One in seven Indian patients with acute decompensated heart failure (ADHF) died within 3 months of hospital admission, reported a study by Harikrishnan et al., published in the journal European Society of Cardiology (ESC) Heart Failure.
The study was conducted among 10,851 patients with ADHF (mean age: 59.9 years) from the largest heart failure (HF) registry in India, the National Heart Failure Registry (NHFR). The NHFR registry comprises 53 tertiary care hospitals across 21 states and 4 union territories in India. All patients were followed up for at least 3 months after admission to the hospital.
Of the patients enrolled in the study, 74.4% patients were hospitalized for newly diagnosed ADHF and remaining 25.6% were readmitted for ADHF. Over the 3-month follow-up period, 47.5% of the eligible patients received guideline-directed medical therapy (GDMT) and the mortality rate was 14.2%. Higher mortality rate was reported among patients with HF with reduced ejection fraction (HFrEF) and HF with mildly reduced ejection fraction (HFmrEF) who were not administered GDMT compared to those treated with GDMT.
The predictors of 90-day mortality in the study were baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, edema, levels of serum creatinine, serum sodium, and hemoglobin, QRS duration >120 ms, atrial fibrillation, mitral regurgitation, and GDMT utilization. The study results are summarized in the Figure.
Clinical implication: The prescription rate of GDMT was ~1 in 2 patients in this study. As GDMT was found to significantly reduce the mortality in patients with HFrEF and HFmrEF, innovative methods to improve the uptake of GDMT is necessary in Indian patients with HF.
(Reference: Harikrishnan S, Bahl A, Roy A, et al; NHFR investigators. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail. 2022. Doi: 10.1002/ehf2.14096)