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1. Impact of COVID-19 on heart failure hospitalization and outcome in India – A cardiological society of India study (CSI–HF in COVID 19 times study – “The COVID C–HF study”)

Author

B, Jayagopal P., S, Ramakrishnan, P, Mohanan P., A, Jabir, K, Venugopal, Das, M.K., K, Santhosh, N, Syam, Ezhilan, J., Agarwal, Rajeev, P R, Vaidyanathan, Choudhary, Ahmed Hussain, C B, Meena, Malviya, Amit, Gopi, Arun, V K, Chopra, Joseph, Stigi, Goyal, Krishna Kishore, John, John F., Bansal, Sandeep, S, Harikrishnan, Nagula, Praveen, Joseph, Johny, Bagawat, Ajit, Seth, Sandeep, Shah, Urmil, Goel, Pravin K., Asokan, P.K., Sethi, K.K., Sharma, Satyavan, Banerji, (Lt.Gen)Anup, Sikdar, Sunandan, Agarwala, ManojKumar, Chandra, Sharad, Bharti, BishwaBhushan, Ashraf, S.M., Srivastava, Smit, Kesavamoorthy, B., Bali, Harinder Kumar, Sarma, Dipak, Jain, Rajendra Kumar, Dani, Sameer I., Natesh, B.H., Chakraborty, Rabindra Nath, Gupta, Vivek, Khanna, Narendra Nath, Mukhopadhyay, Dipankar, Mandal, Subroto, Majumder, Biswajit, L, Sridhar, Girish, Meennahalli Palleda, Das, DipakRanjan, Devasia, Tom, Vajifdar, Bhavesh, Bhatia, Tanuj, Abdullah, Zia, Sharma, Sanjeev, Kumar, Sudeep, Lincy, Mathew, Naik, Nitish, Kahali, Dhiman, Sinha, Dhurjati Prasad, Dastidar, Dipankar Ghosh, Wander, Gurpreet Sing, Yadav, Rakesh, Tewari, Satyendra, Bhandari, Suman, Chandra Rath, Pratap, Bang, Vijay Harikisan, Roy, Debabrata, Banerjee, ParthoSarathi, Shanmugasundaram, S., and Zachariah, Geevar

Published
2023
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2. One‐year outcomes of rate versus rhythm control of atrial fibrillation in the Kerala‐AF Registry

Author

Calvert, Peter, Chen, Yang, Gue, Ying, Gupta, Dhiraj, Azariah, Jinbert Lordson, George Koshy, A., Zachariah, Geevar, Lip, Gregory Y. H., Gopalan, Bahuleyan Charantharayil, Namboodiri, Narayanan, Jabir, A., George Koshy, A., Zachariah, Geevar, Shifas Babu, M., Venugopal, K., Punnose, Eapen, Natarajan, K. U., Joseph, Johny, Ashokan Nambiar, C., Jayagopal, P. B., Mohanan, P. P., George, Raju, Unni, Govindan, Sajeev, C. G., Syam, N., Roby, Anil, Daniel, Rachel, Krishnakumar, V. V., Pillai, Anand M., Joseph, Stigi, Mini, G. K., Koya, Shaffi Fazaludeen, Eapen, Koshy, Ram, Raghu, Mathew, Cibu, Faizal, Ali, Issac, Biju, Renga, Sujay, Menon, Jaideep, Harikrishna, D., Suresh, K., Nair, Tiny, Susanth, S. S., Anil Kumar, R., Abilash, T. P., Sreekala, P., Rajeev, E., Raj, Arun, Naik, Ramdas, Rajalekshmi, Gopinath, Anoop, Binu, R., Chacko, Jossy, Iqbal, P. T., Sudhir, N. M., Sreedharan, Madhu, Balakrishnan, N., Musthaffa, Muhammed, Jayakumar, B., George, Sheeba, Kumar, Anand, Mathew, Thomas, Pramod, V. K., Shaloob, Muhammed, Chandy, Madhu Paulose, Vinod, K. R., Sajan Ahamad, Z., and Mathew, Pramod

