Heart Failure National Registry Research Articles

Selenium, selenoprotein P and autoantibodies to selenium transport proteins in Swedish heart failure patients - a pilot study in preparation for a randomized supplementation trial

Abstract Background Severe selenium (Se) deficiency, as in Keshan disease, is associated with a fatal form of heart failure (HF), preventable and reversible with Se supplementation. Recent studies have identified Se deficiency as highly prevalent, up to 70%, among patients with HF, and associated with a poorer prognosis. Observational data suggest that Se concentrations <100 μg/L in HF patients and selenoprotein P (SELENOP) concentrations <4.1 mg/L are associated with increased mortality and hospital readmissions. Further, in recent studies, natural autoantibodies (aAb) towards SELENOP have been detected with the potential to disrupt transportation mechanisms. While the evidence does not yet support Se supplementation for HF patients in clinical practice, it does justify the initiation of large, well-designed randomized controlled trials (RCTs). Purpose To assess and confirm the previously reported high prevalence of Se deficiency, measured by both Se and SELENOP concentrations in HF patients and exploring the prevalence of aAb to SELENOP. This will provide a rationale for further, adequately powered and designed, studies of Se supplementation in HF patients. Methods A total of 527 blood samples were obtained from a nationwide Swedish HF biobank, sourced from various hospitals. In those samples; serum Se concentrations in 455 samples using mass spectrometry, SELENOP concentrations in 520 samples using an immunoassay, and prevalence of aAb to SELENOP in 513 samples using an immunoluminometric assay were analyzed. In addition, SELENOP concentrations in 320 HF patients from a Swedish single-center study were analysed. Results The study population had a mean age of 70.3 (±11.8) years (30.5% women). Prevalence of Se deficiency was higher than previously reported. In the national HF registry, the median Se concentration was 75 µg/L and Se concentrations below 100 μg/L were found in 426 (93%) samples. SELENOP concentrations had a median of 3.5 mg/L, corresponding to ~80 μg/L Se, with 80.5% of subjects below SELENOP-concentration of 4.3 mg/L (corresponding to ~100 μg/L Se). In the confirmatory single-center study, the SELENOP median concentration was 3.1 mg/L, corresponding to Se concentrations of ~70 µg/L and SELENOP -concentrations below 4.3 mg/L (corresponding to approximately 100 μg/L Se) were observed in 89.4% of the study population. Further, aAb to SELENOP were prevalent in 9.7% of the population, compared to approximately 1% in healthy subjects. Conclusion This pilot study demonstrates a high prevalence of suboptimal Selenium status in Swedish HF patients which further underscores the need for suitably designed intervention studies to address the efficacy and safety of Se supplementation which can possibly constitute an inexpensive, safe and readily available treatment option for HF patients.

Clinical characteristics, treatment, trajectories and outcome of patients with dilated cardiomyopathy in a national heart failure registry

BackgroundAvailable data on the clinical characteristics and prognosis of patients with heart failure (HF) due to dilated cardiomyopathy (DCM) derive mainly from tertiary care centres for cardiomyopathies or from drug trial sub-studies, which may entail a referral bias. MethodsFrom 2008 to 2021, we enrolled in a nationwide HF Registry 1886 DCM patients and 3899 with ischemic heart disease (IHD). ResultsPatients with DCM were younger, more often female, had more commonly recent onset HF, left bundle branch block, and showed higher LV end-diastolic volume and lower LVEF than IHD. With respect to IHD, DCM patients received more often mineralocorticoid receptor antagonists, renin angiotensin system inhibitors and betablockers, the latter more commonly at doses ≥50% of target, and triple guideline-directed medical therapy (GDMT) (adjusted OR 1.411, 95% CI 1.247-1.595, p < .0001). During one-year follow-up, 819 patients (14.2%) died or were hospitalized for HF [187 (9.9%) DCM, 632 (16.2%) IHD]; DCM was associated with lower risk of the combined end-point (adjusted HR 0.745, 95% CI 0.625- 0.888, p = .0011). Among the 1954 patients with 1-year echocardiograms available, 1483 had LVEF≤40% at baseline; of these,166 (30.6%) DCM and 165 (17.5%) IHD improved their LVEF to >40% (p < .0001). DCM aetiology was associated with higher likelihood of LVEF improvement (adjusted OR 1.722, 95% CI 1.328 -2.233, p < .0001). ConclusionsDCM patients have a different clinical profile, greater uptake of GDMT and better outcomes than IHD subjects. A comprehensive management approach is needed to further address the risk of unfavorable outcomes in DCM.

