Strategies to Optimize Management of Outpatient Worsening Heart Failure: A National Consensus from India

• DOI: 10.4103/jpcs.jpcs_23_25
• Publication Date: 2025-05-01T07:31:35Z
• Authors: Sandeep Seth; Vijay Kumar Chopra; Raja Ram Mantri; Sunil K. Modi; Sanjay Mittal; Jayagopal Pathiyi...; Vinayak Aggarwal; Rajiv Mehrotra; Sundeep Mishra; B. S. Vivek; Sanjiv Aggarwal; B. C. Kalmath; Harmanpreet Singh; Ajay Mahajan; Preeti Gupta; Anwar Ansari; Suvro Banerjee; Samir Kubba; Pravin Kahale; Arvind Das; Sanjeeva Gupta; Biju Govind; Prashant Mishra; Mukesh Goel; Vishal Rastogi; S. N. Pathak; Kamal Sharma; Amit Sharma; K. V. Srikanth; M Kathiresan; Dilip Kumar; Vivek Mahajan; Vikas Kumar; Roshan Kumar; Mohit Bhagwati; Kapil Mehta; Ankit Bansal; Hemant Khemani; Johan Christopher; Gajendra Goyal; Rituparna Baruah; Arindam Pande

Abstract Background: Worsening heart failure (WHF) is characterized by the progression of symptoms in patients with established HF, necessitating intensified treatment, typically diuretics. Outpatient (OP) management WHF offers an alternative to hospitalization, as many experience a gradual onset symptoms, allowing timely intervention. However, OP often underrecognized and excluded from clinical trials, highlighting need for structured guidance. This expert consensus aims address this gap providing practice recommendations management. Methodology: A panel Indian cardiologists convened meeting moderated leading cardiologist. Based on evidence, insights, live polling, were developed. Results: Experts agreed that defined symptom worsening despite standard HF therapy, decompensation chronic increase oral or intravenous diuretic dose. Vericiguat was recognized suitable reduced eGFR (<30 mL/min/1.73 m²), unlike angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNi) digoxin. While ACEi/ARB/ARNi doses may be renal function, beta-blockers should maintained long possible. prioritize early vericiguat initiation alongside rapid therapy optimization. About 44% experts recommended initiating at first follow-up (3–7 days postdischarge), whereas 33.3% preferred it last-line option. Management end-stage advanced options like assist devices transplants needed drug persisting end-organ failure, repeated hospitalization. Conclusion: highlights department (OPD)-based recognition WHF, OPD-based optimization, improve outpatient settings.