Jay Shah, Ritankur Barkotoky, R Sivakumar
The leading cause of death in India is cardiovascular disease (CVD) and its prevalence is expected to rise. A 5% prevalence of obesity in India can cause an estimated 1,80,000–3,00,000 cases of heart failure (HF) annually. Since the progression of asymptomatic left ventricular systolic dysfunction (LVSD) leads to HF, early diagnosis can help in delaying or reversing the progression. Six consensus meetings were held at the national level wherein experts from across the country discussed various factors that can hinder early diagnosis of HF and reviewed the SIGMA goals of HF management. The attitude of physicians towards HF must be reformed, and they need to be vigilant of the signs and symptoms of HF. Clinical examination with a history of past month is most crucial in screening HF. Diabetics with hypertension for >5 years must be strongly suspected. Chest radiograph can be done to rule out cardiomegaly, pulmonary venous congestion, and other differential diagnosis. Electrocardiography and echocardiography should rule out abnormal rhythm/ventricular hypertrophy/ischemic heart disease. Usually, asymptomatic patients have increased natriuretic peptides. B-type natriuretic peptide (BNP) levels help in diagnosis of HF with preserved ejection fraction (HFpEF). In the elderly, body mass index must be taken into consideration for HF assessment, and higher values of N-terminal (NT)-proBNP and BNP could predict HF diagnosis. Symptom alleviation, preventing hospitalization, and improving survival are the goals of HF therapy. HF symptom management requires meticulous diagnostic work-up as well as optimal treatment of underlying conditions. The justification for quality-of-life (QoL) inclusion can be drawn from the fact that HF not only affects patient health but also influences QoL domains, such as psychological, social, emotional, sexual, and mental wellâ€‘being. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and/or other cardiovascular drugs as first-line therapies that significantly reduce hospitalization risk.
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