Clinical Characteristics, Etiological Profile, Treatment and Long Term Outcomes in Patients with Non Ischemic Systolic Heart Failure; Himachal Pradesh Heart Failure Registry (HP-HF Registry)

Overview

Journal Indian Heart J

Publisher Elsevier

Specialty Cardiology & Vascular Diseases

Date 2023 Apr 1

PMID 37003535

Authors

Prakash Chand Negi

Ashu Gupta

Meena Rana

Sanjeev Asotra

Neeraj Ganju

Rajeev Marwah

Rajesh Sharma

Arvind Kandoria

Affiliations

Soon will be listed here.

Abstract

Background: The data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF.

Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke.

Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up.

Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes.

References

Zafrir B, Lund L, Laroche C, Ruschitzka F, Crespo-Leiro M, Coats A . Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018; 39(48):4277-4284. DOI: 10.1093/eurheartj/ehy626. View

Dokainish H, Teo K, Zhu J, Roy A, Alhabib K, Elsayed A . Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health. 2017; 5(7):e665-e672. DOI: 10.1016/S2214-109X(17)30196-1. View

Hirashiki A, Kondo T, Okumura T, Kamimura Y, Nakano Y, Fukaya K . Cardiopulmonary Exercise Testing as a Tool for Diagnosing Pulmonary Hypertension in Patients with Dilated Cardiomyopathy. Ann Noninvasive Electrocardiol. 2016; 21(3):263-71. PMC: 6931611. DOI: 10.1111/anec.12308. View

MacDonald M, Tay W, Teng T, Anand I, Ling L, Yap J . Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN-HF Registry. J Am Heart Assoc. 2019; 9(1):e012199. PMC: 6988158. DOI: 10.1161/JAHA.119.012199. View

Grzybowski J, Bilinska Z, Ruzyllo W, Kupsc W, Michalak E, Szczesniewska D . Determinants of prognosis in nonischemic dilated cardiomyopathy. J Card Fail. 1996; 2(2):77-85. DOI: 10.1016/s1071-9164(96)80026-1. View

Ganapathi S, Jeemon P, Krishnasankar R, Kochumoni R, Vineeth P, Nair K . Early and long-term outcomes of decompensated heart failure patients in a tertiary-care centre in India. ESC Heart Fail. 2020; 7(2):467-473. PMC: 7160472. DOI: 10.1002/ehf2.12600. View

Balmforth C, Simpson J, Shen L, Jhund P, Lefkowitz M, Rizkala A . Outcomes and Effect of Treatment According to Etiology in HFrEF: An Analysis of PARADIGM-HF. JACC Heart Fail. 2019; 7(6):457-465. DOI: 10.1016/j.jchf.2019.02.015. View

Sanjay G, Jeemon P, Agarwal A, Viswanathan S, Sreedharan M, Vijayaraghavan G . In-Hospital and Three-Year Outcomes of Heart Failure Patients in South India: The Trivandrum Heart Failure Registry. J Card Fail. 2018; 24(12):842-848. PMC: 7263011. DOI: 10.1016/j.cardfail.2018.05.007. View

Chen C, Liu J, Liu Z, He X, Yuan X, Ouyang X . Electrocardiogram signs of right ventricular hypertrophy may help identify pulmonary hypertension in patients with dilated cardiomyopathy. Int J Cardiol Heart Vasc. 2019; 22:61-66. PMC: 6307311. DOI: 10.1016/j.ijcha.2018.12.006. View

10.

Dziewiecka E, Wisniowska-Smialek S, Karabinowska A, Holcman K, Gliniak M, Winiarczyk M . Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy. J Clin Med. 2020; 9(6). PMC: 7355437. DOI: 10.3390/jcm9061660. View

11.

Zhang W, Xu H, Zheng Y, Zhao X, Mai Q, Liu Q . [Comparison on clinical features between dilated cardiomyopathy patients with or without pulmonary hypertension]. Zhonghua Xin Xue Guan Bing Za Zhi. 2012; 40(9):762-5. View

12.

Li X, Luo R, Fang W, Xu X, Niu G, Xu Y . Effects of ventricular conduction block patterns on mortality in hospitalized patients with dilated cardiomyopathy: a single-center cohort study. BMC Cardiovasc Disord. 2016; 16:136. PMC: 4907257. DOI: 10.1186/s12872-016-0313-4. View

13.

Rihal C, Nishimura R, Hatle L, Bailey K, Tajik A . Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis. Circulation. 1994; 90(6):2772-9. DOI: 10.1161/01.cir.90.6.2772. View

14.

Anker S, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C . Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation. 2003; 107(15):1991-7. DOI: 10.1161/01.CIR.0000065637.10517.A0. View

15.

Sokolska J, Kurian B, Banasiak W, Jankowska E, Ponikowski P . Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry. Cardiol J. 2017; 25(4):512-520. DOI: 10.5603/CJ.a2017.0046. View

16.

Hirashiki A, Kondo T, Adachi S, Nakano Y, Shimazu S, Shimizu S . Prognostic value of pulmonary hypertension in ambulatory patients with non-ischemic dilated cardiomyopathy. Circ J. 2014; 78(5):1245-53. DOI: 10.1253/circj.cj-13-1120. View

17.

Shen L, Ramires F, Martinez F, Bodanese L, Echeverria L, Gomez E . Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy. Circ Heart Fail. 2017; 10(11). DOI: 10.1161/CIRCHEARTFAILURE.117.004361. View

18.

Gulati A, Ismail T, Jabbour A, Alpendurada F, Guha K, Ismail N . The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy. Circulation. 2013; 128(15):1623-33. DOI: 10.1161/CIRCULATIONAHA.113.002518. View

19.

Romeo F, Pelliccia F, Cianfrocca C, Gallo P, Barilla F, Cristofani R . Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients. Clin Cardiol. 1989; 12(7):387-92. DOI: 10.1002/clc.4960120708. View

20.

Mene-Afejuku T, Akinlonu A, Dumancas C, Lopez P, Cardenas R, Sueldo C . Relationship between pulmonary hypertension and outcomes among patients with heart failure with reduced ejection fraction. Hosp Pract (1995). 2019; 47(3):130-135. DOI: 10.1080/21548331.2019.1628615. View