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Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Cardiological Society of India. All rights reserved.)

Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019., Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study., Results: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days., Conclusion: The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ALL PARTICIPATING CENTRE CO INVESTIGATORS reports financial support was provided by Cardiological Society of India., (Copyright © 2023 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Aim: Ensuring adherence to guideline-directed medical therapy (GDMT) is an effective strategy to reduce mortality and readmission rates for heart failure (HF). Use of a checklist is one of the best tools to ensure GDMT. The aim was to develop a consensus document with a robust checklist for stabilized acute decompensated HF patients with reduced ejection fraction. While there are multiple checklists available, an India-specific checklist that is easy to fill and validated by regional and national subject matter experts (SMEs) is required., Methodology: A total of 25 Cardiology SMEs who consented to participate from India discussed data from literature, current evidence, international guidelines and practical experiences in two national and four regional meetings., Results: Recommendations included HF management, treatment optimization, and patient education. The checklist should be filled at four time points- (a) transition from intensive care unit to ward, (b) at discharge, (c) 1st follow-up and (d) subsequent follow-up. The checklist is the responsibility of the consultant or the treating physician which can be delegated to a junior resident or a trained HF nurse., Conclusion: This checklist will ensure GDMT, simplify transition of care and can be used by all doctors across India. Institutions, associations, and societies should recommend this checklist for adaptability in public and private hospital. Hospital administrations should roll out policy for adoption of checklist by ensuring patient files have the checklist at the time of discharge and encourage practice of filling it diligently during follow-up visits., Competing Interests: Conflicts of interest Development of the checklist, writing/editorial support were funded by Novartis Healthcare Pvt Ltd, India. The Sponsor reviewed the initial draft and subsequent versions of the manuscript for own data accuracy and for proprietary evaluation. The authors were advisors of National and Regional Steering Committee Meetings across India to formulate the consensus document and received honoraria from Novartis., (Copyright © 2020. Published by Elsevier B.V.)

The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories., Competing Interests: Conflict of interest There is no conflict of interest with either the corresponding author or any of the authors/co-authors., (Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia., (Copyright © 2018 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management., (Copyright © 2017. Published by Elsevier B.V.)

Sequential cardiac chamber activation and chronotropic response are amongst the important determinants of cardiac performance. This study compared VVIR mode with DDD and VVI mode to assess the contribution of these two factors in the determination of cardiac performance during exercise. Ten patients with a mean age of 68 +/- 5 years were studied during 1988-90, who had complete heart block and sinus node dysfunction with a mean LV ejection fraction of 51.5 +/- 6.25%. Five patients had DDD pacemakers and the rest had VVIR pacemakers. Patients were exercised first in VVI mode followed by either DDD or VVIR mode. Exercise duration, maximum rate pressure product, exercise capacity and cardiac output were measured with graded treadmill test in Bruce protocol. There was remarkable increase in the exercise duration (P < 0.001) and the maximum rate pressure product (P < 0.001) in patients with VVIR as compared to DDD and VVI mode. In DDD mode, as compared to VVI mode, this increase was less remarkable, though statistically significant (P < 0.005). Therefore, it is concluded that patients with chronotropic incompetence as well as complete heart block do better during dynamic exercise when they have VVIR mode compared to VVI or DDD mode.

Sixty-five cases were evaluated for silent myocardial ischaemia (SMI) by computerised treadmill test (TMT) and ambulatory electrocardiographic monitoring (AEM). There were 59 males and 6 females. The cases were divided into GP-I-stable angina (35 cases) GP-II-stable angina after myocardial infarction (15 cases) and GP-III-asymptomatic (15 cases). Age in each group ranged from 36 years to 62 years (GP-I), 40 years to 68 years (GP-II) and 36 years to 48 years (GP-III). Conventional risk factors viz. hypertension, diabetes mellitus, hyperlipidemia, smoking and family history were assessed with a view to see their implication on SMI. 43 patients (62.2%) were found to have SMI including mixed episodes. Out of these 43, TMT was positive in 29 patients (67.4%), AEM was positive in 41 patients (95.3%) and both TMT and AEM were positive in 27 patients (62.7%). Correlative analysis between risk factors and SMI revealed that higher number of was associated with not only more positive TMT and AEM test along with increased episodes of SMI but also increased degree of ST-T depression. It was also found that AEM is more sensitive than TMT (80% Vs 48%) for diagnosing SMI (SED = 9.03%), though specificity of the tests is same (93.3%).

