부산대학교 도서관

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/j.ahj.2017.03.019 Byline: Sivadasanpillai Harikrishnan, DM [drharikrishnan@outlook.com] (a,*), Ganapathi Sanjay, DM (a), Anubha Agarwal, MD (b), N. Pratap Kumar, DM (c), K. Krishna Kumar, MD (d), Charantharayil Gopalan Bahuleyan, DM (e), Govindan Vijayaraghavan, DM (f), Sunitha Viswanathan, DM (g), Madhu Sreedharan, DM (h), R. Biju, DM (i), N. Rajalekshmi, DM (j), Tiny Nair, DM (k), Krishnan Suresh, DM (l), Panniyammakal Jeemon, PhD (m) Background There are sparse data on outcomes of patients with heart failure (HF) from India. The objective was to evaluate hospital readmissions and 1-year mortality outcomes of patients with HF in Kerala, India. Methods We followed 1,205 patients enrolled in the Trivandrum Heart Failure Registry for 1 year. A trained research nurse contacted each participant every 3 months using a structured questionnaire which included hospital readmission and mortality information. Results The mean (SD) age was 61.2 (13.7) years, and 31% were women. One out of 4 (26%) participants had HF with preserved ejection fraction. Only 25% of patients with HF with reduced ejection fraction received guideline-directed medical therapy at discharge. Cumulative all-cause mortality at 1 year was 30.8% (n = 371), but the greatest risk of mortality was in the first 3 months (18.1%). Most deaths (61%) occurred in patients younger than 70 years. One out of every 3 (30.2%) patients was readmitted at least once over 1 year. The hospital readmission rates were similar between HF with preserved ejection fraction and HF with reduced ejection fraction patients. New York Heart Association functional class IV status and lack of guideline-directed medical treatment after index hospitalization were associated with increased likelihood of readmission. Similarly, older age, lower education status, nonischemic etiology, history of stroke, higher serum creatinine, lack of adherence to guideline-directed medical therapy, and hospital readmissions were associated with increased 1-year mortality. Conclusions In the Trivandrum Heart Failure Registry, 1 of 3 HF patients died within 1 year of follow-up during their productive life years. Suboptimal adherence to guideline-directed treatment is associated with increased propensity of readmission and death. Quality improvement programs aiming to improve adherence to guideline-based therapy and reducing readmission may result in significant survival benefits in the relatively younger cohort of HF patients in India. Author Affiliation: (a) Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (b) Duke University, Durham, NC (c) Meditrina Hospital, Trivandrum, India (d) Govindan's Hospital, Trivandrum, India (e) Ananthapuri Hospital, Trivandrum, India (f) KIMS Hospital, Trivandrum, India (g) Medical College Hospital, Trivandrum, India (h) NIMS Hospital, Neyyattinkara, Trivandrum, India (i) Cosmopolitan Hospital, Trivandrum, India (j) SUT Hospital, Trivandrum, India (k) PRS Hospital, Trivandrum, India (l) SK Hospital, Trivandrum, India (m) Public Health Foundation of India, New Delhi, India * Reprint requests: Dr. S Harikrishnan, DM, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum Medical College PO, Trivandrum, Kerala, 695011, India. Article History: Received 27 January 2017; Accepted 31 March 2017 (footnote) Hector O. Ventura, MD, served as guest editor for this article. (footnote) Funding: Indian Council for Medical Research, New Delhi, India.