Management protocols for chronic heart failure in India

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Abstract

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

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Most cited references 61

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The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.

Andrew Ambrosy, Gregg C. Fonarow, Javed Butler … (2014)

Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence-based drug and device therapies, hospitalized heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates that have not changed in the last 2 decades. In addition, the proportion of HHF patients classified as having a preserved EF continues to grow and may overtake HF with a reduced EF in the near future. However, the prognosis for HF with a preserved EF is similar and there are currently no available disease-modifying therapies. HHF registries have significantly improved our understanding of this clinical entity and remain an important source of data shaping both public policy and research efforts. The authors review global HHF registries to describe the patient characteristics, management, outcomes and their predictors, quality improvement initiatives, regional differences, and limitations of the available data. Moreover, based on the lessons learned, they also propose a roadmap for the design and conduct of future HHF registries. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Heart failure: preventing disease and death worldwide

Piotr Ponikowski, Stefan D. Anker, Khalid AlHabib … (2014)

Heart failure is a life-threatening disease and addressing it should be considered a global health priority. At present, approximately 26 million people worldwide are living with heart failure. The outlook for such patients is poor, with survival rates worse than those for bowel, breast or prostate cancer. Furthermore, heart failure places great stresses on patients, caregivers and healthcare systems. Demands on healthcare services, in particular, are predicted to increase dramatically over the next decade as patient numbers rise owing to ageing populations, detrimental lifestyle changes and improved survival of those who go on to develop heart failure as the final stage of another disease. It is time to ease the strain on healthcare systems through clear policy initiatives that prioritize heart failure prevention and champion equity of care for all. Despite the burdens that heart failure imposes on society, awareness of the disease is poor. As a result, many premature deaths occur. This is in spite of the fact that most types of heart failure are preventable and that a healthy lifestyle can reduce risk. Even after heart failure has developed, premature deaths could be prevented if people were taught to recognize the symptoms and seek immediate medical attention. Public awareness campaigns focusing on these messages have great potential to improve outcomes for patients with heart failure and ultimately to save lives. Compliance with clinical practice guidelines is also associated with improved outcomes for patients with heart failure. However, in many countries, there is considerable variation in how closely physicians follow guideline recommendations. To promote equity of care, improvements should be encouraged through the use of hospital performance measures and incentives appropriate to the locality. To this end, policies should promote the research required to establish an evidence base for performance measures that reflect improved outcomes for patients. Continuing research is essential if we are to address unmet needs in caring for patients with heart failure. New therapies are required for patients with types of heart failure for which current treatments relieve symptoms but do not address the disease. More affordable therapies are desperately needed in the economically developing world. International collaborative research focusing on the causes and treatment of heart failure worldwide has the potential to benefit tens of millions of people. Change at the policy level has the power to drive improvements in prevention and care that will save lives. It is time to make a difference across the globe by confronting the problem of heart failure.

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Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap.

Sanjiv Shah, Dalane W. Kitzman, Barry Borlaug … (2016)

Heart failure (HF) with preserved ejection fraction (EF; HFpEF) accounts for 50% of HF cases, and its prevalence relative to HF with reduced EF continues to rise. In contrast to HF with reduced EF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, an HFpEF treatment strategy is proposed that addresses HFpEF-specific signaling and phenotypic diversity. In HFpEF, extracardiac comorbidities such as metabolic risk, arterial hypertension, and renal insufficiency drive left ventricular remodeling and dysfunction through systemic inflammation and coronary microvascular endothelial dysfunction. The latter affects left ventricular diastolic dysfunction through macrophage infiltration, resulting in interstitial fibrosis, and through altered paracrine signaling to cardiomyocytes, which become hypertrophied and stiff because of low nitric oxide and cyclic guanosine monophosphate. Systemic inflammation also affects other organs such as lungs, skeletal muscle, and kidneys, leading, respectively, to pulmonary hypertension, muscle weakness, and sodium retention. Individual steps of these signaling cascades can be targeted by specific interventions: metabolic risk by caloric restriction, systemic inflammation by statins, pulmonary hypertension by phosphodiesterase 5 inhibitors, muscle weakness by exercise training, sodium retention by diuretics and monitoring devices, myocardial nitric oxide bioavailability by inorganic nitrate-nitrite, myocardial cyclic guanosine monophosphate content by neprilysin or phosphodiesterase 9 inhibition, and myocardial fibrosis by spironolactone. Because of phenotypic diversity in HFpEF, personalized therapeutic strategies are proposed, which are configured in a matrix with HFpEF presentations in the abscissa and HFpEF predispositions in the ordinate.

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Author and article information

Contributors

S. Mishra

Journal

Journal ID (nlm-ta): Indian Heart J

Journal ID (iso-abbrev): Indian Heart J

Title: Indian Heart Journal

Publisher: Elsevier

ISSN (Print): 0019-4832

Publication date (Print): Jan-Feb 2018

Publication date (Electronic): 22 November 2017

Volume: 70

Issue: 1

Pages: 105-127

Affiliations

[a ]Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India

[b ]Department of Cardiology, Fortis Hospital, Shalimar Bagh, New Delhi, 110088, India

[c ]Department of Cardiology, PRS Hospital, Thiruvananthapuram, 695002, India

[d ]Department of Clinical and Preventive Cardiology, Medanta − The Medicity, Gurugram, Haryana, 122001, India

[e ]Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India

[f ]Department of Cardiology, Medical College, Kolkata, 700073, India

[g ]Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, 70026, India

[h ]Department of Cardiology, King George's Medical University, Ludhiana, Uttar Pradesh, 226003, India

[i ]Heart Failure Subspecialty, Cardiological Society of India, Kolkata, India

[j ]Department of Cardiology, Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, 700020, India

[k ]Department of Cardiology, Ruby Hall Clinic, Pune, 411001, India

[l ]Cardiological Society of India, Kolkata, India

Author notes

[* ]Corresponding author at: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India. sundeepmishraihj@ 123456gmail.com

Article

Publisher ID: S0019-4832(17)30943-4

DOI: 10.1016/j.ihj.2017.11.015

PMC ID: 5903070

PubMed ID: 29455764

SO-VID: d6059f25-bced-494d-8b67-3beaa1fa1063

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Management protocols for chronic heart failure in India

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Abstract

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JMIR: Research Protocols

Most cited references 61

The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.

Heart failure: preventing disease and death worldwide

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap.

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