quality of care and clinical outcomes of HF patients by promoting the adoption of evidence-based, guideline-recommended therapies, in particular CRT.MethodsOverall, 471 patients on optimized medical therapy and meeting CRT implantation guidelines were followed up in 12 Indian hospitals. During the 2-year follow-up period, clinical response in terms of clinical composite score, overall performance and changes in HF performance metrics, mortality and hospitalizations rates were evaluated.ResultsOf 471 patients, 116 (24.6%) accepted to be implanted with a CRT device, while 355 (75.4%) refused, financial constraints being the main reason for refusing a CRT device. The study met its primary outcome, as the number of patients associated with an improvement in clinical composite score at 24 months was significantly higher (69.1%) in the CRT group than in the no-CRT group (44.7%) [odds ratio = 2 (95% confidence interval 1.25–3.20), p = 0.004]. Also, changes in HF metrics, mortality and hospitalizations rates indicated a more favorable response among patients who underwent CRT.ConclusionsThe results from the SASHFR registry show a clear superiority of CRT over optimal pharmacological therapy in terms of improvement in clinical conditions among HF patients. The low rate of CRT acceptance, in patients indicated to this therapy, highlights the need for new health-care policies to improve awareness about HF disease and its therapies and possibly to enhance financial coverage of indicated therapies.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiac resynchronization therapy is associated with improvement in clinical outcomes in Indian heart failure patients: Results of a large, long-term observational study

Naik

Yadav

Pandurangi

et al. 2018

Indian Heart Journal

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“…A Chinese study reported the highest prevalence of PVCs in patients with HF (68.30%), while VT prevalence was 14.50% 25 . Another study enrolled 2205 HF patients in India reported that 58% of HF patients had arrhythmia: 15% bradyarrhythmia, 15% AF, 10% other SVT, and 4.5% VT 30 . On the other side, another study reported the highest prevalence of VT in HF patients, they detected VT and VF episodes in 199 HF patients with CRT-D as 25.8%, increased to 37.8% in patients with chronic kidney disease, P value <0.05 31 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization and one year mortality

Abdellah

El-Nagary

2018

The Egyptian Heart Journal

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Background and objectivesP-wave dispersion (PWD) and Interatrial block (IAB) are common in heart failure (HF), and could be associated with adverse cardiac events. We aimed to assess the prevalence of PWD and IAB and their relationship with functional status, hospitalization and mortality rate in patients with systolic HF.MethodsWe enrolled 110 HF patients in sinus rhythm & LVEF <50%. Patients had undergone clinical evaluation, 6 min walking test (6MWT), 12-lead electrocardiography (ECG), 24-h Holter ECG & echocardiogram. Hospitalization and mortality rate were followed-up for one year. PWD was defined as the difference between maximum & minimum P-wave duration >40 ms. IAB was defined as maximum P duration >110 ms. Measurements were done by 2 blinded investigators using a caliber, a ruler and a magnifying lens.ResultsMean age was 58.9 ± 9.7 years and 67.3% were males. Prevalence of PWD and IAB was 68.2% and 57.3%, respectively. Patients with PWD showed these features: 84% in NYHA class III or IV HF, 77.4% had LVEF <35%, 78.7% had paroxysmal Atrial Fibrillation (AF) and 89.4% couldn’t complete >200 m (m) in 6MWT. Patients with PWD had more hospitalizations (72% vs 28.6%, P value <0.02) and higher 1-year mortality rate (20% vs 8.6%, P value <0.04) than patients without PWD. Likewise, patients with IAB had nearly similar clinical features, hospitalization and mortality as patients with PWD.ConclusionPWD and IAB are prevalent in patients with systolic HF and they are significantly associated with low LVEF, paroxysmal AF, poor functional capacity, hospitalization and mortality rate.

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“…Early acute myocardial ischemia and myocardial injury can result in unstable electrical activity in the heart, as well as ventricular re-polarization, which may lead to malignant arrhythmia and sudden death [1]. Myocardial ischemia is mitigated by rapid and effective recovery, but myocardial ischemia and reperfusion can aggravate heart failure caused by ischemia and myocardial cell damage, leading to intracellular calcium overload, apoptosis and inflammatory reactions [2].…”

Section: Introductionmentioning

confidence: 99%

Effect of pinocembrin pre-treatment on expressions of Cx43 protein and claudin 1 in myocardial ischemia cardiomyocytes of arrhythmic rats

Zhang¹,

Zhong²,

Hu³

et al. 2018

Trop. J. Pharm Res

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To investigate the effects of pinocembrin on ventricular rhythm and the expression of cardiomyocyte ligament junction protein (Cx43) and claudin 1 (ZO-1) in ischemia/reperfusion (I/R) rats. Methods: Ischemia/reperfusion (I/R) model rats (n = 15) were divided into 5 groups: IR group, control group, and 3 pinocembrin groups (3, 10 and 30 mg/kg). The serum levels of creatine kinase-MB isoenzyme (CK-MB) and troponin I (cTnI) were measured by enzyme-linked immunosorbent assay (ELISA). Changes in myocardial tissue were detected by H & E staining, while mRNA and protein levels of Cx43, ZO-1 and Kir2.1 were measured by reverse transcriotion-polymerase chain reaction (RT-PCR) and Western blotting, respectively. Results: In pinocembrin groups, heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) levels were significantly higher compared with IR group (p < 0.05). Moreover, the extent of arrhythmia and the levels of CK-MB and cTnI in pinocembrin groups were lower relative to IR group, while Na +-K +-ATPase and Ca 2+-Mg 2+-ATPase activities, as well as Cx43 mRNA, ZO-1 mRNA, and protein levels of Cx43, ZO-1 and Kir2.1 were significantly higher than the corresponding values for IR group (p < 0.05). Conclusion: These results suggest that pinocembrin reduces ventricular arrhythmias in I/R rats by upregulation of expressions of Cx43, ZO-1 and Kir21, and inhibition of redistribution of ZO-1 and Cx43. These findings provide the basis for the clinical application of pinocembrin in the treatment of arrhythmia.

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Profiling cardiac arrhythmia and heart failure patients in India: The Pan-arrhythmia and Heart Failure Observational Study

Abstract: The India PANARM HF study provides new information and insights into the demographic, clinical, interventional therapy, referral and consultation pattern profiles of CA/HF patients in India.

Cited by 14 publications

References 11 publications

Cardiac resynchronization therapy is associated with improvement in clinical outcomes in Indian heart failure patients: Results of a large, long-term observational study

Cardiac resynchronization therapy is associated with improvement in clinical outcomes in Indian heart failure patients: Results of a large, long-term observational study

Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization and one year mortality

Effect of pinocembrin pre-treatment on expressions of Cx43 protein and claudin 1 in myocardial ischemia cardiomyocytes of arrhythmic rats

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