ESC Heart Failure (Apr 2020)

Early and long‐term outcomes of decompensated heart failure patients in a tertiary‐care centre in India

  • Sanjay Ganapathi,
  • Panniyammakal Jeemon,
  • Rajasekharan Krishnasankar,
  • Rajamoni Kochumoni,
  • Purushothaman Vineeth,
  • Krishna Kumar Mohanan Nair,
  • Ajit Kumar Valaparambil,
  • Sivadasanpillai Harikrishnan

DOI
https://doi.org/10.1002/ehf2.12600
Journal volume & issue
Vol. 7, no. 2
pp. 467 – 473

Abstract

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Abstract Aim Long‐term outcome data of acute decompensated heart failure (HF) are scarce from India. The aim of the study was to collect in‐hospital and long‐term outcome data of HF patients admitted during 2001–2010 in a tertiary‐care centre in South India. Methods and results Consecutive patients admitted with first episode of decompensated HF were part of the registry. Data regarding diagnosis, risk factors, treatment, early (in‐hospital), and late (5 and 10year) mortality outcomes were captured. During this period, 1502 patients were admitted with first episode of decompensated HF [37.7% of women, mean age of 51.1 (SD = 14.3) years]. Common causes were ischaemic heart disease (36.2%), rheumatic heart disease (34.3%), and cardiomyopathies (9.9%). HF with reduced ejection fraction (HFrEF) was present in 26.9% of patients, and 33.8% had atrial arrhythmias. Diabetes, hypertension, and renal dysfunction were prevalent in 27.4%, 28.6%, and 37.4%, respectively. Median duration of hospitalization was 6 days (interquartile range: 3–10), and 247 patients (16.4%) died during index admission. The total time at risk was 6248 person years, and 1051 patients died during the study period with a median survival time of 3.7 years. Overall mortality rate was 16.8 per 100 person years (95% CI: 15.8–17.9 per 100 person years). Older age [hazard ratio (HR) = 1.08, 95% CI: 1.02–1.14, P = 0.007], anaemia (HR = 1.34, 95% CI: 1.08–1.65, P = 0.007), renal dysfunction (HR = 1.38, 95% CI: 1.20–1.59, P < 0.001), HFpEF (HR = 0.61, 95% CI: 0.52–0.73, P < 0.001 against HFrEF), and the use of guideline‐directed therapies (GDT; beta blockers: HR = 0.57, 95% CI: 0.49–0.66, P < 0.0001; and angiotensin converting enzyme inhibitor/angiotensin receptor blocker: HR = 0.59, 95% CI: 0.51–0.69, P < 0.001) were important predictors of mortality. Patients with HF and mid‐range EF also benefited from GDT. Conclusion In our cohort, ischaemic and rheumatic heart diseases were the leading contributors for HF. Anaemia, renal dysfunction, poor ejection fraction, and suboptimal prescriptions of GDT were the main predictors of long‐term mortality. Both patients with HFrEF and mid‐range EF benefited from GDT.

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