Abstract

There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala‐AF represents the largest prospective AF cohort study from the Indian subcontinent. To compare 12‐month outcomes between rate and rhythm control strategies. Patients aged ≥18 years with non‐transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all‐cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression. A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p= .955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p= .848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p= .013), BMI <18 (aOR 1.51; p= .025), permanent AF (aOR 0.78; p= .010), HFpEF (aOR 1.40; p= .023), HFrEF (aOR 1.39; p= .004), chronic kidney disease (aOR 1.36; p< .001), and prior thromboembolism (aOR 1.31; p= .014). In the Kerala‐AF registry, 12‐month outcomes did not differ between rate and rhythm control cohorts. No significant difference was found between rate and rhythm control approaches to atrial fibrillation management in the 1‐year follow‐up of the Kerala‐AF cohort. Independent predictors of adverse outcomes included age, underweight BMI, heart failure, and chronic renal failure.

Published
2024
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3. Team based collaborative care model, facilitated by mHealth enabled and trained nurses, for management of heart failure with reduced ejection fraction in India (TIME-HF): design and rationale of a parallel group, open label, multi-centric cluster randomised controlled trial

Author

Jeemon, Panniyammakal, primary, Bahuleyan, Charantharalyil Gopalan, additional, Chandgalu Javaregowda, Devaraju, additional, Punnoose, Eapen, additional, Rajendiran, Gopalan, additional, Unni, Govindan, additional, Abdullakutty, Jabir, additional, Balakrishnan, Jayakumar, additional, Joseph, Johny, additional, Gnanaraj, Justin Paul, additional, Sreedharan, Madhu, additional, Pillai, Meera R, additional, KR, Neenumol, additional, Thomas, Paul, additional, Sebastian, Placid, additional, Daniel, Rachel, additional, Edakutty, Rajeev, additional, Ahmad, Sajan, additional, Mattummal, Shafeeq, additional, Thomas, Sunu C, additional, Joseph, Stigi, additional, Pisharody, Sunil, additional, Chacko, Susanna, additional, Syam, N, additional, Nair, Tiny, additional, Nanjappa, Veena, additional, Ganesan, Vijayan, additional, George, Vijo, additional, Ganapathi, Sanjay, additional, and Harikrishnan, Sivadasanpillai, additional

Published
2023
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4. Team based collaborative care model, facilitated by a mHealth enabled and trained nurse, for management of heart failure in India (TIME-HF): design and rationale of a parallel group, open label, multi-centric cluster randomized controlled trial

Author

Jeemon, Panniyammakal, primary, Bahuleyan, Charantharalyil Gopalan, additional, Chandgalu Javaregowda, Devaraju, additional, Punnoose, Eapen, additional, Rajendiran, Gopalan, additional, Unni, Govindan, additional, Abdullakutty, Jabir, additional, Balakrishnan, Jayakumar, additional, Joseph, Johny, additional, Gnanaraj, Justin Paul, additional, Sreedharan, Madhu, additional, Pillai, Meera R, additional, KR, Neenumol, additional, Thomas, Paul, additional, Sebastian, Placid, additional, Daniel, Rachel, additional, Edakutty, Rajeev, additional, Ahmad, Sajan, additional, Mattummal, Shafeeq, additional, Thomas, Sunu C, additional, Joseph, Stigi, additional, Pisharody, Sunil, additional, Chacko, Susanna, additional, Syam, N, additional, Nair, Tiny, additional, Nanjappa, Veena, additional, Ganesan, Vijayan, additional, George, Vijo, additional, Ganapathi, Sanjay, additional, and Harikrishnan, Sivadasanpillai, additional

Published
2023
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7. Kerala acute heart failure registry—Rationale, design and methods

Author

Joseph Stigi, A. Jabir, G. Sanjay, Jeemon Panniyammakal, C. Varghese Anwar, and S. Harikrishnan

