30% heart failure patients die in hospital, finds AIIMS study

The number of patients who die of heart failure at AIIMS is 30.8 per cent compared to 4-7 per cent in the US and Europe, the study says. The findings have been published in the Journal of Practice of Cardiovascular Sciences, a new journal started by the Department of Cardiology at AIIMS.

Heart failure patients reporting to AIIMS are also much younger than in the West with a mean age of 53 years against 65-73 years in Europe and the US.

“This is an indication of how sick the patients are when they report to us. Basic knowledge of managing heart failure or detecting the disease at an early stage is missing, so it is difficult to manage them in the hospital. Among those we treat successfully and who get discharged, compliance to precautions like salt and fat intake and medicine compliance is so poor that they end up developing complications, which may be fatal,” Dr Sandeep Seth, professor of cardiology and editor of the journal who is one of the authors of the study, said.

Ninety patients who reported to the hospital with Acute Decompensated Heart Failure (ADHF) over a period of six months were included in the study, of which 63 per cent were male. Of the 30.8 per cent who died in the hospital during treatment, 92 per cent died directly from heart failure, while six per cent died of irreversible situations of poor heart beat, a condition known as intractable arrhythmias or kidney failure.

Within six months of discharge, 39.5 per cent patients needed re-hospitalisation due to complications, of whom 26.3 per cent died. In comparison, according to two international scales in the US and Europe, 4-7 per cent heart failure patients die after reporting to hospitals during treatment, 5-15 per cent patients die within 90 days of being discharged, and 24-31 per cent patients need re-hospitalisation during the same period.

Ejection fraction or the capacity of the heart to pump blood after heart failure was much lower in the AIIMS data — 29.2 per cent compared to the global figures of 34.4 to 39 per cent. “This supports the concept that heart diseases affect younger people in India than in other countries. This could be due to genetic factors or many other reasons, which have not been comprehensively established yet,” Dr Seth said.

Dr Balram Bhargava, professor of cardiology at AIIMS, said. “We rely on international data on severity and recovery rates of heart failures. There is a need for institutions in India to start producing and collaborating to get country-specific data, which may help us in understanding heart disease better.”

Doctors said the very high rates of mortality in AIIMS could also be because the patients reporting to the institute are very critical. “This reflects the very sick nature of the patients who ultimately get admitted at this tertiary hospital due to triage…,” the study notes.