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Dr Saumitra Ray, Kolkata 05 October 2022

Heart failure (HF) is a serious problem in India with high mortality, a high rate of recurrent hospitalization and poor quality of life.
Four foundational groups of medicines have improved the outcome greatly, but the uptake in India is still very poor.
All efforts must be made to introduce these medicines as soon as the diagnosis of heart failure with reduced ejection fraction (HFrEF) is made and attain the highest tolerated recommended doses.
Admission with acute HF should not be a cause for discontinuation of therapy if already on. Instead, it is recommended to introduce the medicines, if not on already, before hospital discharge.
In the renin-angiotensin-aldosterone system (RAAS) blocker category, angiotensin receptor-neprilysin inhibitor (ARNI) has been recommended by all guidelines as the default choice, and ACEI/ARB is only used if ARNI cannot be given for some reason.
De novo HF is no different from acute exacerbation of chronic HF and should be treated with similar aggression.
For long-term improvement in the quality of HF care in India, a concerted effort must be made among all stakeholders with public and doctor education, development of infrastructural facilities, affordable and available medicines, and formation of paramedical HF support teams.

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