Demographics and clinical characteristics of Indian patients with heart failure visiting outpatient clinics: a cross-sectional observational study

Data on heart failure (HF) phenotypes in India remain limited. We examined clinical characteristics and factors associated with HF phenotype defined according to ejection fraction (EF) in a large multicentre outpatient cohort.

We performed a retrospective cross-sectional analysis of adult HF outpatients with documented EF at centres across India (April 2021–March 2023). Patients were classified as HFrEF (EF ≤40%), HFmrEF (41%–49%), or HFpEF (≥50%); multivariable logistic regression identified factors associated with phenotype.

Among 1207 patients (62 ± 10 years; 73% male), HFrEF was present in 822 (68.1%), HFmrEF in 89 (7.4%), and HFpEF in 296 (24.5%). Patients with HFpEF had higher systolic blood pressure (153 ± 26 vs 122 ± 25 mmHg), higher body mass index (BMI; 27.5 ± 4.9 vs 26.4 ± 4.4 kg/m²), and more chronic kidney disease (45% vs 23%) and stroke (27% vs 6.2%) than those with HFrEF (all P ≤ .003). Ischaemic heart disease (66% vs 56%; P = .002) and higher NT-proBNP [median 3705 (481–6232) vs 140 (121–521) pg/ml; P < .001) were more common in HFrEF. In multivariable analysis, higher BMI [odds ratio (OR) 1.35 per 5 kg/m², 95% confidence interval (CI) 1.10–1.65], higher systolic blood pressure (OR 1.48 per 10 mmHg, 95% CI 1.37–1.60), and stroke (OR 1.99, 95% CI 1.11–3.54) were associated with higher odds of HFpEF, whereas higher NT-proBNP (OR 0.46, 95% CI 0.40–0.53) and diabetes (OR 0.56, 95% CI 0.38–0.83) were associated with lower odds of HFpEF.

Higher BMI and blood pressure were associated with HFpEF, whereas elevated NT-proBNP and diabetes were associated with HFrEF. These cross-sectional associations may support phenotype-specific management of HF.