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. 2022 Dec;9(6):3898-3908.
doi: 10.1002/ehf2.14096. Epub 2022 Aug 10.

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

Sivadasanpillai Harikrishnan  1 , Ajay Bahl  2 , Ambuj Roy  3 , Animesh Mishra  4 , Jayesh Prajapati  5 , C N Manjunath  6 , Rishi Sethi  7 , Santanu Guha  8 , Santhosh Satheesh  9 , R S Dhaliwal  10 , Meenakshi Sarma  10 , Sanjay Ganapathy  1 , Panniyammakal Jeemon  11 ; NHFR investigators
Collaborators, Affiliations

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

Sivadasanpillai Harikrishnan et al. ESC Heart Fail. 2022 Dec.

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 results: The 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.

Keywords: Guideline-directed medical therapy; Heart failure; India; Mortality; National Heart Failure Registry.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Intake of key drugs in men and women.ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; BB, beta‐blocker; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonists.
Figure 2
Figure 2
Guideline‐directed medical therapy, heart failure groups and 90 day survival.GDMT, guideline‐directed medical therapy; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 3
Figure 3
Educational status and mortality.(A) Crude mortality rate. (B) After adjustment for all variables as in the multi‐variable Cox proportional hazard model. CI, confidence interval.
See this image and copyright information in PMC

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