The first data set from the National Heart Failure Registry (NHFR), a multi-centre clinical registry of acute decompensated heart failure (HF) patients from across 21 States, has reported an all-cause mortality rate of 14.2% at 90 days
Ischaemic heart disease or coronary artery disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). The data showed that while guideline-directed medical therapies (GDMT) improved the survival of HF patients, only 47.5% of the eligible patients received this care.
In short, one of seven HF patients in the registry died during the first 90 days of follow-up. Only one of two patients received GDMT.
While heart failure seemed to affect both the affluent as well as the poor equally, what was striking from the NHFR data was the clear inverse relationship between educational level and mortality, with 90-day mortality being the highest in individuals with low educational status .
The study, funded by Indian Council for Medical Research and coordinated by the Sree Chitra Tirunal Institute for Medical Sciences (SCTIMST), Thiruvananthapuram, had looked at a cohort of 10,851 relatively young patients with a mean age of 60 years from the National Heart Failure Registry, spread across 53 tertiary care centres across 21 States. Women patients constituted 31% of the patients
“The 90 -day mortality among HF patients from the first ever heart failure registry in the country, the Trivandrum HF Registry at SCTIMST, in 2013, had been 18%. The slight reduction in mortality by 4% in the current study indicates increased awareness amongst doctors, availability of new drugs and better uptake of recommended medical therapies over the past six years. Innovative quality improvement initiatives to improve heart failure treatment can result in better survival of HF patients,” S. Harikrishnan, Principal investigator of the study and Professor of Cardiology, SCTIMST, said.
“While guideline-directed therapies can improve survival, much more needs to be done to improve the access to and affordability of these treatment options. As the study indicated, poor education and low socio economic status adversely impacts treatment access and affordability, leading to increased mortality. NHFR data shows a higher mortality in women (14.9%) than in men (13.9%), especially in the group who did not receive recommended medications, and it is a cause for concern,” Dr. Harikrishnan added.
Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood. A complex, clinical syndrome, it is disabling and associated with high morbidity and mortality. Even in high-income settings as in the US, one million adults are hospitalised annually, with a one-year mortality of 23.6% among the hospitalised.
Though there were previous three major HF registries from India, the geographic representation of patients was inadequate. The NHFR bridges this crucial gap, with the participation of 53 major hospitals from 21 States and four Union Territories.