Clinical outcomes by serum potassium levels for patients hospitalized for heart failure: Secondary analysis of data from the China National Heart Failure Registry.

Dyskalemia is a mortality risk factor in patients with heart failure (HF). We described the prevalence of dyskalemia, and clinical outcomes by serum potassium (sK) levels, in Chinese patients hospitalized for HF. In this secondary analysis of the prospective China National Heart Failure Registry, adult patients hospitalized between January 1, 2013 and June 30, 2015 who had at least one baseline sK measurement were followed for up to 3 years after discharge. The use of renin-angiotensin-aldosterone system inhibitors at baseline and clinical outcomes during follow-up were compared among sK groups. Among 6950 patients, 5529 (79.6%) had normokalemia (sK >3.5-5.0 mmol/L), 1113 (16.0%) had hypokalemia (sK 0-3.5 mmol/L), and 308 (4.4%) had hyperkalemia (sK >5.0 mmol/L). Baseline characteristics that were most common in patients with hyperkalemia than those with hypo- and normokalemia included older age, HF with reduced ejection fraction, New York Heart Association Class III/IV status, hypertension, and chronic kidney disease. Use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) differed across sK groups (p = .0001); reported in 64.1%, 63.4%, and 54.5% of patients with hypo-, normo-, and hyperkalemia, respectively. Overall, 26.6%, 28.6%, and 36.0% of patients with hypo-, normo-, and hyperkalemia had rehospitalization for worsened HF, or cardiovascular mortality; p = .0057 for between-group comparison. Patients with hyperkalemia received ACEIs or ARBs for HF treatment at baseline less frequently than those with hypo- or normokalemia, and had worse prognoses. This warrants further investigation into effective hyperkalemia management in HF.

What determines who gets cardiac resynchronization therapy in europe?

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Supported by Swedish Heart and Lung foundation and Stockholm County Council. Background/Introduction Cardiac resynchronization therapy (CRT) is a valuable treatment in selected patients with heart failure (HF) but is still underutilized. Aim We compared three informative data sources, which enrolled patients with HF at different organization setting and identified clinical, organizational, and level of care factors linked to CRT implantation in these cohorts. Methods Data from three large cohorts of patients with HF were compared. Patients with HF with reduced ejection fraction (HFrEF) in an ESC HF-Long Term Registry (ESC-HF-LT, n=25,621), a National HF Registry - Swede HF (n=156,621) and in the ESC-CRT Survey II (n=11088, all receiving CRT across 42 ESC countries), contributed data to the analysis. The ESC Survey II recruited patients at implanting centers, ESC-HF-LT at HF centers, whereas SwedeHF enrolled HF patients at different levels of care. Firstly, we compared patient characteristics, socio-economic and organizational factors between cohorts as well as between overlapping countries participating both in CRT Survey II and ESC HF LT. Secondly, we identified independent predictors of CRT use in the two registries using multivariable logistic regressions. Results Of the 1031 patients in ESC-HF-LT and the 5008 patients in Swede-HF, CRT was not used in 53-75 % of guideline- indicated patients. Women constituted 22% and median age ranged between 68-72 years. Guideline Directed Medical Therapy (GDMT), atrial fibrillation, previous myocardial infarction (SwedeHF) and HF hospitalization (ESC-HF-LT) was associated with more CRT use as was enrollment at university hospital and follow-up at HF center/Hospital. In Swede-HF above median income and higher education level were also independently associated with use of CRT. In the ESC-CRT Survey II (n=11.088) all patients received CRT with differences in the clinical indications between countries. Conclusion(s) CRT is an important treatment option for eligible patients with HF, which is still largely underused. The findings reported demonstrate that awareness of CRT indications as well as demographics, organizational and economic factors play an important role in CRT utilization.

