Epidemiology of Acute Heart Failure in India

posted Jan 25, 2017, 10:40 PM by sourav ghosh
Sandeep Seth
All India Institute of Medical Sciences , New Delhi, India

In a study done from AIIMS (The AFAR study) , the patients were relatively young (mean age 53 years), the causes were usually ischemic cardiomyopathy or idiopathic cardiomyopathy though RHD was also a contributor. Mortality was high though patients were receiving medications as per the HF guidelines though at lower doses.
The mean age (53 years) was lower than Western cohorts (ranging from 65 to 73 years) such as EuroHeart Failure (EURO-HF) Study, the Acute Decompensated Heart Failure National Registry (ADHERE), the Organized Program to Initiate Life-Saving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), and the Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure (EVEREST). This supports the concept that cardiovascular disease affects patients in India at a younger age than their Western counterparts. Overall, the mean ejection fraction was lower (29.2%) than ADHERE (34.4%) and OPTIMIZE-HF (39%).
The patients had high rates of in-hospital mortality (30.8%), 6-month mortality (26.3%) and 6-month re-hospitalization (39.5%). Data from ADHERE, OPTIMIZE-HF, EURO-HF demonstrate an overall in-hospital mortality rate of 4-7%, 90-day (limit of follow-up) mortality rate of 5-15%. 
Inpatient medication rates were different from rates in Western literature. Intravenous inotropes were used more commonly in our inpatient cohort (75%) compared to OPTIMIZE-HF data (5.4%). In-hospital mortality of the subset of patients who received inotrope therapy and had admission systolic BP <120 mmHg was 17.9% in OPTIMIZE-HF and 44.4% in our patient cohort, reflecting the severity of disease in this subgroup. Baseline mean renal function, which typically affects the clinical decision to begin inotrope therapy, appeared lower compared to OPTIMIZE-HF. Mean serum sodium, which is another prognostic marker for HF, was also lower compared to OPTIMIZE-HF (134.8 mmol/dl compared to 136.7 mmol/dl). 
Discharge medication rates of ACE-I/ARB (71.1%) were at or above levels seen in ADHERE and OPTIMIZE-HF. Despite similar diagnostic rates and adherence to performance measures as compared to Western literature, 6-months mortality and 6-months re-hospitalization rates in the patients were 26.3% and 39.5%, respectively, which may reflect the severity of illness presentation in this cohort.
This data and similar data from some small studies from other parts of India suggest that acute heart failure is a major problem in India which needs to be tackled on an urgent basis.