Long-Term Prognosis in Heart Failure: Findings from the Ten-Year Follow-Up of the Trivandrum Registry

BACKGROUND AND METHODS The Trivandrum Heart Failure Registry (THFR) is a prospective cohort study of patients hospitalized with acute decompensated heart failure (HF) in 18 hospitals across Trivandrum, Kerala, from January to December 2013. Trained nurses collected detailed clinical and treatment data, and participants were followed every 3-6 months for ten years. We used Kaplan-Meier survival curves and the Cox proportional hazards model to analyze factors associated with mortality in HF. RESULTS A total of 1,205 patients were enrolled (mean age 61.2 ± 13.6 years), with a male predominance (n=834, 69%). The majority (n=752, 62.4%) had heart failure with reduced ejection fraction (HFrEF), 21.8% had mildly reduced EF (HFmrEF), and 15.8% had preserved EF (HFpEF). Comorbid conditions were common, with 55% having diabetes and 58% hypertension. Ischemic heart disease was the leading cause of HF (71.9%), followed by dilated cardiomyopathy (12.9%) and rheumatic heart disease (7.9%). At discharge, only 25.4% of HFrEF patients received guideline-directed medical therapy (GDMT), a combination of an ACE inhibitor or ARB, a beta-blocker, and a mineralocorticoid receptor antagonist. Complete follow-up data was available for 88.8% of participants. The overall mortality at 10 years was 875 (82.7%) out of 1,058 patients available for follow-up, with cardiovascular causes accounting for 838 (96%) of deaths; the remainder were attributed to COVID-19 and other non-cardiovascular conditions. Mortality was highest among those with HFrEF (85.3%), followed by HFmrEF (82.1%) and HFpEF (72.7%) (Log-rank p<0.001). Among patients with HFrEF on follow-up, the mortality was 126 (75.9%) for those prescribed GDMT at baseline, compared with 437 (88.6%) for those not prescribed GDMT (HR=0.71; 95% CI 0.57-0.88, p=0.002). CONCLUSIONS In this Indian HF registry, 83% of patients died over 10 years, reflecting high mortality. GDMT for HFrEF showed lasting survival benefits, while patients with HFpEF had lower mortality than HFrEF and HFmrEF. The findings stress the need for better implementation of GDMT and wider preventive strategies to reduce HF burden.