Advanced heart failure beckons: where are the cardiologists?
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Advanced heart failure beckons: where are the cardiologists? Vishal Rastogi 1
&
Aparna Jaswal 2
Received: 25 July 2020 / Accepted: 29 July 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Advanced Heart Failure is one of the leading causes of death and hospitalization worldwide. Its incidence is increasing steadily in India as well. Despite a huge need, not many cardiologists take heart failure as a career option. The present article seeks to explore the potential reasons for this lack of interest among cardiologists of the country. It also briefly attempts to suggest remedial actions. Keywords Advanced Heart failure . Cardiologists
Chronic heart failure, a relentlessly progressive disease, is a major cause of recurring hospitalization and mortality globally. India is also a victim of the ever-increasing burden of the disease. However, improved delivery of therapeutic options of acute coronary syndromes and acute heart failure reduces inhospital and 30-day mortality but predisposes to subsequent chronic heart failure. The price of increased longevity seems greater for some due to progression to heart failure in them. Despite significant improvements in medical treatment, heart failure continues to remain a progressive condition, leading to worsening of the heart function and degradation of the clinical status. The current estimates about the incidence of heart failure (HF) in India vary widely from 1.3 to 23 million [1]. Heart failure patients in India are a decade younger, have a greater incidence of diabetes, and are subject to higher inhospital mortality compared with Western counterparts [2, 3]. Of this large heart failure population, approximately 10% suffer from advanced heart failure. Advanced heart failure is a clinical syndrome in which a patient has persistent and progressive symptoms despite guideline directed medical therapy (GDMT) [4]. At this stage, the clinical picture is gripped by severe symptoms, frequent episodes of decompensation,
* Vishal Rastogi [email protected] 1
Head Advanced Heart Failure Program, Fortis Escorts Heart Institute, New Delhi, India
2
Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute, New Delhi, India
recurrent hospitalization, and poor quality of life (NYHA class 3B or class 4). The patient in advanced heart failure has progressed to a condition where traditional treatments are ineffective and advanced escalated tailored therapies such as mechanical circulatory support (MCS) and/or heart transplant become necessary. The patients in this phase are classified as stage D heart failure or end-stage heart failure [5]. These patients urgently need a referral to an advanced heart failure program to avoid further decompensation and multi-organ failure which may else render them ineligible for advanced therapeutic options. India, on the verge of being a world capital of lifestyle diseases, is crippled by the lack of heart failure clinics. Limited cardiologists in the country have set up the required speciality
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