Management of heart failure patients with systolic dysfunction in a real world setting-a physician-based survey


  • J. P. Sawhney Department of Cardiology, Sir Ganga Ram Hospital, Delhi, India
  • Peeyush Jain Department of Preventive Cardiology, Fortis Escorts, Delhi, India
  • Kiran Kantanavar Medical Affairs, Abbott Healthcare Pvt. Ltd., Mumbai, Maharashtra, India



Cardiologists, Ivabradine, HFrEF, Ischemia


Background: The objective of this study was to understand cardiologists’ perspectives on heart failure (HF) management with an emphasis on heart rate (HR) optimization and practice patterns among different medical specialties.

Methods: A digital, cross-sectional, questionnaire-based survey involving 149 Indian cardiologists who were experienced in the management of patients with HF in their clinical practice was conducted. The survey questionnaire included 53 items divided into five sections. Responses were analyzed and data were represented as summary statistics.

Results: According to most cardiologists, majority of patients belong to the New York Heart Association (NYHA) categories II and III, with ischemia being the most prevalent cause of HF. For patients with HF with reduced ejection fraction (HFrEF), HR>70 beats per minute and sinus rhythm, 38.9% of clinicians strongly agreed to include ivabradine in the treatment regimen. According to 56.4% of clinicians, 26%-50% of patients with HFrEF were receiving ivabradine therapy at <50% guideline-directed target dose of β-blockers. At the highest therapeutic dosage of ivabradine, 46.3% of clinicians noticed a 6-10 bpm reduction in HR. Additionally, it was reported that a stable HFrEF patient consumed an average of 4-6 tablets daily (67.1%), which increased the pill burden. Overall, 58.4% and 67.1% of clinicians strongly believed that cutting back on medications will assist with therapy adherence and that improved therapy adherence and compliance aid with clinical outcomes, respectively. Majority of the clinicians strongly agreed or agreed that patients should be switched from twice-daily to once-daily ivabradine.

Conclusions: Clinical outcomes of patients with HF could be improved by reducing the pill burden and improving compliance.


Jain D, Pandey UK, Tripathi S, Kaushley A, Verma B, Ghosh S et al. Benefits of angiotensin receptor-neprilysin inhibitor in heart failure with reduced ejection fraction: A longitudinal study. J Clin Diagn Res. 2022;16(4):8-13.

Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H et al. Prevalence, characteristics, management and outcomes of patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain. J Clin Med. 2022;11(17):1-18.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart-disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38-60.

Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Nanjappa MC et al. National Heart Failure Registry, India: design and methods. Indian Heart J. 2019;71(6):488-91.

Riello I. Heart failure with reduced ejection fraction. Cardiology. 2021;77:772-810.

Störk S, Handrock R, Jacob J, Walker J, Calado F, Lahoz R et al. Treatment of chronic heart failure in Germany: a retrospective database study. Clin Res Cardiol. 2017;106(11):923-32.

Mishra S, Mohan JC, Nair T, Chopra VK, Harikrishnan S, Guha S et al. Management protocols for chronic heart failure in India. Indian Heart J. 2018;70(1):105-27.

Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S et al. CSI position statement on management of heart failure in India. Indian Heart J. 2018;70(1):S1-72.

Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI et al. Medical therapy for heart failure with reduced ejection fraction: The CHAMP-HF registry. J Am Coll Cardiol. 2018;72(4):351-66.

Teng TH, Tromp J, Tay WT, Anand I, Ouwerkerk W, Chopra V et al. Prescribing patterns of evidence-based heart failure pharmacotherapy and outcomes in the ASIAN-HF registry: a cohort study. Lancet Glob Health. 2018;6(9):e1008-18.

Fonarow GC, Yancy CW, Hernandez AF, Peterson ED, Spertus JA, Heidenreich PA. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J. 2011;161(6):1024-30.

Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010;376(9744):875-85.

Anthoine E, Moret L, Regnault A, Sébille V, Hardouin JB. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014;12(1):1-10.

Mehrotra S, Sharma TM, Bahl A. Impact of comorbidities in heart failure–prevalence, effect on functional status, and outcome in Indian population: A single-center experience. J Clin Prev Cardiol. 2019;8(4):166-72.

Chopra VK, Mittal S, Bansal M, Singh B, Trehan N. Clinical profile and one-year survival of patients with heart failure with reduced ejection fraction: The largest report from India. Indian Heart J. 2019;71(3):242-8.