Congestive Heart Failure in Indian Elders

Congestive Heart Failure (CHF) is a common complex clinical syndrome that underlines the inability of the heart to perform its circulatory function with the desired efficiency due to structural and/or functional alterations. There is paucity of good and reliable data in India and many developing countries on heart failure. The management of heart failurehas evolved over the years with the advent of new drugs and devices.But there is a need to uneartha true and meaningful nationaldata on the risk factors,available treatment options,and challenges in management that could be addressed to take advantage of the recent advances. CHF is a disease of the “elderly,” frequently occurs in the setting of normal ejection fraction, and has a poor prognosis, regardless of the level of systolic function. The highest prevalence of CHF is reported among Indigenous Australian population (5.3%), Germany (4%) and Canada 3.6%, Turkey 2.9%, and USA 2.6% as compared to only 0.3% in Indian population. Overall, more than 5 persons aged 60 to 69 and 10 persons per 1,000 population after 65 years of age suffer from CHF. The incidence of CHF is equally frequent in men and women globally, but it is more amongelderly women in India comparedto elderly men. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. CHF not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. We need to acknowledge the fact that diagnostic and therapeutic methods available are also underused in the community. This review article is the result of witnessing the heart failure in 4 individuals in January 2023. Their symptomsand signs included Shortness of breath with routine activity like walking or household chores, fatigue, and weakness, Pedal oedema, rapid or irregular heartbeat, fluctuating Blood Pressure and Blood sugar levels, reduced ability to exercise and vomiting and aspirational pneumonia. The exponential rise in the incidence of uncontrolled hypertension and DM over the last couple of years has shaped the trajectory of HF development seen today. The key risk factors and causes of HF in our cases included hypertension (HT), diabetes mellitus (DM); chronic kidney disease (CKD). With the bestpossible management practices in cities likeBengaluru and Mysuru in Karnataka we could save only two of the 4 cases,both first-time hospitalized patients. Materials &amp; Methods: The third week of January2023 (17-25 January), the author had a misfortune being a witnessfor 3 women and one man between 64-85 years of age’s hospitalized for CHF with an outcome of 50% of them succumbing to CHF. This manuscript is a review of available information on the websites of World Heart Federation 2020, WHO, Global burden of disease 2019 report, ICC - National Heart Failure Registry, Reports of the Best Charities that fight Heart Diseases in 2023 including American Heart Association, The Children’s Heart Foundation, British Heart Foundation, Mended Hearts, Women Heart, Needy heart Foundation Bangalore and published papers in Indiaas evidences.

Abstract 13692: Gender, Process of Care and Mortality in Heart Failure Patients in India: Findings From the National Heart Failure Registry India

Introduction: HF mortality rate vary by gender in high income countries. Process of care is often associated with differences in HF mortality. Hypothesis: We hypothesized that, HF process of care is associated with differential mortality in men and women. Methods: National Heart Failure Registry is a nationwide registry . Data from 10851 consecutive acute decompensated heart failure patients (ESC2016) criteria was analysed. At baseline we examined sociodemographic characteristics, clinical features , disease etiology and co-morbid conditions of patients. We assessed both in-hospital and 90-day mortality. Results: The mean age of study population was 59.9 (SD=13.5). More than two third (69%) participants were men. Sixty-five percent (Women = 58.6%, Men =68.2%, p value = p&lt;0.001) and 13%( Women = 19.5%, Men =9.6%, p value = p&lt;0.001) of patients had HF with reduced ejection fraction and HF with preserved ejection fraction, respectively. In this study, 71.2%(Women =74.2 %, Men = 69.8%, p value = p&lt;0.001) of patients had New York Heart Association (NYHA) Class III or Class IV. In-hospital and 90-day mortality rate were 6.7%(Women = 7.6%, Men = 6.3%, p value = 0.010) and 14.2%(Women = 14.9%, Men = 13.9%, p value =0.160), respectively(Fig:1). Beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) were prescribed in 75.7% (Women=74.2%, Men=76.4%, p value = 0.015), 61.2% (Women=60.6%, Men=61.4%, p value = 0.405) and 64.7% (Women=66.4%, Men=64.0%, p value = 0.016), respectively. The study population had very low usage of devices like the automatic implantable cardioverter-defibrillator 0.9% (Women=0.4%, Men=1.1%, p value =p&lt;0.001), cardiac resynchronization therapy defibrillator 1.0% (Women=1.1%, Men=1.0%, p value =0.75). Conclusion: The HF process of care differences may partially explains the differences in mortality in men and women.