Subjects
Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Heart failure (HF) is recognized as a major public health problem in both the low and high- income countries. However, data are scarce on the burden, prevailing practice patterns and long-term health outcomes of HF patients in India. The Kerala heart failure registry (KHFR) is a multi-centric, prospective, and hospital based registry in Kerala, India. Consecutive patients admitted with the diagnosis of acute heart failure satisfying the European Society of Cardiology (ESC) criteria will be enrolled in the registry. Data on demographic, clinical, laboratory, imaging, other diagnostics and therapeutic approaches employed and the usage of guideline based medical therapy will be collected as part of the registry. Additionally, all registered patients will be followed-up regularly at 1-month, and thereafter at every 3-months. Both mortality and hospital admission data will be collected during the follow-up visits. We will be recruiting 7500 HF patients in the KHFR. Once completed, KFHR is going to be the largest HF registry in India. We will validate a HF mortality risk score developed based on a previously conducted Trivandrum Heart Failure Registry in the KHFR patients. Keywords: Heart failure, Registry, Coronary artery disease, Cardiomyopathy, Guideline directed medical therapy

Published
2018
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8. A multicentric, 2 × 2 factorial, randomised, open-label trial to evaluate the clinical effectiveness of structured physical activity training and cognitive behavioural therapy versus usual care in heart failure patients: a protocol for the PACT-HF trial

Author

Jeemon, Panniyammakal, primary, Reethu, Salim, additional, Ganapathi, Sanjay, additional, Lakshmi Kanth, Lakshmipuram Rajappan, additional, Punnoose, Eapen, additional, Abdullakutty, Jabir, additional, Mattumal, Shafeeq, additional, Joseph, Johny, additional, Joseph, Stigi, additional, Venkateswaran, Chitra, additional, Sunder, Poornima, additional, Babu, Abraham Samuel, additional, Padickaparambil, Sebastian, additional, Neenumol, Kandagathuparambil Rajan, additional, Chacko, Susanna, additional, Shajahan, Shamla, additional, Krishnankutty, Krishnaja, additional, Devis, Selma, additional, Joseph, Rani, additional, Shemija, Bhagavathikandy, additional, John, Sneha Anna, additional, and Harikrishnan, Sivadasanpillai, additional

Published
2022
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10. Abstract P194: Polypill Eligibility For Patients With Heart Failure With Reduced Ejection Fraction In South India: A Secondary Analysis Of A Prospective, Interrupted Time Series Study

Author

Vijay, Aishwarya, primary, Mohanan, Padinhare P, additional, Kondal, Dimple, additional, Baldridge, Abigail S, additional, Davies, Divin, additional, Devarajan, Raji, additional, Unni, Govindan, additional, Abdullakutty, Jabir, additional, natesan, syam, additional, Joseph, Johny, additional, Jayagopal, Pathiyil B, additional, Joseph, Stigi, additional, Gopinath, Rajesh, additional, Prabhakaran, Dorairaj, additional, Huffman, Mark D, additional, and Agarwal, Anubha, additional

Published
2022
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11. Pulmonary Hypertension Registry of Kerala, India (PRO-KERALA): One-year outcomes

Author

Harikrishnan, S., primary, Mani, Avinash, additional, G, Sanjay, additional, M, Ashishkumar, additional, Menon, Jaideep, additional, G, Rajesh, additional, Kumar, R. Krishna, additional, Koshy, A. George, additional, Attacheril, Thankachan V., additional, George, Raju, additional, Punnose, Eapen, additional, Ashraf, S.M., additional, SR, Arun, additional, Cholakkal, Mohammed, additional, Jeemon, Panniyammakal, additional, Joseph, Stigi, additional, Govindan, Unni, additional, Joseph, Johny, additional, Eapen, Koshy, additional, Sreedharan, Madhu, additional, Kumar, Anil, additional, and Venugopal, K., additional

Published
2022
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12. The Cardiology Society of India-Kerala Acute Heart Failure Registry: poor adherence to guideline-directed medical therapy

Author

Joseph, Stigi, primary, Panniyammakal, Jeemon, additional, Abdullakutty, Jabir, additional, S, Sujithkumar, additional, Vaikathuseril L, Jayaprakash, additional, Joseph, Johny, additional, Mattummal, Shaffeq, additional, Punnose, Eapen, additional, Unni, Govindan, additional, Natesan, Syam, additional, and Sivadasanpillai, Harikrishnan, additional

Published
2021
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13. Polypill Eligibility for Patients with Heart Failure With Reduced Ejection Fraction in South India: A Secondary Analysis of a Prospective, Interrupted Time Series Study

Author

Vijay, Aishwarya, Mohanan, Padinhare P, Kondal, Dimple, Baldridge, Abigail, Davies, Divin, Devarajan, Raji, Unni, Govindan, Abdullakutty, Jabir, Natesan, Syam, Joseph, Johny, Jayagopal, Pathiyil B, Joseph, Stigi, Gopinath, Rajesh, Prabhakaran, Dorairaj, Huffman, Mark D, and Agarwal, Anubha

Subjects
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Abstract

RESEARCH LETTER - No abstract available.

