Clinical comparison of different cardiovascular risk scores for cardiovascular risk prediction in Indian patients

Background: Cardiovascular diseases (CVD) are the main cause of mortality and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVD. The present study was conducted to compare different cardiovascular calculators for CVD risk assessment models in young Indian patients presenting with myocardial infarction.Methods: This study included 85 patients with myocardial infarction (MI). Their predicted 10-year risk of CVD was calculated using three clinically most relevant risk assessment models viz. Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association (RiskACC/AHA) and the 3rd Joint British Societies risk calculator (RiskJBS).Results: RiskFRS recognized the highest number of patients (15.4%) at high CVD risk while RiskACC/AHA and RiskJBS calculators provided inferior risk assessment but statistically significant relationship. RiskFRS and RiskACC/AHA (Pearson's r 0.870, p<0.001).Conclusions: RiskFRS seems to be as most useful CVD risk assessment model in young Indian patients. RiskFRS is likely to identify the number of patients at ‘high-risk’ as compared to RiskJBS and RiskACC/AHA

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

RESEARCH LETTER - No abstract available

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

BackgroundWe report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study.MethodsKERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF.ResultsMean age at recruitment was 67.2 years (range 18-98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA2DS2-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%).ConclusionsDespite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry

Infective endocarditis caused by Granulicatella adiacens

Granulicatella adiacens, a recently nomenclatured bacterium, was considered as one of the nutritionally variant streptococci (NVS) and is a mouth commensal. It is redesignated as a streptococcus like bacterium since it differs from streptococci. We report a case of infective endocarditis (IE) caused by this fastidious and unusual bacteria in a 63-year-old man with rheumatic valvular heart disease. G. adiacens was isolated from four of his blood culture samples, which was sensitive to beta lactams, moderately sensitive to gentamicin and resistant to erythromycin and co-trimoxazole. Patient recovered completely on treatment with high dose of ampicillin and gentamicin for 28 days

Feasibility of Radial artery access for primary angioplasty and high risk subgroup analysis - A paradigm shift

Objective: Radial access (RA) for angioplasty is an established technique, with proven benefits. The paradigm shift has made us to evaluate the feasibility of routine use of radial access in primary percutaneous coronary intervention (PCI). Also high risk subgroups (HRG) analysis was done to identify the clinical and procedure-related variables associated with higher complication rates. Materials and Methods: Total of 315 patients (112 HRG and 203 non HRG) presenting with ST-segment elevation acute myocardial infarction (STEMI) considered for primary PCI through RA at operator discretion were included in the study. The study analyzed the various risk factors and baseline characteristics in whole cohort and subgroup analysis comparing HRG and non HRG. Results: Patient had different spectrum of STEMI, with majority having LV systolic dysfunction. Primary PCI with drug eluting stent was done in majority of patients. Procedural parameters were compared and TIMI- 3 flow was achieved in 86.03%, fluoroscopy time 5-10 min in 90.16% and majority contrast volume used were less than 100 ml. Complications rate was low. Conclusion: This study proved the procedural success of RA for primary PCI in patients with various risk factors and baseline characteristics and supports its routine use for primary PCI. It also showed RA can be used in primary angioplasty in different type of HRG cases without any increase in procedural parameters and complications in comparison with non HRG

Impact of the 2017 ACC/AHA guidelines on the prevalence of hypertension among Indian adults: Results from a cross-sectional survey

BackgroundThe impact of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for diagnosis and management of hypertension on the prevalence of hypertension in India is unknown.MethodsWe analyzed data from the Cardiac Prevent 2015 survey to estimate the change in the prevalence of hypertension. The JNC8 guidelines defined hypertension as a systolic blood pressure of ≥140&nbsp;​mmHg or diastolic blood pressure of ≥90&nbsp;​mmHg. The 2017 ACC/AHA guidelines define hypertension as a systolic blood pressure of ≥130&nbsp;​mmHg or diastolic blood pressure of ≥80&nbsp;​mmHg. We standardized the prevalence as per the 2011 census population of India. We also calculated the prevalence as per the World Health Organization (WHO) World Standard Population (2000-2025).ResultsAmong 180,335 participants (33.2% women), the mean age was 40.6&nbsp;​±&nbsp;​14.9 years (41.1&nbsp;​±&nbsp;​15.0 and 39.7&nbsp;​±&nbsp;​14.7 years in men and women, respectively). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%) and 2,878 (1.6%) participants belonged to age group 18-19, 20-44, 45-54, 55-64, 65-74 and&nbsp;​≥&nbsp;​75 years respectively. The prevalence of hypertension according to the JNC8 and 2017 ACC/AHA guidelines was 29.7% and 63.8%, respectively- an increase of 115%. With the 2011 census population of India, this suggests that currently, 486 million Indian adults have hypertension according to the 2017 ACC/AHA guidelines, an addition of 260 million as compared to the JNC8 guidelines.ConclusionAccording to the 2017 ACC/AHA guidelines, 3 in every 5 Indian adults have hypertension