Acute Heart Failure is emerging as the greatest health care challenge among various cardiac diseases prevalent in Kerala, according to a recent study conducted by the Cardiology Society of India (CSI) Kerala Chapter and published in the prestigious European Heart Journal.
The research team led by Dr. Stigi Joseph, Department of Cardiology, Little flower Hospital, Angamali, Dr. Harikrishnan. S , Professor, Sree Chitra Tirunal Institute, Thiruvananthapuram and Dr. P. Jeemon, Achutha Menon Centre of SCT IMST have found an early onset of Heart failure in the state population. While the world average age of hospital admission with heart failure is 70, Kerala registers more patients over the age of 60, a release said.
Emphasizing the need for general awareness of what constitutes heart failure and how it differs from a heart attack, the investigators explained that Heart attacks are due to the blockage of arteries that supply blood to heart muscles. The heart muscles starve and die, causing the heart attack. Heart failure is the net result of many cardiac illnesses which causes the weakness of the heart’s ability to pump blood around the body to nourish the body cells. Heart attacks form only one of, albeit the leading cause of Heart Failure. In Kerala 2/3rd of the patients had Coronary Artery Disease ( Heart Attack) induced heart failure, the study noticed. The majority of these patients have Diabetes and Hypertension.
‘Blood is pumped out with each heartbeat when the heart contracts. Normally the left ventricle pumps out more than 50% of blood it receives, which is named Ejection Fraction (EF). Depending upon the level of Ejection Fraction the patients may develop three different Categories of Heart Failure, Dr.Stigi Joseph said.
Heart failure with reduced left ventricular function results when muscles of the left chamber fail to pump enough blood out of the heart. The left Ventricle becomes enlarged or dilated, this results in further pumping inefficiency and the vicious cycle propagates. Treatment at the initial stage is needed to break this chain and promote pumping efficiency. Heart failure also occurs with preserved left ventricular function. ‘Here the contraction or Ejection Fraction is normal but the chamber (left ventricle) muscular wall gets abnormally thick and stiff, so the chamber filling becomes ineffective. In fact, 15 % of patients in the study had this type of Heart failure. In between these two types is an intermediary group of patients with mildly reduced pumping efficiency which also constitutes around 15-18 %.
The study named “The Cardiological Society of India-Kerala Acute Heart Failure Registry (CSI-KHFR)” was conducted after establishing an observational registry with prospective follow up from 50 hospitals with a Cardiology facility in Kerala. More than 7500 patients with acute Heart Failure participated in the study.
The research found that 7 per cent of patients admitted with Heart Failure die while in the hospital and 11 per cent of patients die within the next three months. During the initial three months period after diagnosis 11 percent of patients are re-admitted to the hospital with consequences of Heart failure illness.
Another important fact highlighted by the study was inadequate treatment received by the patients. Only 28 per cent of the patients received the recommended medications – Guideline-Directed Medical Therapy (GDMT). Those receiving the recommended medicines (GDMT) had better survival. A negligible -less than 2% of patients had device aided therapy. The major obstacle to treatment is lack of awareness and financial support-the investigators pointed out.
CSI-KHFR is currently the largest published data on Heart Failure from India. CSI-Kerala Chapter is doing a lot of research on different aspects of Heart-related ailments in Kerala- Dr. Zulfikar Ahmed, President of the CSI-Kerala Chapter said. Considering the importance of study, the European Heart Journal wrote an Editorial on CSI-KHFR Study.
A major social drive to improve the awareness about heart failure, ensuring social and economic security to patients, motivating patients to take prescribed medications and undergo a healthy lifestyle are the ways to improve the treatment outcome, he added. The investigators are planning an extended follow up of these patients and hope for more information on the illness.