Published
2021

15. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry.

Author

Harikrishnan, Sivadasanpillai, Bahl, Ajay, Roy, Ambuj, Mishra, Animesh, Prajapati, Jayesh, Manjunath, C.N., Sethi, Rishi, Guha, Santanu, Satheesh, Santhosh, Dhaliwal, R.S., Sarma, Meenakshi, Ganapathy, Sanjay, Jeemon, Panniyammakal, Abdullakutty, Jabir, Joseph, Stigi, Narayanan, Sajan, G, Rajesh, Varghese, Anwar C., Damodara, Ramakrishna, and Joseph, Johny

Subjects
HEART failure patients, HEART failure, BODY mass index, ATRIAL fibrillation, DILATED cardiomyopathy, MITRAL valve insufficiency
Abstract

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 results: The 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. [ABSTRACT FROM AUTHOR]

Published
2022
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16. Presentation, Management, and In-Hospital Outcomes of Patients with Acute Heart Failure in South India by Sex: A Secondary Analysis of a Prospective, Interrupted Time Series Study

Author

Agarwal, Anubha, primary, Mohanan, Padinhare P., additional, Kondal, Dimple, additional, Chopra, Aashima, additional, Baldridge, Abigail S., additional, Davies, Divin, additional, Devarajan, Raji, additional, Unni, Govindan, additional, Abdullakutty, Jabir, additional, Natesan, Syam, additional, Joseph, Johny, additional, Jayagopal, Pathiyil B., additional, Joseph, Stigi, additional, Gopinath, Rajesh, additional, Prabhakaran, Dorairaj, additional, and Huffman, Mark D., additional

Published
2021
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17. Effect of a quality improvement intervention for acute heart failure in South India: An interrupted time series study

Author

Agarwal, Anubha, primary, Mohanan, Padinhare P., additional, Kondal, Dimple, additional, Baldridge, Abigail, additional, Davies, Divin, additional, Devarajan, Raji, additional, Unni, Govindan, additional, Abdullakutty, Jabir, additional, Natesan, Syam, additional, Joseph, Johny, additional, Jayagopal, Pathiyil B., additional, Joseph, Stigi, additional, Gopinath, Rajesh, additional, Huffman, Mark D., additional, and Prabhakaran, Dorairaj, additional

Published
2021
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18. One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry

Author

Bahuleyan, C.G., primary, Namboodiri, Narayanan, additional, Jabir, A., additional, Lip, Gregory Y.H., additional, Koshy A, George, additional, Shifas, Babu M., additional, Viswanathan S, Kartik, additional, Zachariah, Geevar, additional, Venugopal, K., additional, Punnose, Eapen, additional, Natarajan, K.U., additional, Mini, G.K., additional, Joseph, Johny, additional, Nambiar C, Ashokan, additional, Jayagopal, P.B., additional, Mohanan, P.P., additional, George, Raju, additional, Unni, Govindan, additional, Sajeev, C.G., additional, Muhammed, Shaffi, additional, Syam, N., additional, Roby, Anil, additional, Daniel, Rachel, additional, Krishnakumar, V.V., additional, Pillai, Anand M., additional, Joseph, Stigi, additional, and Jinbert Lordson, A., additional

Published
2021
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20. Cardiology Society of India-Kerala Acute Heart Failure Registry: poor adherence to guideline-directed medical therapy.

