Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry

AIMS

Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India.

METHODS AND RESULTS

The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality.

CONCLUSION

One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.

Population-specific left ventricular hypertrophy in three groups from the northeastern region of India

BACKGROUND

People living in the hills are continuously exposed to strenuous physical activity for their day-to-day work. Besides hypertension, left ventricular hypertrophy in different populations may be related to continuous physical activity.

METHODS

Electrocardiogram, blood pressure and sociodemographic information of 12 252 subjects > or = 30 years of age from three different population groups living in Mizoram (hilly) and Assam (plain) were recorded. Of them, 8058 were from Mizoram and 3180 and 1014 were Indigenous Assamese and tea garden workers of Assam.

RESULTS

Among the subjects from Mizoram the percentage of smokers (41.9%), mean (SD) BMI (21.9 [3.8]) and waist-hip ratio (0.87 [0.02]) were significantly higher than in those from other groups. Tea garden workers had a higher mean systolic blood pressure (145.2 [25.7]) and diastolic blood pressure (87.6 [13.6]). The prevalence of left ventricular hypertrophy was highest among tea garden workers (16.5%) followed by people from Mizoram (3.7%) and the indigenous Assamese (2%) people. In spite of a significantly higher prevalence of hypertension among the indigenous Assamese community than among those from Mizoram, left ventricular hypertrophy was found to be lower in the former.

CONCLUSION

High prevalence of left ventricular hypertrophy among tea garden workers was possibly related to a higher prevalence of hypertension but the higher prevalence of left ventricular hypertrophy among people from Mizoram might be related to more physical activity.

Hypertension in the native rural population of Assam

BACKGROUND

Recent studies have reported an increasing prevalence of hypertension in India. However, there are few epidemiological data with regard to the occurrence of hypertension in the native population of Assam.

METHODS

Three thousand one hundred and eighty individuals (1441 men and 1739 women), > or =30 years of age and from 25 villages of 5 districts in Assam were selected by the stratified random sampling method. They were interviewed and their blood pressure measured along with other anthropometric variables. Hypertension was defined according to the Sixth Report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VI).

RESULTS

The overall prevalence of hypertension was 33.3%. Among the patients with hypertension, 21.6% were aware of their illness. The determinants of hypertension were age, intake of extra salt in the diet, body mass index and waist-hip ratio (derived by multiple logistic regression analysis with backward elimination of non-significant factors). Multivariate analysis showed that females had a higher risk of hypertension than males.

CONCLUSION

The prevalence of hypertension in the native population of Assam is high. Implementation of an effective awareness programme with lifestyle modifications is necessary to control the cardiovascular disease burden in this population.

Differences in blood pressure level and hypertension in three ethnic groups of northeastern India

A cross sectional study on hypertension was done on 294 subjects aged 30 years and above. 150 households were selected randomly representing 50 households from each locality inhabited exclusively by the rural Mizos, indigenous rural Assamese and the tea-garden workers respectively, in the northeastern region of India. Blood pressure was measured by sphygmo-manometer in sitting posture. Anthro-pometric measurements were taken using standard procedure for measuring height, weight, waist and hip girth. Information on age, sex, ethnicity, literacy, alcohol intake, smoking pattern, physical activity, occupation, amount of salt consumption was collected using a standard and pre-tested questionnaire. Significant differences were observed in both the systolic and diastolic blood pressure levels among the three different ethnic groups selected for this study (p < 0.0001). Multiple regression analyses indicated that in Mizos, age, waist circumference and alcohol intake were independently associated with increase in systolic blood pressure whereas smoking was found to be negatively associated with systolic blood pressure (R2 = 0.391, p < 0.001). Factors, which were the best predictors of diastolic blood pressure, were age and body mass index [(kg/m2) (R2 = 0.227, p < 0.001)]. In the rural Assamese population, the best predictors of systolic blood pressure were age and waist circumference (R2 = 0.263, p = 0.018). For the diastolic blood pressure, age, alcohol intake and body mass index were important correlates (R2 = 0.131, p < 0.001). In the tea garden community, important predictors of systolic blood pressure were age, gender and marital status (R2 = 0.187, p < 0.001). On the other hand, age and alcohol intake were best predictors for diastolic blood pressure (R2 = 0.09, p < 0.001).

Hypertension and its risk factors in tea garden workers of Assam

BACKGROUND

Hypertension is emerging as a major public health problem in India. The diversity and heterogeneity of distribution of the population makes it difficult to arrive at the precise prevalence. In Assam, reports from hospitals in tea gardens reveal a high prevalence of hypertension among workers in tea gardens. However, no systematic study has been carried out in this population.

METHODS

We selected, by systematic sampling, 1015 individuals (512 men and 503 women) 30 years or more in age, who were interviewed and clinically examined for hypertension. Blood pressure of all the study participants was measured using a standardized technique. Crude and adjusted odds ratios were estimated by unconditional simple and multiple logistic regression analyses. Mantel-Haenszel chi2 analysis was also used to test for the association of potential risk factors with hypertension after controlling for co-variables in a stratified analysis. Risk factors considered for hypertension included age, gender, marital status, occupation, alcohol consumption (locally prepared), extra salt intake, smoking history, khaini (a form of tobacco quid containing a mixture of tobacco and lime) intake, body mass index and waist-hip ratio.

RESULTS

The overall prevalence of hypertension was 60.8%. Increasing age, consumption of locally prepared alcohol, intake of extra salt in food and beverages and the habit of taking khaini were found to increase the risk of hypertension. Multivariate logistic regression models showed that the independent determinants of hypertension were age, gender, consumption of locally prepared alcohol and intake of extra salt. Gender-specific and age-stratified analyses showed the association of increased risk with intake of khaini in women only, while consumption of locally prepared alcohol was an important risk factor for hypertension in both men and women.

CONCLUSION

The disease burden of hypertension among workers in tea gardens is large, despite the community not being obese. Interventions directed at these workers as well as studies to determine the reasons for the high prevalence of hypertension are required.

Left anterior fascicular block: an ischaemic response during treadmill testing

A patient in whom exercise induced reversible ischaemic left anterior fascicular block is reported. Glyceryl trinitrate relieved the fascicular block. Coronary angiography showed a 90% obstruction of the left anterior descending artery. The left anterior fascicular block induced by exercise disappeared after a successful coronary angioplasty.