RUHS Journal of Health Sciences (Sep 2023)

Heart Failure Etiologies, Management and Short-term Outcomes in Hospitalized and Clinic-Based Patients in India

  • Rajeev Gupta, Vaibhav Grover, Krishna Kumar Sharma, Bhawani S Mishra, Sanjeeb Roy, Ajeet Bana

DOI
https://doi.org/10.37821/ruhsjhs.3.1.2018.5-10

Abstract

Read online

Introduction: Heart failure epidemiology has been very poorly studied in India. There are only limited studies that have evaluated etiologies and outcomes. The aim of this study was to determine etiologies and management of heart failure in hospital and clinic-based patients. Methodology: Successive patients presenting to a tertiary care hospital with acute decompensated heart failure (ADHF, n=102) and stable heart failure (SHF, n=179) were enrolled. Etiology of heart failure was diagnosed using clinical examination and echocardiography. Both the groups were followed for 90 days. Descriptive statistics are presented. Results: Etiologies of heart failure in ADHF vs SHF patients, respectively, was coronary heart disease 50.0 v/s 53.6%, hypertension 27.4 v/s 15.1%, dilated cardiomyopathy 16.7 v/s 7.3%, rheumatic heart disease 4.9 v/s 14.0%, and hypertrophic cardiomyopathy 1.0 v/s 7.3%. Heart failure with normal ejection fraction was in 23 ADHF (22.5%) and 2 SHF (1.1%) patients. In-hospital treatments included diuretics, nitrates, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA), digoxin, anticoagulants, vasodilators and vasopressors. In-hospital mortality in ADHF was 10.3% (n=11). At discharge significantly greater numbers of patients with ADHF v/s SHF were on loop-diuretics (95.5 v/s 78.2%), antiplatelets (74.4 v/s 64.2%) and antiarrhythmics/ivabradine (23.3 v/s 6.1%) while lesser were on thiazides (1.5 v/s 9.5%), MRA (33.4 v/s 43.0%), ACEFARB (34.5 v/s 76.0%) and beta-blockers (33.4 v/s 45.8%) (p<0.05). 90-day mortality in ADHF was 26.7% (n=24) and in SHF 6.7% (n=7) (p<0.01). Conclusions: Coronary and hypertensive heart diseases are important causes of heart failure at a tertiary-care hospital in India. Rheumatic heart disease and primary cardiomyopathies are also present in significant proportion. In ADHF patients there is low use of evidence-based therapies (ACEI/ARBs, beta-blockers)

Keywords