Abstract
Background and Aims: High-income countries have reported common causes of heart failure as ischaemic heart diseases, hypertension, valvular heart diseases, and cardiomyopathies. There are limited data available about epidemiology of heart failure in low-income countries like Nepal. The main objective of this study is to explore etiological spectrum of heart failure in Nepal.
 Methods: This cross-sectional study was conducted at the cardiology department of Kathmandu Medical College from April 15, 2019, to July 15, 2019. Data were collected from patients diagnosed as heart failure following the European Society of Cardiology criteria and having left ventricular ejection fraction less than 50% and classified into Heart failure with midrange or reduced ejection fraction. Diastolic heart failure, Cor-pulmonale, and stroke were excluded. The data were entered and analyzed in Statistical Package for Social Sciences 20.0 using descriptive and inferential statistics.
 Results: Among 132 heart failure patients (mean age: 63.9±13.9 years), around two-thirds (65.2%) had heart failure with reduced ejection fraction (ejection fraction of less than 40%) and one third (34.8%) had heart failure with mid-range ejection fraction (40 to 49%). Dilated cardiomyopathy was the leading cause of heart failure among nearly half (47.7%) of study participants, followed by valvular heart disease (19.7%), hypertensive heart disease (14.4%) and ischaemic heart disease (13.6%). Almost half of the study participants with dilated cardiomyopathy had severe left ventricular systolic dysfunction. (p<0.05).
 Conclusion: Dilated cardiomyopathy was the most prevalent cause of heart failure, followed by valvular heart disease in our study.
Highlights
Heart Failure (HF) is emerging as a global epidemic with the prevalence of 1-2% in the adult population, rising to ≥10% after the age of more than 70 years[1]
Data were collected from the HF patients, age 18 years and above, visiting cardiology Out-patient department of Kathmandu Medical College Teaching Hospital (KMCTH) and patients admitted to cardiology ward, after completion of initial investigations and echocardiogram
Based on European Society of Cardiology criteria, heart failure was categorized into Heart failure with mid-range ejection fraction (HFmrEF) that includes LVEF 40 to 49% and Heart failure with reduced ejection fraction (HFrEF) which includes LVEF less than 40%1
Summary
Heart Failure (HF) is emerging as a global epidemic with the prevalence of 1-2% in the adult population, rising to ≥10% after the age of more than 70 years[1]. One year mortality rates for hospitalized and ambulatory HF patients are 17% and 7%, and hospitalization rates are 44% and 32%, respectively[2] It leads to high economic burden[3], which has greater impact in low and middleincome countries (LMICs) due to limited resources to manage such conditions[4]. High-income countries have reported common causes of heart failure as ischaemic heart diseases, hypertension, valvular heart diseases, and cardiomyopathies. Data were collected from patients diagnosed as heart failure following the European Society of Cardiology criteria and having left ventricular ejection fraction less than 50% and classified into Heart failure with midrange or reduced ejection fraction. Dilated cardiomyopathy was the leading cause of heart failure among nearly half (47.7%) of study participants, followed by valvular heart disease (19.7%), hypertensive heart disease (14.4%) and ischaemic heart disease (13.6%). Conclusion: Dilated cardiomyopathy was the most prevalent cause of heart failure, followed by valvular heart disease in our study
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