Highest mortality due to Heart Failure cardiac deaths in India: Study
- One year mortality higher in Indian patients than those from China, Southeast Asia and Middle East
- Heart Failure patients in India, Africa and Southeast Asia are approximately 10 years younger than those in South America and China
June 2, 2017, India: An international Congestive Heart Failure (INTER-CHF) study, conducted across six geographies, has revealed that cardiac deaths accounted for 46 percent of mortality at one year in patients with heart failure in India, as compared to non-cardiac causes that led to 16 percent deaths. Ischemic heart disease was the cause of death in 39 percent and hypertensive heart disease in 17 percent patients.
The INTER-CHF study was aimed to measure mortality at one year in patients due to heart failure in India, Africa, China, the Middle East, southeast Asia and South America. The rate of mortality amongst Indian heart failure patients is significantly higher than their counterparts in other geographies.
Heart failure, which is a potentially life-threatening condition where the heart cannot pump enough blood around the body is a global health problem. It affects about 26 million people worldwide[1] with 5.4 million estimated heart failure patients in India alone[2]. It is associated with high mortality and is estimated to have cost the global economy about US$100 billion in 2012[3].The disease remains poorly understood and often confused to be an aftermath of a cardiac arrest in the region. Factors such as low awareness, inaccurate or delayed diagnosis, unhealthy dietary patterns and lack of effective treatment protocol has seen an increased incidence of heart failure in India.
Heart failure can have different causes and varying levels of severity. Common reasons leading to heart failure are blocked arteries, heart attack, cardiomyopathy (damage to the heart muscles from infections or alcohol or drug abuse), or conditions that overwork and thus damage the heart like diabetes, high blood pressure, obesity, kidney disease or thyroid malfunction. In many cases heart failure does not have one single cause[4][5].
Heart Failure patient mortality in India:
* Cardiac deaths led to 46% of mortality
* Non-cardiac causes led to 16% deaths
* Ischemic heart disease caused 39% deaths
* Hypertensive heart disease led to death in 17% patients
* Mean age at the time of death was 59 years
Data from low-income and middle-income countries (LMIC) suggests that mortality in patients with heart failure in these countries is greater than that in high income countries[6][7].
“With increasing life expectancy of the population (more elderly population) and availability of effective treatments to prevent death acutely (so that patients survive with damaged heart muscles), incidence of heart failure is increasing in an epidemic proportion. The marked variation in mortality in low-income countries like India can be attributed to low awareness, economic burden, healthcare infrastructure, quality and access to primary healthcare facilities, environmental and genetic factors,” said Dr. Immaneni Sathyamurthy, Apollo Hospitals, Chennai.
The INTER-CHF study also highlighted that heart failure patients in India, Africa and Southeast Asia are approximately 10 years younger than patients in US and Europe. Mean age at the time of death was 56 years in Africa, 59 years in India, 57 years in Southeast Asia, 60 years in the Middle East, 69 years in China, and 72 years in South America. Despite being in the youngest cohorts at baseline, patients in India and Africa had the highest mortality.
This finding may be related to patients with heart failure presenting later for medical care (that is, when they are sicker) in low-income compared with high-income regions, and late presentation being associated with a worse prognosis[8].
Highlighting the importance of timely diagnosis and treatment to arrest the progression of heart failure, Dr. Sathyamurthy added, “The need of the hour is to develop a comprehensive approach to identify patients with heart failure at an early stage to ensure timely diagnosis and treatment for improving their quality of life. We need to prioritize heart failure as a non-communicable disease (NCD), which needs urgent attention from all stakeholders in the medical and healthcare industry.”
The INTER-CHF study enrolled 5823 patients across 108 centres in six geographies. Patients were followed up at six months and one year from enrolment. The mean age of patients was 59 years, with a male to female ratio of 60:40. Enrolled patients included 66 percent clinic outpatients and 34 percent hospital in patients. The primary outcome of the study was to record all-cause mortality within one year. The cause of death was also recorded, and categorised by local investigators as cardiac, non-cardiac, or unknown.
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[2] Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol 2014; 171: 368–76.
[3] Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol 2014; 171: 368–76.
[4] Harrison’s ‘Principles of Internal Medicine’, Seventeenth Edition pages 1442 - 1455
[5] Mosterd A, Hoes, A, Clinical epidemiology of heart failure, Heart 2007;93:1137-1146
[6] Howlett JG, Ezekowitz JA, Podder M, et al. Global variation in quality of care among patients hospitalized with acute heart failure in an international trial: findings from the acute study clinical effectiveness of nesiritide in decompensated heart failure trial (ASCEND-HF). Circ Cardiovasc Qual Outcomes 2013; 6: 534–42.
[7] Callender T, Woodward M, Roth G, et al. Heart failure care in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 2014; 11: e1001699.
[8] Ambrosy AP, Gheorghiade M, Chioncel O, Mentz RJ, Butler J. Global perspectives in hospitalized heart failure: regional and ethnic variation in patient characteristics, management, and outcome. Curr Heart Fail Rep 2014; 11: 416–27.
