Sivadasanpillai Harikrishnan1, Panniyammakal Jeemon2, Sanjay Ganapathi3, Anubha Agarwal4, Sunitha Viswanathan5, Madhu Sreedharan6, Govindan Vijayaraghavan7, Charantharayil G Bahuleyan8, Ramabhadran Biju9, Tiny Nair10, N Pratapkumar11, K Krishnakumar12, N Rajalekshmi13, Krishnan Suresh14, Mark D Huffman15. 1. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. Electronic address: drharikrishnan@gmail.com. 2. Achuthamenon Center, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. 3. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. 4. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5. Medical College Hospital, Trivandrum, Kerala, India. 6. NIMS Hospital, Neyyattinkara, Trivandrum, Kerala, India. 7. Kerala Institute of Medical Sciences, Trivandrum, Kerala, India. 8. Ananthapuri Hospital, Trivandrum, Kerala, India. 9. Cosmopolitan Hospital, Trivandrum, Kerala, India. 10. PRS Hospital, Trivandrum, Kerala, India. 11. Meditrina Hospital, Trivandrum, Kerala, India. 12. Govindan Hospital, Trivandrum, Kerala, India. 13. SUT Hospital, Trivandrum, Kerala, India. 14. SK Hospital, Trivandrum, Kerala, India. 15. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; The George Institute for Global Health, University of New South Wales, Sydney, Australia.
Abstract
INTRODUCTION: Heart failure (HF) has emerged as an important and increasing disease burden in India. We present the 5-year outcomes of patients hospitalized for HF in India. METHODS: The Trivandrum Heart Failure Registry (THFR) recruited consecutive patients admitted for acute HF among 16 hospitals in Trivandrum, Kerala in 2013. Guideline-directed medical therapy (GDMT) was defined as the combination of beta-blockers (BB), renin angiotensin system blockers (RAS), and mineralocorticoid receptor antagonists (MRA) in patients with HF with reduced ejection fraction (HFrEF, EF < 40%) at discharge. We used Cox proportional hazards models and Kaplan-Meier survival plots for analysis. The MAGGIC risk score variables were included as exposure variables. RESULTS: Among 1205 patients [69% male, mean (SD) age = 61.2 (13.7) years], HFrEF constituted 62% of patients and among them, 25% received GDMT. The 5-year mortality rate was 59% (n = 709 deaths), and median survival was 3.1 years. Sudden cardiac death and pump failure caused 46% and 49% of the deaths, respectively. In the multivariate Cox model, components of GDMT associated with lower 5-year mortality risks were discharge prescription of BB, RAS blocker, and MRA. Older age, lower systolic blood pressure, NYHA class III or IV, and higher serum creatinine were also associated with higher 5-year mortality. CONCLUSIONS: Three out of every 5 patients had died during 5-years of follow-up with a median survival of approximately 3 years. Lack of GDMT in patients with HFrEF and frequent readmissions were associated with higher 5-year mortality. Quality improvement programmes with strategies to improve adherence to GDMT and reduction in readmissions may improve HF outcomes in this region.
INTRODUCTION:Heart failure (HF) has emerged as an important and increasing disease burden in India. We present the 5-year outcomes of patients hospitalized for HF in India. METHODS: The Trivandrum Heart Failure Registry (THFR) recruited consecutive patients admitted for acute HF among 16 hospitals in Trivandrum, Kerala in 2013. Guideline-directed medical therapy (GDMT) was defined as the combination of beta-blockers (BB), renin angiotensin system blockers (RAS), and mineralocorticoid receptor antagonists (MRA) in patients with HF with reduced ejection fraction (HFrEF, EF < 40%) at discharge. We used Cox proportional hazards models and Kaplan-Meier survival plots for analysis. The MAGGIC risk score variables were included as exposure variables. RESULTS: Among 1205 patients [69% male, mean (SD) age = 61.2 (13.7) years], HFrEF constituted 62% of patients and among them, 25% received GDMT. The 5-year mortality rate was 59% (n = 709 deaths), and median survival was 3.1 years. Sudden cardiac death and pump failure caused 46% and 49% of the deaths, respectively. In the multivariate Cox model, components of GDMT associated with lower 5-year mortality risks were discharge prescription of BB, RAS blocker, and MRA. Older age, lower systolic blood pressure, NYHA class III or IV, and higher serum creatinine were also associated with higher 5-year mortality. CONCLUSIONS: Three out of every 5 patients had died during 5-years of follow-up with a median survival of approximately 3 years. Lack of GDMT in patients with HFrEF and frequent readmissions were associated with higher 5-year mortality. Quality improvement programmes with strategies to improve adherence to GDMT and reduction in readmissions may improve HF outcomes in this region.
Authors: Nilay S Shah; Anubha Agarwal; Mark D Huffman; Deepak K Gupta; Clyde W Yancy; Sanjiv J Shah; Alka M Kanaya; Hongyan Ning; Donald M Lloyd-Jones; Namratha R Kandula; Sadiya S Khan Journal: J Card Fail Date: 2021-05-25 Impact factor: 5.712