Table 1.
A summary of findings from secondary cardiovascular disease prevention registries and epidemiological cohorts in India.
| Initiative Year of Publication | Patient Population; Population size | Key Findings | Limitations |
|---|---|---|---|
| PINNACLE – India Quality Improvement Program (PIQIP)8, 9, 10, 11, 12 2015 |
Patients with coronary artery disease, heart failure, and atrial fibrillation evaluated in the outpatient setting. n > 100,000 | <35% of HFrEF patients had documentation of guideline-directed therapies. Women had lower rates of guideline-directed therapies documented for both, CAD and HF. |
High rate of missing data. |
| Kerala Acute Coronary Syndrome registry13,14 2013 |
Patients presenting to the hospital with acute coronary syndrome (ACS). n = 25,748 | Observed in-hospital mortality for ACS patients was around 8%. <50% of STEMI patients and <30% of non-STEMI/unstable angina patients underwent reperfusion (primary PCI or thrombolytic therapy). |
Possible selection bias (ACS patients included only if survived to be admitted to a coronary care unit) Voluntary participation of hospitals. |
| Acute Coronary Syndromes: Quality Improvement in Kerala (ACS QUIK)15,16 2017 |
Patients presenting to the hospital with acute coronary syndrome (ACS). Control group: n = 10,066 Intervention group: n = 11,308 |
Care of patients with the help of a quality improvement tool kit did not improve all-cause death, reinfarction, stroke, or major bleeding compared with standard care. However, it increased the prescription of optimal in-patient and out-patient medications. | Short-term follow up. |
| CREATE registry17 2008 |
Acute myocardial infarction (STEMI or non-STEMI) or suspected myocardial infarction in patients with prior ischemic heart disease. n = 20,937 | Higher proportion of STEMI cases in India compared with other nations. 30-day mortality 9% for STEMI; 4% for non-STEMI. Mean age of patients with ACS around 10 years younger than the Western world. |
Observational registry. |
| The Tamil Nadu–ST-Segment Elevation Myocardial Infarction (TN-STEMI) Program18 2017 |
Regional system-of-care program for STEMI patients. n = 2420 | Tamil Nadu – STEMI program included a regional system of care intervention through a hub-and-spoke model. Post-intervention: increased rates of coronary angiography, PCI and reduction in 1-year mortality (14.2% vs. 17.6% pre-intervention). |
Heterogeneity between different regions of India may limit ability to scale the hub-and-spoke model to other states. |
| Detection and Management of Coronary Heart Disease (DEMAT) Registry19 2013 |
Patients presenting with ACS at 10 tertiary care centers across 9 cities in India. Data were prospectively collected to compare gender differences in ACS presentation, management, and outcomes. n = 1565 | Women presenting with ACS had comparable in-hospital management, discharge management, and 30-day outcomes compared with men who presented with ACS. | Small sample size, short duration of follow up, convenient sampling and limited clinical endpoints. |
| North Indian ST-Segment Elevation Myocardial Infarction (NORIN STEMI) Registry20 2019 |
All patients >18 years of age presenting with STEMI at two tertiary care hospitals in India .n~3500 (data collected on 558 patients thus far) | 45% of patients presented to the emergency department more than 1 h after symptom onset. More data to follow after further enrollment. |
Two hospitals in New Delhi, limiting generalizability. |
| Prospective observational longitudinal registry of patients with stable coronary artery disease (CLARIFY)21 2017 |
Patients with stable coronary artery disease. n = 1537 | Patients in India were significantly younger than rest of the world and had a higher prevalence of diabetes. Indian patients were also less likely to be on aspirin, statins, and beta-blockers. High LDL-C, low HDL-C was more common in Indian patients. |
Participants were selected from major cities, leading to urban bias. |
| Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry22 2017 | Young patients (men age < 55 years and women age < 65 years) with CAD from 22 centers in India. n = 997 | Conventional risk factors (family history of CAD, hypertension, dyslipidemia, tobacco use, diabetes mellitus) were highly prevalent in these patients. Females were older and had higher burden of comorbidities. | Lack of data on genetic risk factors. |
| Indian Heart Rhythm Society – Atrial Fibrillation (IHRS-AF) registry23 2017 |
Patients with atrial fibrillation. n = 1537 | Mean onset of AF in Indian patients occurs 10 years earlier than in the West. | Possible selection bias (patients primarily recruited from tertiary centers). |
| Trivandrum Heart Failure registry25 2015 |
In-hospital heart failure admissions. n = 1205 | Most common cause of heart failure in this registry was ischemic heart disease accounting for > 70% of cases. 25% of HFrEF patients prescribed guideline-directed therapies at discharge. |
No drug-dosing data. |
ACS: acute coronary syndrome; AF: atrial fibrillation; HDL: high-density lipoprotein; HFrEF: heart failure with reduced ejection fraction; LDL: low-density lipoprotein; NSTEMI: non-ST-elevation myocardial infarction; PCI: percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction.