Heart Failure Etiologies, Management and Short-term Outcomes in Hospitalized and Clinic -Based Patients in India

Heart failure epidemiology has been very poorly studied in India.There are only limited studies that have evaluated etiologies and outcomes. The aim of this study was to determine etiologies and management of heart failure in hospital and clinic -based patients. Methodology: Successive patients presenting to a tertiary care hospital with acute decompensated heart failure (ADHF, n=102) and stable heart failure (SHF, n=179) were enrolled. Etiology of heart failure was diagnosed using clinical examination and echocardiography. Both the groups were followed for 90 days. Descriptive statistics are presented. Results: Etiologies of heart failure in ADHF v/s SHF patients, respectively, was coronary heart disease 50.0 v/s 53.6%, hypertension 27.4 v/s 15.1%, dilated cardiomyopathy 16.7 v/s 7.3%, rheumatic heart disease 4.9 v/s 14.0%, and hypertrophic cardiomyopathy 1.0 v/s 7.3%. Heart failure with normal ejection fraction was in 23 ADHF (22.5%) and 2 SHF (1.1%) patients. In -hospital treatments included diuretics, nitrates, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA), digoxin, anticoagulants, vasodilators and vasopressors. In -hospital mortality in ADHF was 10.3% (n=11). At discharge significantly greater numbers of patients with ADHF v/s SHF were on loop -diuretics (95.5 v/s 78.2%), antiplatelets (74.4 v/s 64.2%) and antiarrhythmics/ivabradine (23.3 v/s 6.1%) while lesser were on thiazides (1.5 v/s 9.5%), MRA (33.4 v/s 43.0%), ACEI/ARB (34.5 v/s 76.0%) and beta-blockers (33.4 v/s 45.8%) (p<0.05). 90 -day mortality in ADHF was 26.7% (n=24) and in SHF 6.7% (n=7) (p<0.01). Conclusions: Coronary and hypertensive heart diseases are important causes of heart failure at a tertiary -care hospital in India. Rheumatic heart disease and primary cardiomyopathies are also present in significant proportion. In ADHF patients there is low use of evidence -based therapies (ACEI/ARBs, beta-blockers) and short-term mortality is high. INTRODUCTION Heart failure is an emerging clinical and public health problem in India and many other low and lower -middle income countries.' Global Burden of Diseases Study (2010) reported that heart failure leads to more than 300,000 deaths annually.2 Majority of these deaths occur in high -income countries where the prevalence of this condition is increasing.' This is due to a combination of population aging, better management of heart failure risk factors such as hypertension and better management of acute coronary events. In lowand lower -middle income countries decline in incidence of rheumatic fever and nutritional and infective causes of cardiomyopathies has led to greater proportion of heart failure with ischemic heart disease and hypertension.1'4 Heart failure is classified as heart failure with reduced ejection fraction (HFrEF) and with normal or preserved ejection fraction (HFnEF).5 Although there is a significant overlap in etiologies of these two conditions, the latter is characterized by greater frequency of acute presentation and inferior outcomes.' Minnesota Heart Study reported that while long-term mortality from HFrEF declined over a 20 year period from 1980 to 2000, that from HFnEF did not.6 Heart failure has also been classified as acute