TY - JOUR
T1 - Five-year mortality and readmission rates in patients with heart failure in India
T2 - Results from the Trivandrum heart failure registry
AU - Harikrishnan, Sivadasanpillai
AU - Jeemon, Panniyammakal
AU - Ganapathi, Sanjay
AU - Agarwal, Anubha
AU - Viswanathan, Sunitha
AU - Sreedharan, Madhu
AU - Vijayaraghavan, Govindan
AU - Bahuleyan, Charantharayil G.
AU - Biju, Ramabhadran
AU - Nair, Tiny
AU - Pratapkumar, N.
AU - Krishnakumar, K.
AU - Rajalekshmi, N.
AU - Suresh, Krishnan
AU - Huffman, Mark D.
N1 - Funding Information:
We thank Indian Council of Medical Research (ICMR) , India (Project No. 5/4/1-11/11-NCD-II - Comprehensive heart failure intervention program) and Indian Council of Medical Research (ICMR), India - Trivandrum Heart Failure Cohort . File number 50/1(5) / TF CVD / 16 / NCD-II for funding this study.
Funding Information:
SH has received project funds from ICMR for Trivandrum HF Cohort, National HF registry and CARE HF (2019–2023). PJ is supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015–2020). MDH has received previous support from the World Heart Federation via Boehringer Ingelheim, Bupa, and Novartis and the American Heart Association, Verily, and AstraZeneca for work unrelated to this research. MDH has received salary support from the American Medical Association for his role as an associate editor for JAMA Cardiology. The George Institute for Global Health has a patent, license, and has received investment funding with intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines, but MDH is not directly involved with this research.
Funding Information:
All study participants provided written informed consent. The study was approved by the Institutional Review Board of Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (SCT/IEC/477/December-2012) and was funded by the Indian Council of Medical Research.
Publisher Copyright:
© 2020
PY - 2021/3/1
Y1 - 2021/3/1
N2 - 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.
AB - 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.
KW - Cohort
KW - Heart failure
KW - India
KW - Long term
KW - Mortality
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=85096952603&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2020.10.012
DO - 10.1016/j.ijcard.2020.10.012
M3 - Article
C2 - 33049297
AN - SCOPUS:85096952603
SN - 0167-5273
VL - 326
SP - 139
EP - 143
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -