Date: {{ $ActivityAssignDate }}

Dear Dr. {{ $doctorName }},

Subject:NODE Survey Study: AdoptioN Of Guideline-Directed medical therapy (GDMT) and four pillar in the management of heart failure.

Cardiac failure which is also known as heart failure, is characterized by impaired pumping of blood leading to inadequate blood circulation throughout the body. According to American College of Cardiology (ACC), Heart Failure Society of America (HFSA), American Heart Association (AHA), and European Society of Cardiology (ESC) heart failure is defined as a complex clinical syndrome which is caused by any structural or functional impairment of ventricular filling or blood ejection. Various conditions like systemic diseases, cardiac conditions and genetic abnormalities can result in heart failure. As determined by Global Burden of Disease Study, heart failure encompasses of approximately 17 primary aetiologies and over 2/3 of heart failure cases can be attributed to 4 underlying conditions including ischemic heart disease, chronic obstructive pulmonary disease, hypertensive heart disease and rheumatic heart disease. In India, the annual incidence of heart failure among patients with coronary heart disease ranged between 0.4% to 2.3% per year and prevalence of 0.12 to 0.44% ranging between 1.3 to 4.6 million individuals. Annually, 1.8 million hospitalizations were attributed to heart failure. Globally, heart failure is a rapidly emerging public health concern with an estimated prevalence of >37.7 million individuals. As of 2011, within the USA approximately 5.7 million individuals were living with heart failure, and around 8,70,000 new cases were diagnosed yearly', by 2030 it is expected to increase by 46% that is more than 8 million individuals. Advances in contemporary medical management to treat patients with heart failure have opened doors for life-saving Guideline-Directed Medical Therapy (GDMT). GDMT is proven to reduce morbidity and mortality, in patients with heart failure with reduced ejection fraction (HFrEF). GDMT is the cornerstone pharmacological treatment for patients with HFrEF, comprising four main drug classes: B-blockers, Angiotensin Receptor-Neprilysin Inhibitor (ARNI), Mineralocorticoid Inhibitors (MRAs), and Sodium Glucose Co-transporter 2 (SGLT2) Inhibitors forming the Four Pillars of heart failure therapy. The B-blockers, are a class of drugs, that reduce oxygen demand, slow down specific cell activities, regulate blood pressure, and heart rate. The Angiotensin Receptor-Neprilysin Inhibitor (ARNIs) helps to reduce blood pressure during heart failure by preventing blood vessels from constricting and enhancing the left ventricle's performance. The Mineralocorticoid receptor antagonists (MRAS) effectively counteract the harmful effects of aldosterone, especially in heart failure (HF) patients. The Sodium Glucose Co-Transporter 2 (SGLT2) inhibitors are novel type drugs that have shown effectiveness against heart failure regardless of ejection fraction and diabetic status. Additionally, increased B-type Natriuretic Peptide (BNP) and NT- proBNP act as diagnostic markers for cardiac dysfunction in heart failure (HF) patients with HFrEF or HFpEF. However, the major challenge is despite of high mortality rates from heart failure GDMT adherence is consistently low globally, across various countries, healthcare systems, patient groups, and providers. Large registries consistently show insufficient GDMT rates, emphasizing the need for prompt implementation of all four life-saving drug classes in heartfailure treatment in India.

The purpose of the study to understand the factors contributing to heart failure, as perceived by physicians and cardiologists, through the utilization of Guideline-Directed Medical Therapy (GDMT) and the integration of the four pillars in heart failure treatment in India.

We invite you to participate in this study. On acceptance, you will need to capture the relevant data as mentioned in the standard Data Collection Form (DCF) provided, from the patient's medical records (case papers and investigational reports - hereafter referred as source documents).

We would recommend you to capture data fulfilling the criteria as outlined in the protocol and whose relevant laboratory investigations are available for the preceding 3 months.

We wish to inform you that the DCF will capture all data in de-identified form and any identifiable parameters which may potentially disclose the identity of the patient such as name or address will strictly not be captured so as to ensure we maintain patient confidentiality. We would encourage you to carefully fill all available information to the fullest as recommended in the DCF