In 265 patients of acute myocardial infarction (AMI) heparin followed by warfarin sodium was used routinely whenever there was no contraindication to the drug. Patients were followed up to 2 years with weekly estimation of prothrombin time. Another 265 patients of AMI having identical clinical profiles were taken as control and neither any anticoagulant nor any antiplatelet agent was used in them. Both groups were also treated with identical coronary dilators whenever needed. 2 years cardiac mortality was 11.6% in the control group and 5.9% in the anticoagulant therapy (ACT) recipient group (P less than 0.05). Incidence of reinfarction (RMI) was 14.4% during the period in the control group whereas it was only 6.7% in the ACT group (P less than 0.05). The incidence of intracranial events were also more frequent in control group (8.4%) compared to ACT group (3.1%) (P less than 0.05). However on further analysis of intracranial events, it was found that haemorrhagic intracranial events were slightly more frequent in ACT (2.3%) than in the control group (2%), but this difference was statistically insignificant (P greater than 0.05); non-haemorrhagic intracranial events were however significantly less in ACT group (1.96%) compared to the control group (6%) (P less than 0.05). There was no major or fatal extracranial haemorrhagic complication in either group. Only minor extracranial haemorrhages were more commonly observed in the ACT group (4.3%) compared to the control group (1.2%) (P less than 0.05).

The study included 45 consecutive patients in the age group of 27 to 39 years presenting with AMI diagnosed by typical history, ECG changes and enzyme response. Prognostic significance of various risk factors in AMI in young was evaluated. There were 41 M (91.1%) and 4 F (8.9%) with mean age of 34.6 years. ECG showed anterior myocardial infarction (MI) in 18 (40%), inferior MI in 15(33.3%), Subendocardial inf in 10(22.5%) and combined anterior and inferior MI in 2 (4.5%) cases. Various risk factors were: Smoking (60%), hyperlipidemia (44.4%), stress (40%), hypertension (28.9%), family history (28.9%), diabetes mellitus (15.7%) and obesity (8.8%). Attention was given on atherogenic index (AI) (22.2%). Coronary angiogram was done in 20, which revealed significant coronary arterial obstruction in 15 cases; 3-vessel disease (n = 7), 2 vessel disease (n = 4) and single vessel disease (n = 4). Both 3 VD and 2 VD were associated with high AI. Risk factors (RF) were grouped as RFGI when combination of 3 or more RF were present, and RFG II when 2 or less RF were present. RFGI and RFGII were present in 40% and 60% cases respectively. Prognostically, patients were divided in two groups of MI-fatal (6) and nonfatal (39), the latter were subdivided into complicated (14) and uncomplicated (25). It was observed that more fatal cases were found in RFGI, whereas nonfatal uncomplicated MI was more in RFG II (P less than .001).

Fourteen patients of pure valvular pulmonary stenosis of moderate to severe degree underwent balloon valvuloplasty in the Department of Cardiology, SSKM Hospital, Calcutta. Haemodynamic study revealed that immediately after valvuloplasty, right ventricular pressure dropped down from 125 +/- 17.18 mmHg. to 56.67 +/- 8.72 mmHg. (mean +/- SD). Restudy was done in each case after 4 weeks, which showed that right ventricular systolic pressure had further dropped down to 46.71 +/- 5.06 mmHg. (Mean +/- SD). Patients were further followed up for 6 to 15 months (mean 10 months). During the follow-up period, all the patients remained asymptomatic. Drop of right ventricular systolic pressure was maintained except in one case in which the peak systolic pressure gradient across the pulmonary valve was raised to 61 mmHg. from 24 mmHg., the gradient achieved immediately after valvuloplasty.