ABSTRACT
Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective ß1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities.
Subject(s)
Angiotensin Receptor Antagonists , Bisoprolol , Renal Insufficiency, Chronic , Sodium-Glucose Transporter 2 Inhibitors , Humans , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/drug therapy , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , India/epidemiology , Bisoprolol/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Consensus , Adrenergic beta-1 Receptor Antagonists/therapeutic useABSTRACT
Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF.
Subject(s)
Diabetes Mellitus, Type 2 , Heart Failure , Sodium-Glucose Transporter 2 Inhibitors , Humans , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Heart Failure/drug therapy , India , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/complicationsABSTRACT
Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ß-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
Subject(s)
Heart Failure , Neprilysin , Humans , Neprilysin/pharmacology , Ventricular Remodeling , Tetrazoles/pharmacology , Treatment Outcome , Angiotensin Receptor Antagonists/therapeutic use , Stroke Volume , Heart Failure/drug therapy , Heart Failure/diagnosis , Antihypertensive AgentsABSTRACT
;Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril-Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril-Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril-Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril-Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40-50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.
Subject(s)
Heart Failure , Humans , Heart Failure/drug therapy , Neprilysin/pharmacology , Stroke Volume/physiology , Tetrazoles/therapeutic use , Tetrazoles/pharmacology , Quality of Life , Ventricular Function, Left , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin Receptor Antagonists/pharmacology , Treatment Outcome , Antihypertensive Agents/therapeutic use , Drug CombinationsABSTRACT
Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
Subject(s)
Anemia, Iron-Deficiency , Heart Failure , Iron Deficiencies , Humans , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/complications , Quality of Life , Iron/therapeutic use , Heart Failure/complications , Heart Failure/drug therapyABSTRACT
In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective ß-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a ß-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF.
Subject(s)
Adrenergic beta-1 Receptor Antagonists , Bisoprolol , Heart Failure , Humans , Bisoprolol/therapeutic use , Heart Failure/drug therapy , India , Adrenergic beta-1 Receptor Antagonists/therapeutic use , ConsensusABSTRACT
BACKGROUND: Acute decompensated heart failure (ADHF) is a challenging medical emergency with high mortality and its prevalence is increasing in India. There is paucity of data on ADHF in the country. METHODS: Indian College of Cardiology National Heart Failure Registry (ICCNHFR) is an on-going observational registry on ADHF contributed by 22 hospitals across India; and we present the in-hospital and 30-day outcomes of ADHF patients enrolled from August 2018 to July 2019. Major objective included capturing demographics, comorbid conditions, aetiology, prescription patterns and assessing clinical outcomes. RESULTS: Of 5269 patients (mean age: 61.90 ± 13.85 years) enrolled in this study, males were predominant (67.09%). Mean duration of hospitalization was 5.74 ± 4.74 days. Ischemic heart disease was the most common (75.44%) aetiology. Abnormal electrocardiogram readings were found in most patients (89.86%). LVEF of Ë40% was found in 68.29% of patients. In-hospital mortality rates were 6.98%. The 30-day cumulative mortality was 12.35% and 30-day rehospitalization rate was 7.98%. At discharge, all guideline-based medical therapy (GDMT) were prescribed only to 24.99% of patients and 23.72% adhered to the prescription until 30 days. Older age, high serum creatinine levels and poor LVEF contributed to high mortality and rehospitalization. CONCLUSION: Patients with ADHF were younger and predominantly males. Usage of GDMT in ADHF patients was low (24.99%) and the in-hospital mortality was high. Older age, high serum creatinine levels, poor LVEF contributed for 30-day mortality and rehospitalization. This data on ADHF, could help in developing strategies to improve outcomes for HF patients in India.
Subject(s)
Cardiology , Heart Failure , Acute Disease , Aged , Creatinine , Female , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/therapy , Humans , Male , Middle Aged , Registries , Stroke VolumeABSTRACT
BACKGROUND: The prevalence of hypertension in the young adult population is rising in India. Increased arterial stiffness due to RAAS activation and increased sympathetic overactivity due to stress have been implicated as primary factors for the same. This study was aimed to understand the Indian clinician's perspective on approach to management of hypertension in young adults. METHODS: A cross sectional observational survey using a structured questionnaire was conducted online with 2287clinicians (cardiologists, diabetologists, consultant physicians and family physicians). RESULTS: The prevalence of hypertension was 10-30% as per opinion of 64.8% clinicians. The top three risk factors for hypertension in young were perceived to be smoking, mental stress and obesity. Around 57.4% respondents opined that both increased heart rate and systolic blood pressure were markers of sympathetic overactivity. More than 60% respondents across specialities preferred ARBs to treat hypertension in young adults. Amongst the ARBs, telmisartan was the preferred ARB by >80% respondents. Metoprolol was the preferred beta blocker by almost 64% respondents. The objective of selection of beta-blocker by majority of clinicians due to sympathetic overactivity. Telmisartan and Metoprolol single pill combination achieved the BP goal in 40-60% of patients as reported by 41.3% of the physicians. The combination therapy was well tolerated in young hypertensive patients. CONCLUSIONS: Initiation of an early and appropriate antihypertensive treatment in young population may lower the burden of cardiovascular disease in this population. ARBs and beta -blockers were the preferred class of anti-hypertensive drugs in the cohort of young hypertensive patients .