Shukkoor AA, George NE, Radhakrishnan S, Velusamy S, Gopalan R, Kaliappan T et al. Clinical characteristics and outcomes of patients admitted with acute heart failure: Insights from a single-center heart failure registry in South India. Egyptian Heart J. 2021;73(1):38-48.

Lam CS, Anand I, Zhang S, Shimizu W, Narasimhan C, Park SW et al. Asian Sudden Cardiac Death In Heart Failure (ASIAN‐HF) registry. Eur J Heart Fail. 2013;15(8):928-36.

Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A et al. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health. 2017;5(7):e665-72.

Dokainish H, Teo K, Zhu J, Roy A, Al Habib KF, El Sayed A et al. Heart failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol. 2016;204:133-41.

Sanjay G, Jeemon P, Agarwal A, Viswanathan S, Sreedharan M, Vijayaraghavan G et al. In-hospital and three-year outcomes of heart failure patients in South India: The Trivandrum Heart Failure Registry. J Card Fail. 2018;24(12):842-8.

Harikrishnan S, Sanjay G, Anees T, Viswanathan S, Vijayaraghavan G, Bahuleyan CG et al. Clinical presentation, management, in‐hospital and 90‐day outcomes of heart failure patients in Trivandrum, Kerala, India: The Trivandrum Heart Failure Registry. Eur J Heart Fail. 2015;17(8):794-800.

Pokharel Y, Wei J, Hira RS, Kalra A, Shore S, Kerkar PG et al. Guideline‐directed medication use in patients with heart failure with reduced ejection fraction in India: American College of Cardiology's PINNACLE India Quality Improvement Program. Clin Cardiol. 2016;39(3):145-9.

Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Manjunath CN et al. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail. 2022;9(6):3898-908.

Khan MS, Samman Tahhan A, Vaduganathan M, Greene SJ, Alrohaibani A, Anker SD et al. Trends in prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail. 2020;22(6):1032-42.

Sharma A, Zhao X, Hammill BG, Hernandez AF, Fonarow GC, Felker GM et al. Trends in noncardiovascular comorbidities among patients hospitalized for heart failure: insights from the Get with The Guidelines-Heart Failure Registry. Circ Heart Fail. 2018;11(6):e004646.

Inpatient Initiation of HFrEF Therapies. Available at: Inpatient Initiation of HFrEF Therapies-American College of Cardiology. Accessed on 12 February, 2023.

Joseph J, PS S, James J, Abraham S, Abdullakutty J. Guideline-directed medical therapy in heart failure patients: impact of focused care provided by a heart failure clinic in comparison to general cardiology out-patient department. Egyptian Heart J. 2020;72:1-8.

Haydock PM, Flett AS. Management of heart failure with reduced ejection fraction. Heart. 2022;108(19):1571-9.

Iron Deficiency in Heart Failure. Available at: Iron Deficiency in Heart Failure - American College of Cardiology (

Ouwerkerk W, Teng TH, Tromp J, Tay WT, Cleland JG, van Veldhuisen DJ, et al. Effects of combined renin-angiotensin-aldosterone system inhibitor and beta‐blocker treatment on outcomes in heart failure with reduced ejection fraction: insights from BIOSTAT‐CHF and ASIAN‐HF registries. European J Heart Fail 2020;22(8):1472-82.

Yumita Y, Nagatomo Y, Takei M, Saji M, Goda A, Kohno T et al. Personalized target heart rate for patients with heart failure and reduced ejection fraction. J Pers Med. 2022;12(1):50-62.

Barywani S, Petzold M. Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation. Scand Cardiovasc J. 2017;51(4):190-6.

Psotka MA, Teerlink JR. Ivabradine: role in the chronic heart failure armamentarium. Circulation 2016;133(21):2066-75.

Böhm M, Swedberg K, Komajda M, Borer JS, Ford I, Dubost-Brama A et al. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet. 2010;376(9744):886-94.

Tse S, Mazzola N. Ivabradine (Corlanor) for heart failure: the first selective and specific IF inhibitor. P T. 2015;40(12):810-4.

Farrell B, French Merkley V, Ingar N. Reducing pill burden and helping with medication awareness to improve adherence. Can Pharm J (Ott). 2013;146(5):262-9.

Iuga AO, McGuire MJ. Adherence and health care costs. Risk management and healthcare policy. Risk Manag Healthc Policy. 2014;7:35-44.

Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028-35.






Original Research Articles