Author

Joseph, Stigi, Panniyammakal, Jeemon, Abdullakutty, Jabir, S, Sujithkumar, L, Jayaprakash Vaikathuseril, Joseph, Johny, Mattummal, Shaffeq, Punnose, Eapen, Unni, Govindan, Natesan, Syam, and Sivadasanpillai, Harikrishnan

Subjects
HEART failure, DIAGNOSIS, CARDIOLOGY, HEART failure risk factors, HEART failure patients
Abstract

Aims Data on the burden of acute heart failure (AHF) admissions, practice patterns, and outcomes are rare from India and other low- and middle-income countries. We aimed to describe the baseline characteristics, guideline-directed medical therapy (GDMT) prescribing patterns and 90-day mortality rates in patients admitted with AHF in Kerala, India. Methods and results The Cardiology Society of India-Kerala Acute Heart Failure Registry (CSI-KHFR) is an observational registry from 50 hospitals in Kerala, India, with prospective follow-up. Consecutive patients with AHF, who consented to participate, were enrolled. The 2016 European Society of Cardiology criteria were used for the diagnosis of AHF. Kaplan–Meier survival analysis and Cox-proportional hazard models were used for data analysis. The variables in the MAGGIC risk score were used in the multivariable model. A total of 7507 patients with AHF (37% female) participated in the CSI-KHFR. The mean age was 64.3 (12.9) years. More than two-third had reduced ejection fraction (EF) (67.5%). Nearly one-fourth (28%) of patients with heart failure (HF) with reduced EF received GDMT. Overall, in-hospital and 90-day mortality rates were 7% and 11.6%, respectively. Prescriptions of different components of GDMT were independently associated with 90-day mortality. Conclusion The CSI-KHFR recorded an in-hospital and 90-day mortality of 7% and 11.6%, respectively. Only one of four patients received GDMT. AHF mortality was independently associated with GDMT initiation. Quality improvement initiatives that focus on increasing GDMT prescription may improve the survival of HF patients in India. [ABSTRACT FROM AUTHOR]

Published
2022
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22. Kerala acute heart failure registry-Rationale, design and methods

Author

G. Sanjay, Joseph Stigi, Jeemon Panniyammakal, Sivadasanpillai Harikrishnan, C. Varghese Anwar, and A. Jabir

Subjects
medicine.medical_specialty, Registry, RD1-811, Cardiomyopathy, Short Communication, Cardiology, India, 030204 cardiovascular system & hematology, Health outcomes, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, 030212 general & internal medicine, Registries, Heart Failure, Guideline directed medical therapy, Framingham Risk Score, business.industry, Public health, Disease Management, Hospital based, Guideline, medicine.disease, Research Design, RC666-701, Heart failure, Emergency medicine, Acute Disease, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Heart failure (HF) is recognized as a major public health problem in both the low and high- income countries. However, data are scarce on the burden, prevailing practice patterns and long-term health outcomes of HF patients in India. The Kerala heart failure registry (KHFR) is a multi-centric, prospective, and hospital based registry in Kerala, India. Consecutive patients admitted with the diagnosis of acute heart failure satisfying the European Society of Cardiology (ESC) criteria will be enrolled in the registry. Data on demographic, clinical, laboratory, imaging, other diagnostics and therapeutic approaches employed and the usage of guideline based medical therapy will be collected as part of the registry. Additionally, all registered patients will be followed-up regularly at 1-month, and thereafter at every 3-months. Both mortality and hospital admission data will be collected during the follow-up visits. We will be recruiting 7500 HF patients in the KHFR. Once completed, KFHR is going to be the largest HF registry in India. We will validate a HF mortality risk score developed based on a previously conducted Trivandrum Heart Failure Registry in the KHFR patients. Keywords: Heart failure, Registry, Coronary artery disease, Cardiomyopathy, Guideline directed medical therapy

Published
2017

23. Effect of a Quality Improvement Intervention on Clinical Outcomes in Patients in India With Acute Myocardial Infarction

Author

Somanathan Chozhakkat, Abigail S. Baldridge, Mark D. Huffman, Donald M. Lloyd-Jones, Dorairaj Prabhakaran, Syam Natesan, P.P. Mohanan, Johny Joseph, Lihui Zhao, Joseph Stigi, Sunitha Viswanathan, Mumtaj Ali, Dimple Kondal, Mangalath Narayanan Krishnan, Raji Devarajan, and Rajesh Gopinath