Subject(s)
Angiotensin Receptor Antagonists , Hypertension , Angiotensin Receptor Antagonists/pharmacology , Angiotensin-Converting Enzyme Inhibitors , Antihypertensive Agents/therapeutic use , Blood Pressure , Cross-Sectional Studies , Humans , Hypertension/drug therapy , Hypertension/epidemiology , India/epidemiology , Young AdultABSTRACT
BACKGROUND: The 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. METHODS: We 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 âmmHg or diastolic blood pressure of ≥90 âmmHg. The 2017 ACC/AHA guidelines define hypertension as a systolic blood pressure of ≥130 âmmHg or diastolic blood pressure of ≥80 âmmHg. 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). RESULTS: Among 180,335 participants (33.2% women), the mean age was 40.6 â± â14.9 years (41.1 â± â15.0 and 39.7 â± â14.7 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 â≥ â75 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. CONCLUSION: According to the 2017 ACC/AHA guidelines, 3 in every 5 Indian adults have hypertension.
ABSTRACT
OBJECTIVE: Hypertension is the most important risk factor for cardiovascular morbidity and mortality. There is limited data on hypertension prevalence in India. This study was conducted to estimate the prevalence of hypertension among Indian adults. METHODS: A national level survey was conducted with fixed one-day blood pressure measurement camps across 24 states and union territories of India. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or a diastolic BP ≥90 mmHg or on treatment for hypertension. The prevalence was age- and gender-standardized according to the 2011 census population of India. RESULTS: Blood pressure was recorded for 180,335 participants (33.2% women; mean age 40.6 ± 14.9 years). 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 were of the age group 18-19, 20-44, 45-54, 55-64, 65-74, and ≥ 75 years, respectively. Overall prevalence of hypertension was 30.7% (95% confidence interval [CI]: 30.5, 30.9) and the prevalence among women was 23.7% (95% CI: 23.3, 24). Prevalence adjusted for 2011 census population and the WHO reference population was 29.7% and 32.8%, respectively. CONCLUSION: There is a high prevalence of hypertension, with almost one in every three Indian adult affected.
Subject(s)
Hypertension/epidemiology , Adult , Aged , Blood Pressure Determination , Female , Humans , India/epidemiology , Male , Middle Aged , PrevalenceABSTRACT
OBJECTIVE: To determine the clinical and echocardiographic profiles of women with peripartum cardiomyopathy and ascertain the natural course of the disease. METHODS: Fifty-six women with peripartum cardiomyopathy were followed up for a mean period of 6.1 years and their clinical and echocardiographic profiles were studied as well as their outcomes. RESULTS: The mean+/-SD age at presentation was 31+/-5 years and mean parity was 2.6+/-1. Of the 56 patients, 18 (32.1%) had NYHA Class II, 24 (42.9%) had NYHA Class III, and 14 (25%) had NYHA Class IV symptoms, and 21 (37.5%) and 35 (62.5%), respectively, presented with features of heart failure during pregnancy and the postpartum. During follow-up, the left ventricular ejection fraction improved from 31%+/-7.2% to 43%+/-8% (P=0.05). Nine patients (16.1%) became pregnant, with a mortality of 55.5% during pregnancy and 23.2% during follow-up. CONCLUSION: Women with peripartum cardiomyopathy present with severe left ventricular dysfunction late in the pregnancy or early in the puerperium. A considerable number of women still die from this condition despite the use of angiotensin-converting enzyme inhibitors and beta-blockers. A subsequent pregnancy carries a very high risk of mortality.
