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Review
. 2024 Jun;13(2):243-266.
doi: 10.1007/s40119-024-00367-4. Epub 2024 Apr 30.

Management of Heart Failure in a Resource-Limited Setting: Expert Opinion from India

Peeyush Jain  1 , Santanu Guha  2 , Soumitra Kumar  3 , J P S Sawhney  4 , Kamal Sharma  5 , K P Sureshkumar  6 , Ashwani Mehta  7 , Rajnish Dhediya  8 , Kumar Gaurav  9 , Rajan Mittal  9 , Bhavesh Kotak  9
Affiliations
Review

Management of Heart Failure in a Resource-Limited Setting: Expert Opinion from India

Peeyush Jain et al. Cardiol Ther. 2024 Jun.

Abstract

Heart failure poses a global health challenge affecting millions of individuals, and access to guideline-directed medical therapy is often limited. This limitation is frequently attributed to factors such as drug availability, slow adoption, clinical inertia, and delayed diagnosis. Despite international recommendations promoting the use of guideline-directed medical therapy for heart failure management, personalized approaches are essential in settings with resource constraints. In India, crucial treatments like angiotensin II receptor blocker neprilysin inhibitors and sodium-glucose co-transporter 2 inhibitors are not fully utilized despite their established safety and efficacy. To address this issue, an expert consensus involving 150 specialists, including cardiologists, nephrologists, and endocrinologists, was convened. They deliberated on patient profiles, monitoring, and adverse side effects and provided tailored recommendations for guideline-directed medical therapy in heart failure management. Stressing the significance of early initiation of guideline-directed medical therapy in patients with heart failure, especially with sodium-glucose co-transporter 2 inhibitors, the consensus also explored innovative therapies like vericiguat. To improve heart failure outcomes in resource-limited settings, the experts proposed several measures, including enhanced patient education, cardiac rehabilitation, improved drug access, and reforms in healthcare policies.

Keywords: Guideline-directed medical therapy; Heart failure; Sodium-glucose co-transporter 2 inhibitors.

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Conflict of interest statement

Rajnish Dhediya, Kumar Gaurav, Rajan Mittal, and Bhavesh Kotak are the employees of Dr. Reddy's laboratories. Peeyush Jain, Santanu Guha, Soumitra Kumar, J P S Sawhney, Kamal Sharma, K P Sureshkumar, and Ashwani Mehta have declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Diagnostic approach for heart failure. HFpEF heart failure with preserved ejection fraction, LVEF left ventricular ejection fraction, HFrEF heart failure with reserved ejection fraction, HF heart failure, CBC complete blood count, NT pro-BNP N-terminal pro hormone of brain natriuretic peptide, HFmrEF heart failure with mid-range ejection fraction, BNP brain natriuretic peptide
Fig. 2
Fig. 2
GDMT dose titration in management of heart failure. ARNI angiotensin receptor neprilysin inhibitor, ACEI angiotensin-converting enzyme inhibitor, MRAs mineralocorticoid receptor antagonists, DAPA dapagliflozin, EMPA empagliflozin, GDMT guideline-directed medical therapy
Fig. 3
Fig. 3
Optimal treatment strategy of patients with heart failure combined with diabetes mellitus. HbA1c glycated hemoglobin, SGLT2i sodium/glucose co-transporter-2 inhibitors
See this image and copyright information in PMC

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