title: Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry.
abstract: OBJECTIVE
  To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India.
  
  
  METHODS
  The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in-hospital outcomes, and 90-day mortality data were collected. 'Guideline-based' medical treatment was defined as the combination of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD).
  
  
  RESULTS
  We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4-9 days) with an in-hospital mortality rate of 8.5% (95% confidence interval 6.9-10.0). The 90-day all-cause mortality rate was 2.43 deaths per 1000 person-days (95% confidence interval 2.11-2.78). Guideline-based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90-day mortality.
  
  
  CONCLUSIONS
  Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum.
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College PO, Trivandrum, Kerala, 695011, India.
authors.forename: Sivadasanpillai
authors.initials: S
authors.lastname: Harikrishnan
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College PO, Trivandrum, Kerala, 695011, India.
authors.forename: Ganapathi
authors.initials: G
authors.lastname: Sanjay
authors.affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College PO, Trivandrum, Kerala, 695011, India.
authors.forename: Thajudeen
authors.initials: T
authors.lastname: Anees
authors.affiliation: Government Medical College, Trivandrum, Kerala, India.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Viswanathan
authors.affiliation: Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
authors.forename: Govindan
authors.initials: G
authors.lastname: Vijayaraghavan
authors.affiliation: Ananthapuri Hospital, Trivandrum, Kerala, India.
authors.forename: Charantharayil G
authors.initials: CG
authors.lastname: Bahuleyan
authors.affiliation: NIMS Hospital, Neyyattinkara, Kerala, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Sreedharan
authors.affiliation: Cosmopolitan Hospital, Trivandrum, Kerala, India.
authors.forename: Ramabhadran
authors.initials: R
authors.lastname: Biju
authors.affiliation: PRS Hospital, Trivandrum, Kerala, India.
authors.forename: Tiny
authors.initials: T
authors.lastname: Nair
authors.affiliation: SK Hospital, Trivandrum, Kerala, India.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Suresh
authors.affiliation: SUT Hospital, Trivandrum, Kerala, India.
authors.forename: Ashok C
authors.initials: AC
authors.lastname: Rao
authors.affiliation: Government Medical College, Trivandrum, Kerala, India.
authors.forename: Dae
authors.initials: D
authors.lastname: Dalus
authors.affiliation: Northwestern University, Fienberg School of Medicine, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.affiliation: Public Health Foundation of India, New Delhi, India.
authors.forename: Panniyammakal
authors.initials: P
authors.lastname: Jeemon
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D012042:Registries; D013318:Stroke Volume; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000451:Mineralocorticoid Receptor Antagonists
keywords: Heart failure; India; Mortality; Registry