Subject(s)
Cardiomyopathies/pathology , Heart Failure , Pregnancy Complications, Cardiovascular/pathology , Ventricular Dysfunction, Left , Adult , Age of Onset , Cardiomyopathies/complications , Cardiomyopathies/diagnostic imaging , Disease Progression , Echocardiography , Female , Humans , India , Mortality , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Prospective StudiesABSTRACT
AIM: To ascertain the presence of LV dysfunction in patients of subclinical hypothyroidism and its reversibility after hormone therapy. METHODS AND METERIAL: Thirty two patients with subclinical hypothyroidism (SH) were included in the study, along with thirty two age and sex matched individuals serving as controls. The patients with SH had normal serum T3 and T4 with an elevated TSH value. All patients and the controls were subjected to detailed echocardiographic examination for assessment of LV systolic and diastolic function before and one year after hormone (thyroxine) therapy. RESULTS: The systolic function of LV was normal in patients with SH. There was significant diastolic dysfunction in the SH patients as compared with controls. There was prolongation of deceleration above time (169 +/- 6.1 msec. vs. 148.1 +/- 5.4 msec in controls, p < 0.05), isovolumic relaxation time (89.1 +/- 7.3 msec vs. 79.4 +/- 5.9 msec., p<0.05), increased A wave (0.63 +/- 0.6 m/sec. vs. 0.54 +/- 0.05 m/sec) and reduced E/A ratio (0.7 +/- 0.09 vs. 1.4 +/- 0.3, p < 0.05). Echocardiography at the end of one year of hormone therapy revealed considerable improvement in diastolic function of the LV. There was significant improvement in DT (from 169 +/- 6.1 msec. to 151 +/- 5.2 msec, p < 0.05), IVRT (from 89.1 +/- 7.3 msec. to 80.2 +/- 6.5 msec, p < 0.05) and increased E/A ratio (from 0.7 +/- 0.09 to 1.3 +/- 0.1, p < 0.05). CONCLUSION: Hypothyroidism, even in subclinical stage, can cause diastolic dysfunction of the LV. These abnormalities in diastolic function can be reversed by thyroxine therapy.
Subject(s)
Hormone Replacement Therapy , Hypothyroidism/drug therapy , Thyroxine/therapeutic use , Ventricular Dysfunction, Left/drug therapy , Adult , Case-Control Studies , Diastole/drug effects , Diastole/physiology , Female , Humans , Hypothyroidism/complications , Male , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood , Ventricular Dysfunction, Left/etiologyABSTRACT
OBJECTIVES: Balloon mitral valvuloplasty (BMV) has been performed safely during pregnancy with good results. Reports are few on long-term effects of BMV on childhood development. METHODS: BMV was performed in 40 pregnant women (age 23.4+/-4.8 years) with severe mitral stenosis at 24.2+/-4.6 weeks of gestation. RESULTS: Mitral valve area increased from 0.82+/-0.34 to 1.9+/-0.4 cm(2) (P<0.001). One patient had pericardial tamponade. Mean fluoroscopy time was 5.5+/-3.8 min. There was no maternal death, no abortion, no intrauterine growth restriction and one stillbirth. All 39 babies were normal at birth. One baby died at 7 months due to pneumonia. On follow up for 36+/-15 months, all 38 babies maintained normal growth and development without any thyroid disease or malignancy. CONCLUSIONS: During pregnancy BMV is feasible, safe and effective. Maternal and fetal outcomes are excellent. Growth and milestone of development are not affected.
Subject(s)
Balloon Occlusion , Catheterization , Mitral Valve Stenosis/therapy , Pregnancy Complications, Cardiovascular/therapy , Adolescent , Adult , Child Development , Female , Follow-Up Studies , Humans , Infant, Newborn , Pregnancy , Pregnancy Outcome , Treatment OutcomeABSTRACT
BACKGROUND: The current study was aimed to ascertain presence and severity of coronary artery lesions in patients of Type 2 diabetic mellitus (DM) with coronary artery disease (CAD), in our population, by using scoring system analysis of the coronary angiography. METHODS: 147 consecutive patients with Type 2 DM of chronic stable angina (CSA) were enrolled in the study with 147 age- and sex-matched patients of CSA who did not have diabetes to serve as control. All of them underwent coronary angiography and were evaluated by using four scores to quantify the coronary artery lesions. The scores analyzed were coronary score, extent score, severity score, and atherosclerosis score. Other major risk factors such as smoking and hypertension lipid profile were also evaluated. RESULTS: Type 2 diabetics with CAD had higher coronary score (0.91 +/- 0.63 in diabetics vs. 0.43 +/- 0.39, p < 0.001), extent score (4.91 +/- 3.1 vs. 2.3 +/- 1.8, p < 0.001), severity score (1.85 +/- 0.41 vs. 1.2 +/- 0.32, p < 0.001), and atherosclerosis score (0.52 +/- 0.31 vs. 0.21 +/- 0.26, p < 0.001) as compared to non-diabetics with CAD. Left main stem involvement, 2-vessel disease, and 3-vessel disease were also more frequent in the diabetics. These diabetes also had higher incidence of obesity, hypertension, and dyslipidemia. CONCLUSIONS: In our population, diabetics suffer from higher prevalence of diffuse and extensive coronary atherosclerosis. The grades of stenosis in coronary arteries are also higher in diabetic patients when compared with non-diabetics with CAD, as was the prevalence of other components of the metabolic syndrome.
