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Joseph S, Panniyammakal J, Abdullakutty J, S S, Vaikathuseril L J, Joseph J, Mattummal S, Punnose E, Unni G, Natesan S, Sivadasanpillai H. The Cardiology Society of India-Kerala Acute Heart Failure Registry: poor adherence to guideline-directed medical therapy. Eur Heart J 2021:ehab793. [PMID: 34931232 DOI: 10.1093/eurheartj/ehab793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 11/03/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS Data on the burden of acute heart failure (AHF) admissions, practice patterns, and outcomes are rare from India and other low- and middle-income countries. We aimed to describe the baseline characteristics, guideline-directed medical therapy (GDMT) prescribing patterns and 90-day mortality rates in patients admitted with AHF in Kerala, India. METHODS AND RESULTS The Cardiology Society of India-Kerala Acute Heart Failure Registry (CSI-KHFR) is an observational registry from 50 hospitals in Kerala, India, with prospective follow-up. Consecutive patients with AHF, who consented to participate, were enrolled. The 2016 European Society of Cardiology criteria were used for the diagnosis of AHF. Kaplan-Meier survival analysis and Cox-proportional hazard models were used for data analysis. The variables in the MAGGIC risk score were used in the multivariable model. A total of 7507 patients with AHF (37% female) participated in the CSI-KHFR. The mean age was 64.3 (12.9) years. More than two-third had reduced ejection fraction (EF) (67.5%). Nearly one-fourth (28%) of patients with heart failure (HF) with reduced EF received GDMT. Overall, in-hospital and 90-day mortality rates were 7% and 11.6%, respectively. Prescriptions of different components of GDMT were independently associated with 90-day mortality. CONCLUSION The CSI-KHFR recorded an in-hospital and 90-day mortality of 7% and 11.6%, respectively. Only one of four patients received GDMT. AHF mortality was independently associated with GDMT initiation. Quality improvement initiatives that focus on increasing GDMT prescription may improve the survival of HF patients in India.
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Affiliation(s)
- Stigi Joseph
- Department of Cardiology, Little Flower Hospital and Research Centre, Angamaly, Ernakulam, Kerala 683572, India
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Harikrishnan S, Mani A, G S, M A, Menon J, G R, Kumar RK, Koshy AG, Attacheril TV, George R, Punnose E, Ashraf SM, Sr A, Cholakkal M, Jeemon P, Joseph S, Govindan U, Joseph J, Eapen K, Sreedharan M, Kumar A, Venugopal K. Pulmonary Hypertension Registry of Kerala, India (PRO-KERALA): One-year outcomes. Indian Heart J 2021; 74:34-39. [PMID: 34919965 PMCID: PMC8891004 DOI: 10.1016/j.ihj.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Short term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India. METHODS We conducted a prospective study of 2003 patients with pulmonary hypertension, from 50 centres (PROKERALA) in Kerala, who were followed up for one year. Pulmonary hypertension (PH) was mainly diagnosed on the basis of Doppler echocardiography. The primary outcome was a composite end-point of all-cause death and hospital admission for heart failure. All cause hospitalisation events constituted the secondary outcome. RESULTS Mean age of study population was 56 ± 16 years. Group 1 and Group 2 PH categories constituted 21.2% and 59% of the study population, respectively. Nearly two-thirds (65%) of the study participants had functional class II symptoms. 31% of Group 1 PH patients were on specific vasodilator drugs.In total, 83 patients (4.1%) died during the one-year follow-up period. Further, 1235 re-hospitalisation events (61.7%) were reported. In the multivariate model, baseline NYHA class III/IV (OR 1.87, 95% C.I. 1.35-2.56), use of calcium channel blockers (OR 0.18, 95% C.I. 0.04-0.77), vasodilator therapy (OR 0.5, 95% C.I. 0.28-0.87) and antiplatelet agents (OR 1.80, 95% C.I. 1.29-2.51) were associated with primary composite outcome at one-year (p < 0.05). CONCLUSION In the PROKERALA registry, annual mortality rate was 4%. More than half of the patients reported re-hospitalisation events on follow up. Uptake of guideline directed therapies were suboptimal in the study population. Quality improvement programmes to improve guideline directed therapy may improve clinical outcomes of PH patients in India.
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Affiliation(s)
| | - Avinash Mani
- Department of Cardiology, SCTIMST, Trivandrum, India
| | | | - Ashishkumar M
- Malabar Institute of Medical Sciences, Calicut, India
| | | | | | | | | | | | | | | | - S M Ashraf
- Academy of Medical Sciences, Pariyaram, India
| | - Arun Sr
- General Hospital, Trivandrum, India
| | | | | | | | | | | | | | | | | | - K Venugopal
- Pushpagiri Medical College, Thiruvalla, India
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Bahuleyan CG, Namboodiri N, Jabir A, Lip GYH, Koshy A G, Shifas BM, Viswanathan S K, Zachariah G, Venugopal K, Punnose E, Natarajan KU, Mini GK, Joseph J, Nambiar C A, Jayagopal PB, Mohanan PP, George R, Unni G, Sajeev CG, Muhammed S, Syam N, Roby A, Daniel R, Krishnakumar VV, Pillai AM, Joseph S, Jinbert Lordson A. One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry. Indian Heart J 2020; 73:56-62. [PMID: 33714410 PMCID: PMC7961260 DOI: 10.1016/j.ihj.2020.11.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study. METHODS KERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF. RESULTS Mean age at recruitment was 67.2 years (range 18-98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA2DS2-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%). CONCLUSIONS Despite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.
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Affiliation(s)
- C G Bahuleyan
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India.
| | - Narayanan Namboodiri
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - A Jabir
- Lisie Heart Institute, Ernakulam, India
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom; Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - George Koshy A
- Medical College Hospital, Trivandrum, India 8Global Institute of Public Health, 6. Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Babu M Shifas
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Kartik Viswanathan S
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - K Venugopal
- Pushpagiri Medical College, Thiruvalla, India
| | | | - K U Natarajan
- Amrita Institute of Medical Sciences, Ernakulam, India
| | - G K Mini
- Global Institute of Public Health, Trivandrum, Kerala, India
| | | | | | | | - P P Mohanan
- West Fort Hi-Tech Hospital, Ponkunam, Thrissur, India
| | - Raju George
- Government Medical College Hospital, Kottayam, India
| | | | - C G Sajeev
- Government Medical College Hospital, Calicut, India
| | | | - N Syam
- General Hospital, Kollam, India
| | - Anil Roby
- Dr Damodaran Memorial Hospital, Kollam, India
| | - Rachel Daniel
- N S Memorial Institute of Medical Sciences, Kollam, India
| | - V V Krishnakumar
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Anand M Pillai
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Stigi Joseph
- Little Flower Hospital, M C Road, Angamali, India
| | - A Jinbert Lordson
- Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, India; Global Institute of Public Health, Trivandrum, Kerala, India
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Fischer EJ, Thomas S, Mohan P, Abraham L, Matthai A, Joseph E, Georgekutty V, Baby M, Mathew A, Fischer L, Punnose E. TCTAP A-014 Correlation Between the Age of Thrombus and Short Term Clinical Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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