32 Epidemiology of heart failure in south asia

South Asia has seen rapid epidemiological transition in the last two decades with a rapid rise in cardiovascular diseases, which have emerged as the leading cause of mortality in this region. In India the leading cause of disability adjusted life years is ischaemic heart disease which has seen a 104% increase between 1990 and 2016.1 Similarly the burden of obesity, hypertension and diabetes mellitus has increased markedly over this time and with poor control rates for these risk factors leading to a fertile soil for rise in incidence of heart failure.2 In the absence of active surveillance mechanisms reliable estimates of heart failure burden is missing. However, one study estimates it to the tune of 4.6 million which is probably a severe under-estimate given the risk factor burden.3 The study of the heart failure patients in two large registries, INTER-CHF and Trivandrum Heart Failure Registry,4 5 revealed disturbingly high mortality rates of 23% and 31%, respectively. This was much higher than that of patients from other low and middle income countries.4 The chief driver of this mortality seems to be suboptimal medical management of these patients with a large percentage not receiving beta-blockers and renin-angiotensin aldosterone inhibitors; drugs known to improve survival. Thus, quality improvement program using guideline-directed medical therapy will go a long way in improving survival of these patients. References India State-Level Disease Burden Initiative Collaborators. (2017). Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study. Lancet 2017;390: 2437–2460. Prabhakaran D, Roy A, Praveen PA, Ramakrishnan L, Gupta R, Amarchand R, Kondal D, Singh K, Sharma M, Shukla DK, Tandon N, Reddy KS, Krishnan A. 20-year trend of CVD risk factors: urban and rural national capital region of India. Glob Heart 2017;12:209–217. Huffman MD, Prabhakaran D. Heart failure: epidemiology and prevention in India. Natl Med J India 2010;23:283–288. Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, Palileo-Villaneuva L,Lopez-Jaramillo P, Karaye K, Yusoff K, Orlandini A, Sliwa K, Mondo C, Lanas F, Prabhakaran D, Badr A, Elmaghawry M, Damasceno A, Tibazarwa K, Belley-Cote E, Balasubramanian K, Islam S, Yacoub MH, Huffman MD, Harkness K, Grinvalds A, McKelvie R, Bangdiwala SI, Yusuf S; INTER-CHF Investigators. 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:e665–e672. Harikrishnan S, Sanjay G, Agarwal A, Kumar NP, Kumar KK, Bahuleyan CG, Vijayaraghavan G, Viswanathan S, Sreedharan M, Biju R, Rajalekshmi N, Nair T, Suresh K, Jeemon P. One-year mortality outcomes and hospital readmissions of patients admitted with acute heart failure: Data from the Trivandrum Heart Failure Registry in Kerala, India. Am Heart J 2017;189:193–199.