The impact of elite endurance activity on cardiac remodelling in asians: an echocardiographic case control study

Abstract Background Prolonged endurance training results in physiological changes to elite athletes' hearts. These changes include thickened left ventricular (LV) walls and dilated left and right ventricles that may overlap with those from pathological conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy and arrhythmogenic cardiomyopathy. While reference ranges for elite black and white athletes have been published to facilitate differentiation of physiology from pathology, data on Asian athletes remains scarce. With increasing Asian representation in international sport, it is important to ascertain the extent of physiological cardiac remodelling in Asian athletes. Purpose This study aimed to compare echocardiographic parameters of elite endurance athletes (EAs) and non-endurance controls and describe reference ranges in this population of Asian athletes. Methods Consecutive elite athletes engaging in endurance sport were identified from the Singapore Sports Cardiology Registry from January to October 2018. Controls were obtained from 3 sources: (a) skill-based athletes from the Singapore Sports Cardiology Registry, (b) healthy non-athletic volunteers from a national atrial fibrillation registry, and (c) healthy non-athletic volunteers from a national heart failure registry. All participants underwent resting two-dimensional, M-mode and Doppler transthoracic echocardiography and findings from EA were compared with controls. Results 165 participants (55 EAs, 110 controls) were analysed (median age 29 years, male gender n=95; 58%, Chinese ethnicity n=55 for EAs; 100%) Baseline characteristics between both groups were comparable (Table 1). EAs had larger LV wall thickness (9.2 vs. 8.1 mm, p&amp;lt;0.001), LV cavity size (50.7 vs. 48.2 mm, p&amp;lt;0.001), LV mass index (98.4 vs. 73.8 g/m2, p&amp;lt;0.001), aortic root diameter at sinus of Valsalva (30.6 vs. 28.9 mm, p&amp;lt;0.01), right ventricular dimensions and biatrial volumes compared to controls (Table 2). Similar results were noted after indexing to body surface area. These associations also persisted after adjusting for age. Conclusion(s) Endurance activity in elite Singaporean Chinese athletes was associated with significant structural and functional cardiac remodeling compared to controls. Reference ranges for echocardiographic parameters in this population were described, allowing for more accuracy when differentiating physiology from pathology in Asian athletes. Funding Acknowledgement Type of funding sources: None.

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

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. 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 90days was the main outcome measure. In total, 10851 consecutive patients were recruited (mean age: 59.9years, 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 90day 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 90day 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>120ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90day mortality. One of seven ADHF patients in the NHFR died during the first 90days 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.

Vulnerable Phase of Acute Heart Failure and its Association with Hospital Readmissions Reduction Program.

To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF).We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death). The prevalence of LBBB was 13.5% (95% confidence interval: 12.9%–14.0%). In all registries, patients with LBBB more commonly had coronary artery disease and previous episodes of AHF, were taking chronic spironolactone treatment, had lower left ventricular ejection fraction and systolic blood pressure values and higher NT-proBNP levels. There were no differences in risk for patients with LBBB in any cohort, with adjusted hazard ratios (95% confidence interval) for 1-year mortality in EAHFE/RICA/BASEL-V cohorts of 1.02 (0.89–1.17), 1.15 (0.95–1.38) and 1.32 (0.94–1.86), respectively, and for 90-day postdischarge combined endpoint of 1.00 (0.88–1.14), 1.14 (0.92–1.40) and 1.26 (0.84–1.89). These results were consistent in sensitivity analyses.Less than 20% of patients with AHF present LBBB, which is consistently associated with cardiovascular comorbidities, reduced left ventricular ejection fraction and more severe decompensations. Nonetheless, after taking these factors into account, LBBB in patients with AHF is not associated with worse outcomes.

