Kauvery Heart Failure Registry- A Concept

Annup Balan1,*, S. Aravindakumar2, Venkita S Suresh3

1Associate Consultant, HIC & Microbiology, Kauvery Hospitals, India

2Chief Consultant Interventional Cardiologist, Kauvery Hospital, Heart City-Trichy, India

3Group Medical Director, Kauvery Hospitals, India

*Correspondence: dr.annupbalan@kauveryhospital.com

Heart failure (HF) is a global public health issue that affects all countries, rich or poor, developed or developing. It is a progressive clinical syndrome. Despite significant developments in the management of chronic heart failure, it remains a major cause of morbidity and mortality, with poor prognosis, often requiring repeated hospitalizations. The need for a resource-intensive treatment coupled with patients presenting with multiple comorbidities often leads to huge catastrophic health expenditures with very poor patient outcomes.

Data on the current practice patterns and clinical outcomes of heart failure patients in low and middle-income countries (LMIC) is often limited due to a multitude of factors. The double burden of heart failure is a well- documented phenomenon in LMIC, i.e., the persistence of valvular and untreated congenital heart diseases that co-exists with lifestyle- related ischemic heart disease. Another paradox observed from the National Heart Failure Registry as well as all the other registries in India was that Indian patients were generally younger, with a higher prevalence of Ischemic heart disease and mortality in comparison with published data from the developed nations.

Organized Heart Failure Registries currently available in India are

  1. Trivandrum Heart Failure Registry (THFR)- 1205 patients
  2. INTER-CHF registry – Global Registry; 858 patients
  3. Kerala HF Registry – Multi-centric study;7500 patients
  4. Medanta- The Medicity ;600 patients
  5. Manipal Heart Failure Registry; 500 patients
  6. National Heart Failure Registry (NHFR) – ICMR Funded; >10,000 patients Postgraduate Medical Education and Research (PGIMER)- Chandigarh
    1. Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)- Pondicherry
    2. UN Mehta Institute of Cardiology and Research Centre (UNMIRC)- Ahmedabad
    3. North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)- Shillong
    4. Medical College Hospital (MCH) – Kolkata
    5. King George’s Medical University (KGMC) – Lucknow
    6. Sri Jayadeva Institute of Cardiovascular Sciences and Research – Bangalore
    7. AIIMS- New Delhi
    8. Sree Chitra Tirunal Institute for Medical Sciences and Technology-Trivandrum

The Kauvery Heart Failure Registry

The need for an exclusive Cardiac Rehabilitation Programme was identified by Dr. S. Aravindakumar,  Chief Cardiologist, Heart City, Trichy. The idea was later permuted to a Registry to extend the concept across all hospitals in the Group.

The Kauvery Heart Failure Registry shall be a structured cardiac rehabilitation service for our patients with the ulterior motive to improve their quality of life. Our hospitals are unique for the various strata we cater to. This unique diversity is what makes us special and stand apart from all other hospitals.

Before enrolling the patient in the registry, the patient will be given a copy of the Kauvery Heart Failure Brochure. The Kauvery Heart Failure Brochure is a detailed booklet, designed with the motive of educating the patient on Heart failure, medical and surgical interventions available as well as addressing all the concerns of the patients concerning diet, exercise, restrictions, etc.

The brochure shall comprise of two parts. The first part will cater to the above-mentioned information. The second part of the Brochure will be Consultant specific. This section will encompass details such as treatment and intervention protocols (as per the consultant). The consultants are free to modify this accordingly. The Registry will not interfere with the prescription practices of the respective consultants. The patients will remain on follow- up with their respective consultants.

The Registry shall be used to send alerts and personalized messages to the patients. The registry shall also be used as a database for tackling any health issues encountered by the patients using telemedicine portal. The telemedicine portal will be integral and highly useful during the ongoing pandemic. The Registry can be used to organize peer group discussions or sessions among patients with the sole purpose of maintaining motivation among the patients. This will be again consultant- specific.

Patients with acute decompensated heart failure will be recruited into the registry as per the European Society of Cardiology (ESC) 2021 Guidelines.