Subjects
Male, Research design, medicine.medical_specialty, Myocardial Infarction, Psychological intervention, India, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, Adverse effect, Aged, Intention-to-treat analysis, business.industry, Absolute risk reduction, General Medicine, Odds ratio, Middle Aged, Quality Improvement, Intention to Treat Analysis, Clinical trial, Logistic Models, Treatment Outcome, Research Design, Practice Guidelines as Topic, Female, business
Abstract

Importance Wide heterogeneity exists in acute myocardial infarction treatment and outcomes in India. Objective To evaluate the effect of a locally adapted quality improvement tool kit on clinical outcomes and process measures in Kerala, a southern Indian state. Design, Setting, and Participants Cluster randomized, stepped-wedge clinical trial conducted between November 10, 2014, and November 9, 2016, in 63 hospitals in Kerala, India, with a last date of follow-up of December 31, 2016. During 5 predefined steps over the study period, hospitals were randomly selected to move in a 1-way crossover from the control group to the intervention group. Consecutively presenting patients with acute myocardial infarction were offered participation. Interventions Hospitals provided either usual care (control group; n = 10 066 participants [step 0: n = 2915; step 1: n = 2649; step 2: n = 2251; step 3: n = 1422; step 4; n = 829; step 5: n = 0]) or care using a quality improvement tool kit (intervention group; n = 11 308 participants [step 0: n = 0; step 1: n = 662; step 2: n = 1265; step 3: n = 2432; step 4: n = 3214; step 5: n = 3735]) that consisted of audit and feedback, checklists, patient education materials, and linkage to emergency cardiovascular care and quality improvement training. Main Outcomes and Measures The primary outcome was the composite of all-cause death, reinfarction, stroke, or major bleeding using standardized definitions at 30 days. Secondary outcomes included the primary outcome’s individual components, 30-day cardiovascular death, medication use, and tobacco cessation counseling. Mixed-effects logistic regression models were used to account for clustering and temporal trends. Results Among 21 374 eligible randomized participants (mean age, 60.6 [SD, 12.0] years; n = 16 183 men [76%] ; n = 13 689 [64%] with ST-segment elevation myocardial infarction), 21 079 (99%) completed the trial. The primary composite outcome was observed in 5.3% of the intervention participants and 6.4% of the control participants. The observed difference in 30-day major adverse cardiovascular event rates between the groups was not statistically significant after adjustment (adjusted risk difference, −0.09% [95% CI, −1.32% to 1.14%]; adjusted odds ratio, 0.98 [95% CI, 0.80-1.21]). The intervention group had a higher rate of medication use including reperfusion but no effect on tobacco cessation counseling. There were no unexpected adverse events reported. Conclusions and Relevance Among patients with acute myocardial infarction in Kerala, India, use of a quality improvement intervention compared with usual care did not decrease a composite of 30-day major adverse cardiovascular events. Further research is needed to understand the lack of efficacy. Trial Registration clinicaltrials.gov Identifier:NCT02256657

Published
2018
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25. Pulmonary Hypertension Registry of Kerala, India (PRO-KERALA): One-year outcomes

Author

Harikrishnan, S., Mani, Avinash, G, Sanjay, M, Ashishkumar, Menon, Jaideep, G, Rajesh, Kumar, R. Krishna, Koshy, A. George, Attacheril, Thankachan V., George, Raju, Punnose, Eapen, Ashraf, S.M., SR, Arun, Cholakkal, Mohammed, Jeemon, Panniyammakal, Joseph, Stigi, Govindan, Unni, Joseph, Johny, Eapen, Koshy, Sreedharan, Madhu, Kumar, Anil, and Venugopal, K.

Abstract

Short term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India.