Clinical characteristics and 30-day outcomes in patients with acute decompensated heart failure: Results from Indian College of Cardiology National Heart Failure Registry (ICCNHFR)

BackgroundAcute decompensated heart failure (ADHF) is a challenging medical emergency with high mortality and its prevalence is increasing in India. There is paucity of data on ADHF in the country. MethodsIndian College of Cardiology National Heart Failure Registry (ICCNHFR) is an on-going observational registry on ADHF contributed by 22 hospitals across India; and we present the in-hospital and 30-day outcomes of ADHF patients enrolled from August 2018 to July 2019. Major objective included capturing demographics, comorbid conditions, aetiology, prescription patterns and assessing clinical outcomes. ResultsOf 5269 patients (mean age: 61.90 ± 13.85 years) enrolled in this study, males were predominant (67.09%). Mean duration of hospitalization was 5.74 ± 4.74 days. Ischemic heart disease was the most common (75.44%) aetiology. Abnormal electrocardiogram readings were found in most patients (89.86%). LVEF of ˂40% was found in 68.29% of patients. In-hospital mortality rates were 6.98%. The 30-day cumulative mortality was 12.35% and 30-day rehospitalization rate was 7.98%. At discharge, all guideline-based medical therapy (GDMT) were prescribed only to 24.99% of patients and 23.72% adhered to the prescription until 30 days. Older age, high serum creatinine levels and poor LVEF contributed to high mortality and rehospitalization. ConclusionPatients with ADHF were younger and predominantly males. Usage of GDMT in ADHF patients was low (24.99%) and the in-hospital mortality was high. Older age, high serum creatinine levels, poor LVEF contributed for 30-day mortality and rehospitalization. This data on ADHF, could help in developing strategies to improve outcomes for HF patients in India.

Prevalence and impact on prognosis of right-bundle branch block in patients with acute heart failure: Findings from the RICA registry

ObjectivesThis work aims to determine the prevalence, characteristics, and impact on prognosis of right bundle branch block (RBBB) in a cohort of acute heart failure (AHF) patients. MethodsWe prospectively analyzed 3,638 AHF patients included in the RICA registry (National Heart Failure Registry of the Spanish Internal Medicine Society). We independently analyzed the relationship between baseline and clinical characteristics and the presence of RBBB as well as the potential impact of RBBB on 1-year all-cause mortality and a composite endpoint of 90-day post-discharge hospitalization or death. ResultsThe prevalence of RBBB was 10.9%. Patients with RBBB were older, a higher proportion were male, had more pulmonary comorbidities, had higher left ventricular ejection fraction values, and had worse functional status. There were no differences in risk for patients with RBBB, with an adjusted hazard ratio (95% confidence interval) for 1-year mortality of 1.05 (0.83–1.32), and for the composite endpoint of 90-day post-discharge hospitalization or death of 0.97 (0.74–1.25). These results were consistent on the sensitivity analyses. ConclusionsFew patients with AHF present with RBBB, which is consistently associated with advanced age, male sex, pulmonary comorbidities, preserved left ventricular ejection fraction, and worse functional status. Nonetheless, after considering these factors, RBBB in AHF patients is not associated with worse outcomes.

Prevalencia e impacto en el pronóstico del bloqueo de rama derecha en pacientes con insuficiencia cardíaca aguda: hallazgos del registro RICA

ObjectivesThis work aims to determine the prevalence, characteristics, and impact on prognosis of right bundle branch block (RBBB) in a cohort of acute heart failure (AHF) patients. MethodsWe prospectively analyzed 3,638 AHF patients included in the RICA registry (National Heart Failure Registry of the Spanish Internal Medicine Society). We independently analyzed the relationship between baseline and clinical characteristics and the presence of RBBB as well as the potential impact of RBBB on 1-year all-cause mortality and a composite endpoint of 90-day post-discharge hospitalization or death. ResultsThe prevalence of RBBB was 10.9%. Patients with RBBB were older, a higher proportion were male, had more pulmonary comorbidities, had higher left ventricular ejection fraction values, and had worse functional status. There were no differences in risk for patients with RBBB, with an adjusted hazard ratio (95% confidence interval) for 1-year mortality of 1.05 (0.83-1.32), and for the composite endpoint of 90-day post-discharge hospitalization or death of 0.97 (0.74-1.25). These results were consistent on the sensitivity analyses. ConclusionsFew patients with AHF present with RBBB, which is consistently associated with advanced age, male sex, pulmonary comorbidities, preserved left ventricular ejection fraction, and worse functional status. Nonetheless, after considering these factors, RBBB in AHF patients is not associated with worse outcomes.

