Overview

Heart failure (HF) is a complex clinical syndrome characterized by reduced or inadequate cardiac output to meet metabolic demands (Ponikowski et al. 2016; "Global Public Health Burden of Heart Failure"). Heart failure can be classified into Acute (sudden onset or worsening of HF signs and symptoms) and Chronic (HF signs and symptoms present for three months or more) on the basis of time course. New York Heart Association (NYHA) classifies HF into four classes based on the severity of symptoms; Class I - no limitation in physical activity, Class II - Slight limitation with reliving of symptoms at rest, Class III - Marked limitation in daily routine activities with reliving of symptoms at rest, Class IV - severe limitation in daily activities with symptoms present even at rest (Mishra et al. 2018). HF is considered as global pandemic with estimated prevalence of 1-2% affecting about 26 - 37 million (Ponikowski et al. 2016; Ziaeian and Fonarow 2016; Savarese and Lund 2017) and it is estimated that the number of patients would rise by 25% by 2030 (Ziaeian and Fonarow 2016).

Another important trend of HF is the increasing burden in emerging economies of Asia, Middle East and South America (Callender et al. 2014; Dokainish et al. 2017) along with large pool of unreported cases from low and middle income countries (Rajadurai et al. 2017). The prevalence of HF in South east Asia is about 9 million cases and in China, the prevalence is about 4.2 million individuals (Rajadurai et al. 2017). India also has a substantial number of HF cases with prevalence number varying from 1.3 million to 23 million based on different data sources (Rajadurai et al. 2017; Lam et al. 2016; Mishra et al. 2018). Multiple studies conducted in the West and in Asian nations including India suggest that there is a marked regional and ethnic difference observed in HF patients. When we compare Western HF data against data from Asia and India, there are striking differences like, the mean age of onset in west is 69-78 yrs., in Asia it is 64-69 yrs., and in India the mean age dips to 53-60 yrs.(Dokainish et al. 2017; Mishra et al. 2018; Lam et al. 2013), there is male predomination globally with 61% cases of HF globally being males, in India 62% of HF cases are males (Dokainish et al. 2016). The differences are also prominent in aetiologies, risk factors, co-morbidities associate with HF.

The data from India presents a wide range of variations, like the prevalence which varies from 1.3 million to 23 million. This variation was traditionally attributed to the lack of reliable large scale studies from India, as the most of the data presented is the generalisation of results conducted on a small population in different geographies of the country.

Heart Failure data in India is mostly derived from major metropolitan centres located across North, South and Western geographies and thus the generalisability of the data to entire nation is limited. Hence we plan to setup a country wide hospital based registry across different regions of India to generate a reliable data on HF in India. As a first step towards this process, we plan a hospital feasibility study across five centres in small to medium sized towns in North, South, East, West and North East region of India.

Study Objectives

Primary objectives:

1. To understand the pattern of causes of heart failure among attending and hospitalised patients
2. To understand the pattern of care and outcomes of heart failure among attending and hospitalised patients.
3. To assess the feasibility of establishing the heart failure registry in different geographies of India.

Secondary objectives:

1. To upscale the present model with similar objectives to national level with more number of centres.