Heart failure silent killer, lands 1.8mn Indians in hospital/year — Asia

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New Delhi: Heart failure leads to 1.8 million hospitalisations in India every year, according to a report by the Asian Pacific Society of Cardiology (APSC), which has called for action to control the condition.

The APSC represents 22 cardiology societies in the Asia-Pacific region, and its report — ‘Heart Failure Unseen: Unmasking the gaps and escalating crisis in Asia Pacific’ — was presented at the body’s 27th congress held in Singapore from 13-15 July.

Heart failure (HF) is a serious, life-threatening cardiovascular condition in which the heart is unable to pump adequate blood to meet the needs of the body.

The disease affects around 64 million people around the world, the report says, adding that HF patients in the Asia-Pacific spend between 5 and 12.5 days in the hospital.

As many as 15 percent of those hospitalised with the disease end up getting readmitted within 30 days of discharge, it says.

A registry by the Indian College of Cardiology suggests that heart failure is the commonest cardiac cause for hospitalisation with 1 percent of the general population being affected annually.

Some estimates from states such as Kerala, said Dr Jayagopal P.B., an interventional cardiologist from the state, show that nearly 1.5 percent of the Indian population may be struggling with the condition — or approximately 14-20 million patients.

The Indian College of Cardiology registry also says that patients with heart failure in India are younger, sicker and have a much higher morbidity and mortality.

While the average life expectancy has increased over the past decade, it has not kept pace with the progress made in several developed countries, according to the APSC report.

“We need to have a similar urgency and approach to heart failure as we have seen with cancer,” said Dr Alexandar Mebazza, professor of anaesthesiology and critical care medicine at the Hôpital Lariboisière, Paris, France, and primary investigator of a trial — titled ‘STRONG-HF’ — which has been dwelt on in the APSC report.

The trial was conducted in the US this year to compare a high-intensity intervention involving up-titration (gradual increase of medicine doses) of HF treatments versus usual care among participants with hospital admission for acute HF.

“There are irreversible implications to poorly managed heart failure and as seen with the STRONG-HF trial, with rapid, simultaneous up-titration of therapies and close follow-up, this can lead to marked improvement in patient quality of life,” Mebazaa said.

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South Asia, which includes India and neighbouring countries, constitutes nearly a quarter of the world’s population, but around 60 percent of the global cardiovascular disease (CVD) burden, the report notes.

There is now evidence to suggest that the Covid-19 pandemic has led to an increase in prevalence of CVDs across the world. Several studies have also established a close link between diseases such as type 2 diabetes and heart failure. The number of diabetics in India has now reached an estimated 101 million.

Apart from diabetes, hypertension, family history and age can also be risk factors to develop the condition, which may lead to 7-8 percent people dying during hospitalisation, Jayagopal said.

“Heart failure is silent killer, as symptoms can be as vague as breathlessness, which many patients, and even some general physicians, treat as a respiratory concern or heartburn,” he said.

The other symptoms of the disease include fatigue and weakness, swelling in the legs, ankles and feet, rapid or irregular heartbeat, reduced ability to exercise, and wheezing. It may also be diagnosed in patients who have a history of heart attacks.

The disease is considered serious as 15 percent of the patients die within 30 days of acute heart failure episodes when patients need hospitalisation, 30-35 percent within one year, while five-year survival rate is 50 percent — worse than even some cancers — Jayagopal said.

Diagnosis of the disease is also a problem, despite some cardiac biomarkers such as NT-proBNP — which can lead to a accurate diagnosis through a blood test that is readily available in tertiary care centres, said the cardiologist.

BNP and NT proBNP are proteins made by the heart. Only small levels of BNP and NT-proBNP are found in the bloodstream and high levels can mean that the heart is not pumping effectively and could lead to congestion (in the heart) and fluid retention.

“In up to 30 percent of hospitalised patients too, diagnosis is not properly done mainly due to lack of awareness among treating doctors,” Jayagopal said.

Jayagopal said “treatment adherence in those who survive after hospitalisation” — or chronic HF patients — is very low.

“Just about 25 percent patients continue treatment one year after hospitalisation even though several class of new therapies, which are very effective and widely accessible, are now available to manage the condition,” he added.

For those in whom the condition cannot be managed with medication alone or those in advanced stages of illnesses, a mechanical assist device — a pump that regulates flow of blood in the body — and heart implantation may be the only treatment options.

It is for this reason, says the APSC report, that it is essential that patients with heart failure are identified and encouraged to seek treatment.

“This process can be enhanced by providing the wider community with localised patient awareness campaigns, outreach programmes, and educational materials, particularly for patients of lower socioeconomic statuses,” says the report.

Disclaimer: The author attended a media programme on ‘Uncovering the Burden of Heart Failure in Asia Pacific’ in Singapore at the invitation of Roche.

(Edited by Sunanda Ranjan)

Also read: From disease surveillance to aiding diagnoses — how AI tools are revolutionising Indian healthcare

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