Prevalence, Related Factors and Association of Left Bundle Branch Block With Prognosis in Patients With Acute Heart Failure: a Simultaneous Analysis in 3 Independent Cohorts

To determine the prevalence, characteristics and association with prognosis of left bundle branch block (LBBB) in 3 different cohorts of patients with acute heart failure (AHF). We retrospectively analyzed 12,950 patients with AHF who were included in the EAHFE (Epidemiology Acute Heart Failure Emergency), RICA (National Heart Failure Registry of the Spanish Internal Medicine Society), and BASEL-V (Basics in Acute Shortness of Breath Evaluation of Switzerland) registries. We independently analyzed the relationship between baseline and clinical characteristics and the presence of LBBB and the potential association of LBBB with 1-year all-cause mortality and a 90-day postdischarge combined endpoint (Emergency Department reconsultation, hospitalization or death). The prevalence of LBBB was 13.5% (95% confidence interval: 12.9%-14.0%). In all registries, patients with LBBB more commonly had coronary artery disease and previous episodes of AHF, were taking chronic spironolactone treatment, had lower left ventricular ejection fraction and systolic blood pressure values and higher NT-proBNP levels. There were no differences in risk for patients with LBBB in any cohort, with adjusted hazard ratios (95% confidence interval) for 1-year mortality in EAHFE/RICA/BASEL-V cohorts of 1.02 (0.89-1.17), 1.15 (0.95-1.38) and 1.32 (0.94-1.86), respectively, and for 90-day postdischarge combined endpoint of 1.00 (0.88-1.14), 1.14 (0.92-1.40) and 1.26 (0.84-1.89). These results were consistent in sensitivity analyses. Less than 20% of patients with AHF present LBBB, which is consistently associated with cardiovascular comorbidities, reduced left ventricular ejection fraction and more severe decompensations. Nonetheless, after taking these factors into account, LBBB in patients with AHF is not associated with worse outcomes.

Abstract 12125: Baseline Analysis of National Malaysian Heart Failure Registry Indicates Hospitalization as a Key Opportunity to Initiate GDMT in HF Patients

Introduction: There is scarcity of big data on Heart Failure (HF) in the Asean region in the current era of guideline directed medical therapy (GDMT). Malaysia Heart Failure (MYHF) Registry was set up in 2019 to advance fundamental understanding of the burden, morbidity and mortality among Malaysian patients with HF Objective: This analysis is to determine baseline characteristics, diagnostic work up and treatment pattern of patients admitted with the diagnosis of HF to address the unmet and growing clinical needs of HF patients in Malaysia. Methods: The first ever National HF Registry is planned as a prospective, observational study of HF patients (NYHA II-IV) across 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. This Registry recruited all patients admitted with a clinical diagnosis of HF by the attending physician with a minimum hospital stay of 24 hours for stabilisation prior to discharge. Primary endpoint is all cause mortality and hospital readmission for acute decompensated heart failure (ADHF) at one year. This paper summarizes baseline and clinical characteristics of patients along with treatment pattern and outcomes of index hospitalization. Results: We evaluated 2673 patients with mean age of 60 years (SD 13.8). De novo HF constituted one third of hospitalizations. Mean left ventricular ejection fraction (LVEF) was 36.4% (SD 15.3) stratified into 65% of HFrEF (LVEF ≤ 40%), 21% of HFpEF (LVEF ≥ 50%); and 11% of HFmrEF (LVEF 41-49%). Prior to index HF hospitalization, proportion of patients on BB, ACEi, ARBs, ARNI, MRA and ivabradine were 57%, 32%, 8%, 6%, 24% &amp; 6% respectively changing to 79%, 36%, 8%, 15%, 43% &amp; 12% at discharge of the patient. Mean length of hospital stay was 7.3 days (SD 8.9). In-hospital mortality was 3% attributed largely to cardiac causes (68%). Conclusions: The registry identifies at-risk patient populations with HF and highlights lesser prevalence of HFpEF compared to other HF registries. The analysis shows increased usage of GDMT post HF hospitalization event remarkably for BB, MRA, ivabradine and ARNI indicating hospitalization as a key opportunity to initiate GDMT in HF patients.

