Aims Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. Methods and resultsThe NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. Conclusion One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.

Background: Even in developed countries suboptimal anticoagulation and low adherence to guidelines is frequently observed in Atrial fibrillation (AF) patients. There is no data from our regional population and very scarce Indian data about the utilization patterns and adherence to guidelines for stroke prevention in AF. Aims and Objectives: To characterize clinical profile and assess adherence to guidelines in stroke prevention in AF in north Indian population. Material and Methods: It was a single centre observational study. All patients presenting to outpatient department or admitted in cardiology wards from May 2014 to April 2016 with AF were included. Detailed history, examination and relevant investigations were carried out .CHADS 2 score was used for risk stratifying and prescribing oral anticoagulants in nonvalvular AF. The effectiveness of oral anticoagulant was assessed by INR. Result: Total of 446 patients were included. Mean age of our patients was 60.83±16.86 years. 48% were males and 52% were females. Rheumatic heart disease was most common (37.2%) ethology followed by hypertensive cardiovascular disease (18.2%). Mean CHADS 2 score was 2.63±1.5 in non valvular AF. Out of 446 patients, 409(92%) patients were found to have indication for prescription of OAC as per guidelines, out of which only 290 (71%) patients actually received OAC. OAC prescription was significantly higher in valvular vs. non valvular AF ( p=0.0001).The rates of OAC prescription in our patients in age group, ≤65, 66-75, >75 years were 84.4%, 65% and 60.2% respectively Out of 290 patients who were eligible for OAC ,only 102(25%) patients were optimally anti-coagulated. Conclusion: Discordance between guidelines and practice was found regarding prescription of OACs and maintenance of optimal anticoagulation for stroke prevention in our population. Optimal anticoagulation needs to be emphasized on both patients as well as physicians to prevent strokes and achieve better outcomes.

BackgroundMany subjects in community have non-type 1 Brugada pattern ECG with atypical symptoms, relevance of which is not clear. Provocative tests to unmask type 1 Brugada pattern in these patients would help in diagnosing Brugada Syndrome. However sensitivity and specificity of provocating drugs are variable.MethodsWe studied 29 patients referred to our institute with clinical presentation suggestive but not diagnostic of Brugada or with non-Type 1 Brugada pattern ECG. Flecainide Challenge Test (FCT) was done in these patients (IV Flecainide test in 4 patients and Oral Flecainide in 25 patients). Resting 12-lead ECG with standard precordial leads and ECG with precordial leads placed 1 Intercostal space above were performed after flecainide administration every 5 min for first 30 min and every 30 min thereafter until ECG became normal or upto 6 h. The positivity was defined as inducible Type 1 Brugada pattern in atleast 2 right sided leads.ResultMedian age was 35(range = 5–65) years. In 16 (55%) patients the Type 1 Brugada pattern was unmasked. There were no episodes of major AV block, atrial or ventricular tachyarrhythmia. Three groups were considered for analysis: Group 1(n = 9) – FCT Positive among patients with non-type 1 Brugada ECG pattern, Group 2(n = 4) – FCT Negative among the patients with non-type 1 Brugada ECG pattern, and Group 3(n = 7) – FCT Positive among patients with no spontaneous Brugada ECG pattern. Binary logistic regression analysis found that family h/o SCD was predictive of FCT positivity in Group 1 (Odd’s ratio 21, 95% Confidence interval 1.04 to 698.83, p = 0.004).ConclusionOral flecainide is useful and safe for unmasking of Type I Brugada pattern. In our study, among the many variables studied, family history of sudden cardiac death was the only predictor of flecainide test positivity among those with non-Type 1 Brugada pattern.

The global automobile sector is among the driving forces of worldwide economies. Similarly in Pakistan, the automobile sector is the one of greatest industries. Although the automobile is one of the leading private sectors in Pakistan, the industry is largely protected from the external race. Over the eras, the automotive manufacturing consumes made a known run-of-the-mill presentation in rapports of continual and continuous progress. The vehicle manufacturing of Pakistan ensures not to partake a noteworthy part in the overall additional worth of the industrial segment. This study is finding out the effects of high duties, production, technology, and government policies on automobile growth in Pakistan. It will contribute to other important factors that affect the growth of the Automobile Industry worldwide and specially in Pakistan. Many studies use the Balassa index to analyse comparative global trade benefits, which have been shown (particularly in agriculture), but the selected automotive industry has novel study possibilities. This research focuses on the competitiveness of the car industry, a crucial sector because of its high added value, competitive market, growing technical demands and a high level of employment. The objective of our article is to analyse the comparative benefits indicated by Markov's transition probability and the caplan-meier survival function of the global car trade, and the duration and stability of the Balassa indices. Data sources for 1997-2016 are worldwide HS6 car shipments. The article has arrived at several findings. Initially, analysing the global vehicle trade, it was found that the USA, China, Germany and Japan were the greatest vehicle manufacturers, but in the time examined, the main exporters were Germany, Japan and Canada, collectively accounting for 40% of all goods shipped, with 71% of the top 10 nations. Second, the most traded/exported automotive product, as we analysed it, was a worldwide vehicle with just dazzling internal ignition (1500-300cm 3) (870323), representing more than 40% of the whole 1997-2016 export of vehicles. Third, the Balassa calculations reveal that in every period evaluated by the most prominent automotive exporters in the world, Spain and Japan had the largest comparative advantages. This is a descriptive correlational study and the primary purpose is to examine variables and relationships. This study is conducted in the education sector in Karachi, Pakistan with four variables to investigate the causal relationship among different variables. This study constructed a conceptual framework to illustrate a causal relationship by defining the relevant variables. It indicates the independent variable (the cause) and the dependent variable (the effect). There is a positive relationship between production and automobile growth. The effects of Duties are 0.294 on automobile growth and the effect of government policy is 0.177 on automobile growth and the effect of production is 0.152 on automobile growth and the effect of technology is 0.150.

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