Published
2021
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26. Abstract 15553: Effect of a Quality Improvement Intervention for Acute Heart Failure in India: An Interrupted Time Series Study

Author

Agarwal, Anubha, Mohanan, Padinhare P, Kondal, Dimple, Davies, Divin, Devarajan, Raji, Unni, Govindan, Abdullakutty, Jabir, Natesan, Syam, Joseph, Johny, Jayagopal, Pathiyil B, Joseph, Stigi, Gopinath, Rajesh, Huffman, Mark D, and Prabhakaran, Dorairaj

Abstract

Introduction:Although quality improvement interventions for acute heart failure have been studied in high-income countries, none have been studied in low-and middle-income country settings where the baseline quality of care is often worse.Methods:We evaluated the effect of a locally-contextualized quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized for acute heart failure in 8 hospitals in Kerala, India from February 2018 to August 2018 utilizing a time interrupted series design. The toolkit included discharge checklists, personalized audit-and-feedback, and patient education materials. The primary outcome was rate of guideline-directed medical therapy for patients with heart failure with reduced ejection fraction (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, and aldosterone antagonist) at the time of discharge. We used logistic regression and autoregressive integrated moving average models for analysis.Results:Among 1400 participants, mean (SD) age was 66.6 (12.2) years, and 38% were female. Mean (SD) left ventricular ejection fraction was 35.2% (9.7%). The Tableshows the difference in outcomes during the control and intervention periods. The primary outcome was observed in 41.3% of the intervention group and 28.1% of the control group (difference 13.2%; 95% CI 6.8, 19.0; adjusted OR = 1.7; 95% CI 1.17, 2.48). There were improvements in discharge process of care measures of diet counseling, weight monitoring instructions, and scheduling of outpatient clinic follow-up but not hospital length of stay nor inpatient mortality.Conclusions:A locally-contextualized quality improvement toolkit increased guideline-directed medical therapy in Kerala. Broader implementation of this quality improvement intervention may improve heart failure care in low- and middle-income countries.

Published
2019
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27. Polypill Eligibility for Patients with Heart Failure With Reduced Ejection Fraction in South India: A Secondary Analysis of a Prospective, Interrupted Time Series Study.

Author

Vijay A, Mohanan PP, Kondal D, Baldridge A, Davies D, Devarajan R, Unni G, Abdullakutty J, Natesan S, Joseph J, Jayagopal PB, Joseph S, Gopinath R, Prabhakaran D, Huffman MD, and Agarwal A

Subjects
Humans, India, Interrupted Time Series Analysis, Prospective Studies, Stroke Volume, Ventricular Dysfunction, Left, Cardiovascular Agents therapeutic use, Eligibility Determination, Heart Failure drug therapy, Heart Failure physiopathology
Published
2021
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28. Cardiac Involvement in Vasculotoxic and Neurotoxic Snakebite - A not so Uncommon Complication.

Author

Sunil KK, Joseph JK, Joseph S, Varghese AM, and Jose MP

Subjects
Antivenins, Echocardiography, Humans, Incidence, Prospective Studies, Cardiotoxicity epidemiology, Neurotoxicity Syndromes epidemiology, Neurotoxicity Syndromes etiology, Snake Bites complications, Snake Bites epidemiology
Abstract

Background: Cardiac toxicity following snakebite envenomation has been previously observed, but not studied in detail, especially the involvement in neurotoxic bites. This prospective observational case study evaluates the incidence of cardiac toxicity along with the difference between vasculotoxic and neurotoxic bites and analysing the predictors for development of cardiotoxicity., Method: 96 patients who had snake bite envenomation were evaluated for features of cardiotoxicity with clinical features, ECG, echocardiogram and troponin-I levels., Results: Cardiac toxicity was observed in 42.7% of patients, the majority were either ECG changes, noted in 34.3% and rise in troponin-I, noted in 21.9% of patients. Other changes included echocardiographic changes in 4.2%, and Takotsubo cardiomyopathy in 1%. There was no significant difference in the incidence of cardiotoxicity between the neurotoxic (41.7%) and vasculotoxic (42.9%) (p value =1) snake bites, even though the predominant changes seen in neurotoxic snake bites were ECG changes. There were no deaths in the current study. None of the demographic or clinical parameters studied could predict the development of cardiac events., Conclusion: Cardiac toxicity is a well defined complication of poisonous snake bite and incidence is more frequent than previously thought. Both vasculotoxic and neurotoxic snake bites are associated with cardiac toxicity and is not associated with increase in mortality., (© Journal of the Association of Physicians of India 2011.)

Published
2020

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