In-Hospital and Three-Year Outcomes of Heart Failure Patients in South India: The Trivandrum Heart Failure Registry

Abstract

Background: Long-term data on outcomes of participants hospitalized with heart failure (HF) from low- and middle-income countries are limited.

Methods and results: In the Trivandrum Heart Failure Registry (THFR) in 2013, 1205 participants from 18 hospitals in Trivandrum, India, were enrolled. Data were collected on demographics, clinical presentation, treatment, and outcomes. We performed survival analyses, compared groups and evaluated the association between heart failure (HF) type and mortality, adjusting for covariates that predicted mortality in a global HF risk score. The mean (standard deviation) age of participants was 61.2 (13.7) years. Ischemic heart disease was the most common cause (72%). The in-hospital mortality rate was higher for participants with HF with reduced ejection fraction (HFrEF; 9.7%) compared with those with HF with preserved ejection fraction (HFpEF; 4.8%; P = .003). After 3 years, 540 (44.8%) participants had died. The all-cause mortality rate was lower for participants with HFpEF (40.8%) compared with HFrEF (46.2%; P = .049). In multivariable models, older age (hazard ratio [HR] 1.24 per decade, 95% confidence interval [CI] 1.15-1.33), New York Heart Association functional class IV symptoms (HR 2.80, 95% CI 1.43-5.48), and higher serum creatinine (HR 1.12 per mg/dL, 95% CI 1.04-1.22) were associated with all-cause mortality.

Conclusions: Participants with HF in the THFR have high 3-year all-cause mortality. Targeted hospital-based quality improvement initiatives are needed to improve survival during and after hospitalization for HF.

Keywords: Heart failure; India; registry.

Fig. 1.

Heart failure type and long-term mortality rates in the Trivandrum Heart Failure Registry. HFrEF, heart failure with reduced ejection fraction (<45%); HFpEF, heart failure with preserved ejection fraction (≥45%).

Fig. 2.

Long-term readmission and mortality rates in the Trivandrum Heart Failure Registry (landmark survival analysis).

Fig. 3.

Heart failure type and long-term readmission and mortality rates in the Trivandrum Heart Failure Registry (landmark survival analysis). HFrEF, heart failure with reduced ejection fraction (<45%); HFpEF, heart failure with preserved ejection fraction (≥45%).

Fig. 4.

Heart failure type, guideline-directed medical therapy (GDM) and long-term mortality rates in the Trivandrum Heart Failure Registry. HFrEF, heart failure with reduced ejection fraction (<45%); HFpEF, heart failure with preserved ejection fraction (≥45%).