Inclusion Criteria

  1. Age >18 years
  2. Indian Citizen
  3. Diagnostic Confirmation of Heart Failure as per the ESC 2021 Guidelines
    1. Symptoms and signs of heart failure along with LVEF < 40% for heart failure with reduced ejection fraction (HFrEF)
    2. Symptoms and signs of heart failure with LVEF 41% – 49% for Heart Failure with mid- range ejection fraction (HFmrEF)
    3. Symptoms and signs along with LVEF >50% and structural heart disease by ECHO (LVH or LAE) or LV diastolic dysfunction for Heart Failure with Preserved Ejection Fraction (HFpEF) including Elevated BNP (>35 pg/mL)/ NT Pro BNP (>125 pg/mL)
      1. LV Diastolic dysfunction with normal LVEF (Fulfil 3 out of 4 criteria) o Average E/e’ > 14
      2. Septal e’ velocity < 7 cm/s or Lateral e’ velocity < 10 cm/s
      3. TR velocity > 2.8 m/s
      4. LA volume index > 34 ml/m2
    4. Isolated Right Heart Failure with Signs and Symptoms

    We shall be collecting the demographics, clinical information, laboratory parameters, imaging, diagnostic data, and details of treatment practice from all patients enrolled in the registry. We also hope to collect and analyse data on the number of hospitalization events, requirements for further interventions, and mortality. This data shall help in providing crucial data on aetiology, distribution, and practices in the management of heart failure.

    Data Collection

    An Electronic Health Record (EHR) system shall be integral to creating the registry. EHRs have advanced in many areas offering efficiency, safety, and marked quality of data when compared to conventional case sheets. Both EHR and Registries use clinical information at the patient level. But registries are more focussed on a particular population (Heart Failure patients), they are also purpose-driven and are designed to derive information on health outcomes. When the EHR is standardized, it often makes it easy to create multiple Registries. The EHR also makes it easy to maintain confidentiality, privacy, security and regulate data access while creating a registry. The added convenience of accessing the events patient wise is an added boon for the Clinician. Registries can be designed to capture medication as well as procedure data to study the effect of a particular treatment.

    Variables to consider for the Heart Failure Registry

    1. Demographic data
    2. Aetiology factors- Dilated Cardiomyopathy, Ischemic Heart Disease, Hypertrophic Cardiomyopathy, Rheumatic heart disease, Hypertensive cardiomyopathy and miscellaneous aetiologies can be added.
    3. Substance abuse (Tobacco/ Alcohol consumption)
    4. History of Hypertension, Diabetes, stroke, COPD, CKD
    5. Heart rate and Blood pressure
    6. Serum Creatinine and other biomarkers
    7. NYHA Class
    8. LVEF
    9. Rhythm abnormalities
    10. Hospital Admission, mortality, follow up days
    11. Prescription pattern

    Ethical Considerations and Data Safety

    The data shall be kept safely with state-of-the-art technology that ensures no breach in security and ethical dilemmas. Since it is an internal registry, ensuring that the data is safe and secure is our priority. If the need arises to share our database with an external agency, then the registry can be shared without any personal identifiers.

    A consent form will be attached along with the brochure explaining in detail the objectives of enrolling into the Registry. Patients who consent to take part in the registry will only be included in the registry.

    Current status of the EMR at The Heart City

    The IT team has designed the EMR with feedbacks from Consultants. The current template is physician-friendly and is well designed. The support from both the developers as well as the doctors is prime to put the EMR to its best possible use. The software encompasses various modules integrated into it for displaying ECG, ECHO report, Angiograms, and other diagnostic information displayed patient wise available at the fingertips of the respective consultant.

    Dr-B-Annup-Balan

    Dr. B. Annup Balan

    Associate Consultant

     

    Dr-S-Aravindakumar

    Dr. S. Aravindakumar

    Chief Consultant Interventional Cardiologist

     

    Dr-Venkita-S-Suresh

    Dr. Venkita S. Suresh

    Group Medical Director

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