Is Heart Failure a public health priority in India?

Dr. K. Sarat Chandra, Consultant Cardiologist, Indo US Superspeciality Hospital, President – CSI speaks to IndiaMedToday about the status of Heart Failure management in India

• What are the significant advances in the management of heart failure? Like other areas of cardiology, heart failure also has seen great strides in management. We have a number of evidence based medications like ace inhibitors/arbs, betablockers, aldosterone antagonists and lately ARNI therapy which have  shown further reduction of mortality in heart failure patients. We have today devices like CRT which can improve the ejection fraction and outcomes in patients with left bundle branch block. The patients can also go for a LV assist device if they choose it. Of course we have cardiac transplantation for the relatively younger patients with severe symptoms. All these management and interventions are available in India.
• Pls could you tell us about burden of heart failure?

The burden of heart failure is huge with 26 million people all over the world suffering from heart failure.

• Pls could you tell us about the reason for the rising prevalence of HF in India?

Heart failure is a disease of advancing age. Like the rest of the world India also is witnessing a longer lifespan of its population. Incidentally, diabetes mellitus, hypertension and coronary artery disease are increasing in incidence and prevalence. Additionally, with established therapies like thrombolytic therapy and primary angioplasty more and more patients survive the initial heart attack; but the flip side is that there are more patients who have partially damaged hearts. It is no wonder then that for all these multiple reasons we see more patients of heart failure now-a-days than ever before.

• Is there a difference between the presentations of the disease in the Indian population as compared to the Caucasian population?

The reasons for heart failure seem to be nearly similar in India and west with coronary artery disease being the dominant cause. Rheumatic heart disease obviously makes a significant contribution in India. Further, it is observed that Indian patients are 10 years younger than their western counterparts. In fact, what is striking in India is the much worse outcomes during initial hospital admission and during follow-ups. In the International Congestive Heart Failure (INTER-CHF) prospective cohort study that compared outcomes between different countries Indian patients’ outcomes were behind only African patients. The mortality in the Indian patients was 23 percent at 1 year, which is really high.

•  What is the importance of a Heart Failure Registry? Does this exist in India?

Yes it is very important to have registries for any disease with high morbidity and mortality like heart failure. It tells us what is the ground reality like what is the impact of modern therapies and whether we are doing everything we are supposed to do for all our patients and so on. We have two such registries in India one is the Trivandrum Heart Failure registry by Dr. S. Harikrishnan, Additional Professor, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum and another is part of an international registry called International Heart Failure registry (Inter-HF), the Indian part was led by Dr Ambuj Roy Additional Professor of Cardiology and Consultant Cardiology at Cardio Thoracic Sciences Centre in AIIMS, New Delhi

•  How do co-morbid conditions affect the management of HF?

Co-morbid conditions like diabetes, hypertension and chronic kidney disease have a  great impact on heart failure. While they impart a worse prognosis, they also make management difficult. Some of the examples are that diabetes needs control only to a certain extent but not aggressively which can increase the mortality of heart failure. Chronic kidney disease forces you to avoid certain drugs normally indicated for heart failure or need to modify the doses of the drugs used which affects the prognosis.

•  What is the status of heart transplant in India?

I would say the heart transplantation situation in India is somewhat peculiar. While individual centres have acquired great success in cardiac transplantation, the numbers are rather small for the size of the country. The major bottle neck is the cost involved and social barriers for donating the heart by a brain dead persons relatives. At the same time states in the south have demonstrated considerable public awareness and increasing numbers of donations.

• Is heart failure a public health priority in India?

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