Naik Ajay, Singh Balbir, Yadav Rakesh, Pandurangi Ulhas, Kler T S, Shankar Bhim, Radhakrishnan Rajesh, Rajan Vinayakrishnan, Bhatia Vinit, Kaul Upendra, Varma Jagmohan, Dora Santosh, Narasimhan Calambur
Care Institute of Medical Sciences, Ahmedabad, India.
Medanta-The Medicity, Gurgaon, India.
Indian Heart J. 2018 Dec;70 Suppl 3(Suppl 3):S377-S383. doi: 10.1016/j.ihj.2018.07.010. Epub 2018 Aug 25.
Heart failure (HF) is a common health problem in South Asia, and its incidence and prevalence are projected to rise. Cardiac resynchronization therapy (CRT) has been shown to improve mortality, reduce hospitalizations, and improve symptoms in selected patients with HF. The South Asian Systolic Heart Failure Registry (SASHFR) was designed to be a large and comprehensive registry of Indian HF patients with the purpose of enhancing the quality of care and clinical outcomes of HF patients by promoting the adoption of evidence-based, guideline-recommended therapies, in particular CRT.
Overall, 471 patients on optimized medical therapy and meeting CRT implantation guidelines were followed up in 12 Indian hospitals. During the 2-year follow-up period, clinical response in terms of clinical composite score, overall performance and changes in HF performance metrics, mortality and hospitalizations rates were evaluated.
Of 471 patients, 116 (24.6%) accepted to be implanted with a CRT device, while 355 (75.4%) refused, financial constraints being the main reason for refusing a CRT device. The study met its primary outcome, as the number of patients associated with an improvement in clinical composite score at 24 months was significantly higher (69.1%) in the CRT group than in the no-CRT group (44.7%) [odds ratio = 2 (95% confidence interval 1.25-3.20), p = 0.004]. Also, changes in HF metrics, mortality and hospitalizations rates indicated a more favorable response among patients who underwent CRT.
The results from the SASHFR registry show a clear superiority of CRT over optimal pharmacological therapy in terms of improvement in clinical conditions among HF patients. The low rate of CRT acceptance, in patients indicated to this therapy, highlights the need for new health-care policies to improve awareness about HF disease and its therapies and possibly to enhance financial coverage of indicated therapies.
心力衰竭（HF）是南亚地区常见的健康问题，预计其发病率和患病率将会上升。心脏再同步治疗（CRT）已被证明可改善特定HF患者的死亡率、减少住院次数并缓解症状。南亚收缩期心力衰竭注册研究（SASHFR）旨在成为一个庞大而全面的印度HF患者注册库，通过推广采用循证、指南推荐的治疗方法，尤其是CRT，来提高HF患者的护理质量和临床结局。
总体而言，12家印度医院对471例接受优化药物治疗且符合CRT植入指南的患者进行了随访。在2年的随访期内，评估了临床综合评分、总体表现和HF性能指标变化方面的临床反应、死亡率和住院率。
在471例患者中，116例（24.6%）接受了CRT设备植入，而355例（75.4%）拒绝了，经济限制是拒绝CRT设备的主要原因。该研究达到了其主要结局，因为CRT组在24个月时临床综合评分改善的患者数量（69.1%）显著高于非CRT组（44.7%）[优势比=2（95%置信区间1.25 - 3.20），p = 0.004]。此外，HF指标的变化、死亡率和住院率表明接受CRT的患者反应更良好。
SASHFR注册研究的结果表明，在改善HF患者临床状况方面，CRT明显优于最佳药物治疗。在适合接受该治疗的患者中，CRT接受率较低，这凸显了需要新的医疗保健政策来提高对HF疾病及其治疗方法的认识，并可能增加对指定治疗的经济覆盖范围。