ABSTRACT
We report a case of systemic lupus erythematosus (SLE) whose initial presentation was in the form of myocarditis. The patient did not have arthritis, fever or butterfly rash. Presence of LE cell phenomenon, positive ANA, anti-DS DNA antibodies, leucopenia and high ESR with polyserositis indicated the diagnosis to be SLE. Therapy with steroid resulted in complete recovery. The patient developed atrial fibrillation during her course of acute illness which is being reported for the first time.
Subject(s)
Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Myocarditis/diagnosis , Prednisone/therapeutic use , Adult , Antibodies, Antinuclear/analysis , Diagnosis, Differential , Female , Follow-Up Studies , Humans , India , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Gingival hyperplasia can occur during use of drugs such as diphenylhydantoin, cyclosporine and nifedipine. We report, three cases of gingival hyperplasia induced by amlodipine, a second generation calcium channel blocker. Exact cause of induction of thehyperplasia is not known. Individual variation in metabolism of the drug may be a factor.
Subject(s)
Amlodipine/adverse effects , Gingival Hyperplasia/chemically induced , Adolescent , Adult , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Membranous obstruction of the inferior vena cava is common in African and Asian countries. METHODS AND RESULTS: Between January 1999 and January 2002, 19 patients were prospectively studied. The mean age of the patients was 38+/-6.9 years. All of them had swelling of the abdomen and ankle edema. Five patients (26.3%) had jaundice, 9 (47.3%) had hepatomegaly, and 5 (26.3%) splenomegaly. Ultrasonography could detect the site of obstruction in 18 patients (94.7%). Vena cavography demonstrated obstruction of the inferior vena cava at the level of the diaphragm, with 2 patients (10.5%) having additional intrahepatic obstruction. The mean pressure gradient was 22+/-3.5 mmHg. Seventeen patients underwent balloon angioplasty using a Joseph balloon. The procedure was successful in 15 patients (88.2%). The post-angioplasty mean pressure gradient was 5+/-1.4 mmHg. On follow-up, 3 patients (20%) developed features of restenosis: out of them, 2 underwent successful redilatation. CONCLUSIONS: Balloon angioplasty of membranous obstruction of the inferior vena cava is feasible with a high success rate, without any rupture of the inferior vena cava.
Subject(s)
Angioplasty, Balloon, Coronary , Vena Cava, Inferior/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapy , Adult , Budd-Chiari Syndrome/complications , Budd-Chiari Syndrome/diagnosis , Budd-Chiari Syndrome/therapy , Female , Humans , Male , Prospective Studies , Radiography , Ultrasonography , Venous Thrombosis/complicationsABSTRACT
BACKGROUND: Rheumatic fever and rheumatic heart disease still remain major public health problems. With a dramatic rise in the incidence of coronary artery disease cases, the focus of the physician seems to be shifting away from rheumatic fever and rheumatic heart disease. The aim of the present study was to assess the prevalence of rheumatic fever and rheumatic heart disease, and to ascertain if there was any decline in the prevalence of the disease. For the first time, data on the prevalence of rheumatic fever and rheumatic heart disease are reported from Orissa, an underdeveloped state in eastern India. METHODS AND RESULTS: We scrutinized the records of cardiac patients admitted to the medicine, pediatrics and cardiology wards of the SCB Medical College and Hospital, Cuttack from 1981 to 1990 and 1991 to 2000. During the period 1981-1990, out of 11,782 cardiac patients, 5537 (46.9%) were suffering from rheumatic fever and rheumatic heart disease. During 1991-2000, out of 14,803 cardiac patients, 6670 hospitalized patients (45%) were found to have rheumatic fever and rheumatic heart disease. During the first and second periods, the number of patients with rheumatic fever admitted was 1079 (9.2%) and 1330 (8.9%), respectively. The decline in the percentage of rheumatic fever cases was statistically not significant (p>0.05). During the two periods, the number of rheumatic heart disease patients admitted was 4458 (37.8%) and 5340 (36.1%), respectively. During both the periods studied, the decline in the percentage of rheumatic heart disease cases admitted was statistically not significant (p>0.05). We also compared rheumatic fever and rheumatic heart disease cases admitted during 1981-1985 with those admitted during 1996-2000. This analysis also did not show any demonstrable decline in the prevalence of the disease (2692 [46.2%] v. 3296 [44.4%], p>0.05). CONCLUSIONS: Our results show that rheumatic fever and rheumatic heart disease cases constitute a significant percentage of the admissions of total cardiac cases to our hospital. Over the past 20 years, there is no significant decline in the percentage of rheumatic fever and rheumatic heart disease cases being admitted to a major government hospital.