CSI HFCON2019 calls for raising awareness about heart failure

September 5, 2019 0 By FM

The third edition of the National Heart Failure Conference, themed on ‘Improving heart failure outcomes in India’, highlighted the rise in mortality rates in heart failure, estimated to exceed even those of many cancers.

The two-day convention organized by Cardiological Society of India (CSI) was held at Kochi during 20 and 21st July, 2019.

“The purpose of the conference is mainly to create awareness of heart failure, because it is on the rise and is on epidemic proportions. At the same time, it is a very malignant disease”, says Organising secretary Dr Jabir Abdullakutty, Consultant Cardiologist at Lisie Hospital, Cochin, Kerala.

Data from a snap survey on heart failure patients, conducted by CSI, was released at the event. The study was conducted to take stock of the increasing heart failure incidence in the country and improve outcomes.

It was carried out in select centres across India and found more than 1,200 heart failure cases in a week. The real number of incidences may be 10 or 15 times more than this, said Dr. Jabir.

According to him, the most important factor in dealing with heart failure is proper identification of the disease, treatment with existing guideline medical management, the correct use of drugs at the correct dose and advanced care where necessary.

Of the 1,205 patients surveyed in the Trivandrum Heart Failure Registry (2016), only 25% were on guideline-directed baseline therapies. Most of them were reportedly found to be on inappropriately low dosages as well.

“Only 25-29% of the population in India are given the proper first-line therapy, which include beta blockers and ACE inhibitors. They are cheap and effective in lowering morbidity and mortality rates. Even when drugs are used, they are not used in the proper dosage. Many a time, they are given in minuscule doses, So, there is a lot of deficiency that needs to be corrected first,” said Dr. Prakash Deedwania, Professor of Medicine, University of California, San Francisco.

Heart failure is worse than many cancers: 50% of people will die within 5 years of diagnosis of heart failure. “When people are told about cancer, they get immediate panic and when people are told about heart failure, they do not react that much; even the doctors don’t react,” Dr Deedwania commented.

More number of HF cases are diagnosed today because people are living longer. Heart failure, like atherosclerosis, is a disease of the elderly. People are living longer now, with high blood pressure. Even after a heart attack, people are living much longer than before. Hypertension and heart attacks are the predominant causes of HF today.

Along with rising incidence, the mortality rate is also high with HF. “The TVM Heart Failure Registry has shown that about one-third of the patients don’t make it for one year, and in 3 years, about 45% of them die. It is indeed a miserable disease, even more than cancer,” said Prof. Jayagopal P.B, Interventional Cardiologist, Senior Consultant and Chairman of Lakshmi Hospital, Palakkad, Kerala.

A study showed that about 8-10% of the patients die within the first 30 days, he added.

The registry also indicated that heart failure patients in India were almost a decade younger (mean age 61.2 years) than patients in Europe and United States, and the most common etiology in heart failure was ischemic heart disease (72%).

“In Northern Europe, Sweden, Finland, The Netherlands and the UK, HF patients are usually over 75 to 80 years of age. In Poland our patients maybe 5-7yrs younger. We have more coronary artery disease in younger patients, particularly males. But the case is different in India. There is a difference of about 15-20 years here,” said Dr.Piotr Ponikowski from Wroclaw Medical University, Poland and the former president of Heart Failure Association of European Society of Cardiology.

The average patient in India seems to be about late 50s. It would be a disaster, because if they were allowed to live undiagnosed and not optimally treated, it could lead to an enormously high death rate among those “pretty young people” still in their late 50s, early 60s, he added.

The conference discussed a host of topics, including maintaining an in-hospital and a discharge checklist, training of nurses on guideline-directed medical therapy for HF patients with reduced ejection fraction (HFrEF) – (systolic heart failure) using stimulation. Patient education on tobacco cessation, diet and healthy lifestyle are important to prevent heart failure. Better treatment of heart attack, diabetes, proper lifestyle modification and identification of the disease and early treatment also help to prevent HFs.

The meet also held sessions on reducing the burden of chronic heart failure with the latest diagnosis and device-based treatment options, including cardiac contractility modulation (CCM), left ventricular assist device (LVAD) and mitral clip.

LVAD is used either to partially or completely replace the function of a failing heart and the mitral clip medical device is used to treat mitral valve regurgitation for individuals who should not have open-heart surgery.

The event included three specific workshops demonstrating LVAD, the utility of magnetic resonance imaging MRI in the treatment of heart failure and Cardiac Resynchronization Therapy Pacemaker (CRTP).

Nearly 300 people participated in a Cyclothon – a 20km bicycle ride with the motto ‘Right to protect heart’  — conducted in connection with the event.

Over 600 participants, including 7 international faculty, convened at the conference.