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Long-term (10-year) outcomes of patients admitted with decompensated heart failure in a tertiary care centre in India.

Session Acute heart failure: how to improve survival

Speaker Sivadasanpillai Harikrishnan

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Rapid Fire Abstracts

Authors : S Harikrishnan (Trivandrum,IN), G Sanjay (Trivandrum,IN), P Jeemon (Trivandrum,IN)

Authors:
S Harikrishnan1 , G Sanjay1 , P Jeemon1 , 1Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Cardiology - Trivandrum - India ,

Topic(s):
Acute Heart Failure – Epidemiology, Prognosis, Outcome

Introduction: Heart failure (HF) is emerging as a leading cause of hospitalization in India. There is paucity of long term outcomes of HF from India.

Objective: To assess the long-term outcome of patients admitted with acute decompensated HF(ADHF) at a tertiary care hospital in Kerala, India. 

Methods: The data of consecutive patients from the state of Kerala who were admitted during 2001-2010 with a diagnosis of HF (satisfying European Society of Cardiology Criteria) at SCTIMST were retrospectively collected. Follow-up data were obtained until June 2017 and the follow-up was right censored at ten years.  

Results:  The data of 1502 patients were collected (mean age:51.1 years (SD=14.3); females: 37.7%). Diabetes and hypertension was prevalent in 27.4% and 28.6% of participants at baseline, respectively. The most common etiology was ischemic heart disease (36%) followed by rheumatic heart disease (RHD) (34%), Others were non-RHD valve disease (8.2%), dilated cardiomyopathy (4.8%), other cardiomyopathies (6.4%; restrictive, hypertrophic and endomyocardial fibrosis) and grown-up congenital heart disease (4.8%). One third (33%) of patients were in atrial fibrillation or atrial flutter(AF). When the patients were classified based on ejection fraction (EF), HFpEF (57.9%) was the commonest condition followed by HFrEF (26.8%) and HFmrEF (15.3%) (p-preserved, r-reduced, mr-mid-range). We got the follow-up data in 92% of the patients at June 2017.

The total time at risk was 6248 person-years. Almost three fourths of the patients (n=1051; 72.24%, 95% CI 0.70-0.74) died during the follow-up. The median survival time was 3.7 years and the death rate was 16.8 per 100 person years of follow-up (95% CI: 15.8 to 17.8). One of six patients with HFrEF received guideline directed therapy - GDT (combination of ACE inhibitor/ARB and beta-blocker). Those who received guideline directed therapy reported better cumulative survival rate in both HFrEF and HFmrEF groups (Figure). The survival benefit was however well established in the first three months of follow-up itself.
Conclusions: Compared to data from the west, HF patients in Kerala are relatively younger and predominantly males. Although RHD is a major contributor to HF in this region, ischemic heart disease is the most prevalent etiological condition. Median survival time of 3.7 years is comparatively lower than the Western data. Importantly, guideline directed therapy reduced the mortality in both HFrEF and HFmrEF. Additionally, HF patients with preserved ejection fraction (HFpEF) reported the lowest mortality. This is the first study from India showing long term outcomes of ADHF.

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