Assessment of the impact of heart failure on household economic well-being: a protocol

Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Assessment of the impact of heart failure on household economic well-being: a protocol

Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry

AimsHeart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods. MethodsThis work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008–2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods. ResultsA total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008–2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18–1.85; p < .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07–1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20–2.14; p < .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort. ConclusionsIn 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008–2011 period.

Acute decompensated heart failure (ADHF) during COVID-19 pandemic-insights from South India

AimThis retrospective study compares admissions and outcomes due to acute decompensated heart failure (ADHF) during the COVID-19 pandemic from 25 March to 25 July 2020 with the historical patient control who were admitted during the same period in 2019. Methods and resultsData of the participating hospitals was collected and analysed from the ICC NHFR (Indian College of Cardiology National Heart Failure Registry) for 2019 and 2020. Total number of ADHF admissions, demographics, aetiology, co-morbid conditions and in-hospital mortality was compared and analysed. A significant decrease in the number of hospital admissions due to ADHF from 2019 to 2020 (1056 vs. 526 respectively) was noted. Incidence of admissions with <40% ejection fraction (EF) reduced in 2020 (72.4% and 80.2% in2020 and 2019)and >40% (EF) increased (27.6% and 19.8% in 2019 and 2020 respectively, p = 0.0005). Ischemic heart disease (IHD) was the most common aetiology (78.59% in 2019 and 80.98% in 2020, p = 0.268). The in-hospital mortality was numerically higher in 2020 (10%) than in 2019 (8%), but not statistically significant (p = 0.161). ConclusionThis study from the registry shows that the incidence of ADHF admissions during COVID-19 lockdown significantly reduced compared to the previous year. Demographic patterns remained similar but patients presenting with de-novo HF increased; IHD was the most common cause. The in-hospital mortality was numerically higher during the lockdown. The impact of lockdown perhaps led to fewer hospitalisations and this is to be factored in future strategies to address health care delivery during such crises.

Evolución de la asociación de diabetes y eventos posalta en pacientes con insuficiencia cardíaca crónica descompensada: hallazgos del registro RICA

AimsHeart failure (HF) and diabetes are 2strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2time periods. MethodsThis work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods. ResultsA total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p<.001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p=.015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p<.001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort. ConclusionsIn 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.

Rationale, methodology, and design of Indian College of Cardiology National Heart Failure Registry

Aims: Heart Failure (HF) is a growing epidemic globally and a challenging situation particularly for a country like India. There is paucity of data in the Indian context and the Indian College of Cardiology National Heart Failure Registry (ICCNHFR) would be the first of its kind in understanding the aetiology, demographics and treatment pattern in the country. The rationale and design of the study is described. Methods and Results: This is a prospective observational registry study of Acute Decompensated Heart Failure (ADHF) across various hospitals in India. This would include data of consecutive adult patients admitted with acute heart failure in the hospitals. This study is from Sep 2019 to Sep 2021 and is expected to enroll about 10000 patients. The primary data would be to analyse the demographics, aetiology, comorbid conditions, inhospital mortality, 30 day and one year mortality and rehospitalisation. The secondary aim would be understand the diagnostic patterns and therapeutic options offered for these patients.Conclusion: The present registry is designed to analyse the national data on ADHF. This would identify gaps in HF care and therapy. This would help in improving quality of heart failure care in the country and better resource utilization. This will help in the reduction of mortality and morbidity rate related to HF