Recalibrating Risk: A Call for South Asian-Focused Heart Failure Prediction Models

Background: Heart failure (HF) represents the final common pathway of diverse cardiovascular disorders, including coronary artery disease, primary myocardial pathology, and abnormalities of cardiac conduction. These conditions arise from an interplay of genetic, environmental, and psychosocial influences, making it essential to understand these determinants to improve risk prediction and prevention. Multiple biological pathways of inflammation, fibrosis, coagulation, oxidative stress, lipid dysregulation, endothelial dysfunction, and metabolic disturbances are shaped by inherited susceptibility and modifiable exposures. Together, these mechanisms drive HF development and progression, though their relative contributions vary across populations. Methods: PubMed and Google Scholar were searched for clinical, biomedical, and interdisciplinary studies published between 1 January 2000, and 31 December 2025. Keywords included "Asian," "adult," "India," "heart failure," "risk assessment," "prognosis," and "predictive value." Studies were included if they focused on South Asian Indian adults, with priority given to original research, systematic reviews, and meta-analyses. Pediatric studies and those centered on other ethnic groups were excluded. Results: Among South Asian Indians, cardiovascular disease burden remains disproportionately high compared with Western populations. Unique genetic architecture, environmental exposures, and sociocultural factors appear to contribute to earlier onset and more aggressive disease. Identifying population-specific genetic variants, clarifying psychosocial influences, and addressing environmental risks may help reduce these disparities. Conclusions: This qualitative review highlights key gaps in current knowledge. A deeper understanding of these determinants could refine HF risk stratification, guide targeted prevention strategies, and reduce the growing cardiovascular burden in South Asian Indians. There is an urgent need for South Asian specific HF risk prediction models.