Heart Failure in South Asia

Abstract

South Asia (SA) is both the most populous and the most densely populated geographical region in the world. The countries in this region are undergoing epidemiological transition and are facing the double burden of infectious and non-communicable diseases. Heart failure (HF) is a major and increasing burden all over the world. In this review, we discuss the epidemiology of HF in SA today and its impact in the health system of the countries in the region. There are no reliable estimates of incidence and prevalence of HF (heart failure) from this region. The prevalence of HF which is predominantly a disease of the elderly is likely to rise in this region due to the growing age of the population. Patients admitted with HF in the SA region are relatively younger than their western counterparts. The etiology of HF in this region is also different from the western world. Untreated congenital heart disease and rheumatic heart disease still contribute significantly to the burden of HF in this region. Due to epidemiological transition, the prevalence of hypertension, diabetes mellitus, obesity and smoking is on the rise in this region. This is likely to escalate the prevalence of HF in South Asia. We also discuss potential developments in the field of HF management likely to occur in the nations in South Asia. Finally, we discuss the interventions for prevention of HF in this region

Epidemiology of Heart Failure in Asia

“…44 It also has been demonstrated that patients who develop HF are relatively younger in South Asia, although scant information is available. 16 A report in 2008 from a single center in Pakistan reported that the mean age of HF patients (n=276) was 54.4 years, 49 compared with a mean age of 73.1±13.9 years in 500,000 US patients 50 and 68.2±12.3 years in 10,219 Japanese patients registered in the CHART-2 study. 10 Accordingly, HF patients are generally younger in China and South/South-East Asian countries as compared with those in East Asian and Western countries.…”

“…16 Furthermore, Pillai and Ganapathi also estimated that the prevalence of HF is approximately 30 million in South Asia when extrapolating the same prevalence rate to the whole of South Asia (total population of 1.63 billion in 2011). 16 Thus, it is highly possible that Asian countries will experience a further burden of HF, requiring systematic approaches to surmount this epidemic.…”

“…15 Unfortunately, there is no reliable estimate in South Asia. 16 Huffman et al reported that the estimated number of patients with HF related to CHD, hypertension (HT), obesity, DM and RHD in 2000 in India ranged from 1.3 to 4.6 million. 17 However, it is also reported that, if the prevalence rate of HF in the USA in 2010 was applied, the prevalence of HF would be 1.87% in India and that the number of HF patients would be 22.7 million if In South Asia, in addition to CAD and HT, RHD is a major contributor to HF.…”

“…17 However, it is also reported that, if the prevalence rate of HF in the USA in 2010 was applied, the prevalence of HF would be 1.87% in India and that the number of HF patients would be 22.7 million if In South Asia, in addition to CAD and HT, RHD is a major contributor to HF. 16 Although there are few major studies, a small study from India in 1999 (n=125) reported that RHD was the commonest underlying heart disease (52.8%), followed by ischemic and/or hypertensive heart disease (27.2%). 24 On the other hand, a study from Pakistan reported in 2007 that 77% was related to IHD among 196 HF patients with systolic HF.…”

“…8 In South Asia, it is also possible that etiologies of HF have changed during the past several decades, but there is little information available. 16 …”