ICC - National Heart Failure Registry

The Current Situation

Previous studies and what they reveal about status of heart failure in India:

  • Hospital-based studies from Trivandrum and All India Institute of Medical Sciences (AIIMS) suggest that rheumatic heart disease (RHD) and coronary artery disease (CAD) are both major causes of heart failure in India.
  • The Trivandrum HF registry (THFR)1 enrolled 1205 admissions for HF (834 men, 69%). The mean age was 61.2 years. The most common etiology of HF was ischemic heart disease (72%). HF with preserved ejection fraction (HFpEF) constituted 26%. Patients with HF in the Trivandrum HF registry were younger, and had a higher prevalence of CAD.
  • In another study from AIIMS, adults of six villages in Northern India were screened, and cases of dyspnea were identified by trained health workers. Of 10,163 cases screened, the prevalence of HF in this rural community was estimated to be 1.2/1000. Two-thirds of the patients had HFpEF and all of them had uncontrolled hypertension (HTN).2
  • In another study of 1985 patients from North India the mean age was 49.2 years3. The mean age in THFR was 61.2 years, meaning that this population from North India is much younger, compared to South Indian patients and still younger than patients of Western India. In the in-hospital group, RHD (52%) was the most common cause followed by ischemic heart disease (17%). RHD (37.1%) was the most common etiology followed by CAD (33.4%) in a tertiary hospital cohort3. One reason for the higher rates of RHD could be due to the referral bias of patients from the low socioeconomic sector to public sector hospitals where the study was conducted.
  • Since Indian patients with HF are different and respond differently to therapy, it is necessary to create guidelines in HF therapy which are specific to Indian patients. An exercise was carried out wherein experts from AIIMS, RML, SJH, GB Pant, PGI Chandigarh and Care Hospitals got together to create a consensus statement on the management on HF in India along with members of European Society of Cardiology (ESC).4
  • Data available from global studies conducted in higher income countries, including Global Congestive Heart Failure Registry (G-CHF) and Inter CHF Registry, confirm the high mortality in India.
  • Recently published data shows a high prevalence of diabetes and hypertension in India (7.5% & 25.3%) respectively5. Dyslipidemia is on the rise (79%) as evident from the ICMR- INDIAB study6. Coronary Heart Disease (CHD) prevalence in India has increased and estimated to be around 30 million. Hence, heart failure would be a major reason for morbidity and mortality. Thus this increased burden at a young age leads to loss of productivity and is a barrier for economic growth.

Heart failure facts in India:

  • Heart failure is the commonest cardiac cause for hospitalization with 1% of the general population being affected annually, which adds up to between 8–10 million patients. The 1% average in the general population looks different when only the 65-79 age group is considered where heart failure related hospitalization is 5-10%. In elderly above 80 years of age such hospitalization is even higher at 10-20%.
  • First time heart attack related mortality is 15-20% nationally in India (120,000 to 200,000 deaths) as opposed to 4-5% in the developed counties.
  • Heart failure is also the commonest cause for rehospitalisation in elderly (above 80) after hospital discharge.
  • While the average life expectancy has increased over the past decade, it has not kept pace with the progress made in several developed countries.
  • Patients with HF in India are younger, sicker and have a much higher morbidity and mortality
  • Heart failure patients are unable to tolerate the high level of medications recommended per western guidelines. Devices and other advanced therapies commonly used in the developed countries are priced out of range many of the India Based heart failure patients.