Management of Heart Failure in a Resource-Limited Setting: Expert Opinion from India

Area of Science:

• Cardiology
• Internal Medicine
• Public Health

Background:

• Heart failure is a significant global health burden impacting millions.
• Limited access to guideline-directed medical therapy (GDMT) is a major challenge, driven by factors like drug availability, clinical inertia, and delayed diagnosis.
• Personalized approaches to GDMT are crucial, especially in resource-constrained environments.

Purpose of the Study:

• To develop tailored recommendations for GDMT in heart failure management within resource-limited settings.
• To address the underutilization of key therapies like angiotensin II receptor blocker neprilysin inhibitors and sodium-glucose co-transporter 2 inhibitors in India.
• To foster expert consensus on patient profiles, monitoring, and adverse effects for effective GDMT implementation.

Main Methods:

• An expert consensus involving 150 specialists (cardiologists, nephrologists, endocrinologists) was convened.
• Deliberations focused on patient profiles, monitoring strategies, and management of adverse side effects.
• Recommendations were formulated for optimizing GDMT in heart failure.

Main Results:

• Emphasis on the early initiation of GDMT for heart failure patients, particularly highlighting sodium-glucose co-transporter 2 inhibitors.
• Exploration of novel therapeutic agents such as vericiguat.
• Identification of key strategies to improve heart failure outcomes, including enhanced patient education, cardiac rehabilitation, and improved drug access.

Conclusions:

• Tailored GDMT recommendations are essential for improving heart failure management in resource-limited settings.
• Addressing barriers to drug access and implementing policy reforms are critical for wider adoption of effective therapies.
• A multi-faceted approach involving patient education, rehabilitation, and policy changes can enhance heart failure outcomes.