Which of the following is the most common cause of acute decompensated heart failure in India?

Explanation

## Epidemiology of Acute Decompensated Heart Failure in India **Key Point:** Coronary artery disease (CAD) is the most common cause of acute decompensated heart failure (ADHF) in India, reflecting the ongoing epidemiological transition from communicable to non-communicable diseases. ### Why CAD Leads in Contemporary India 1. **Epidemiological transition** — India has witnessed a dramatic rise in ischemic heart disease over the past two decades, now accounting for the largest proportion of HF hospitalizations in most large registry studies (e.g., INDUS-HF, RSSDI data). 2. **Rising risk factor burden** — Diabetes, dyslipidemia, smoking, and sedentary lifestyle have fueled CAD prevalence across both urban and rural India. 3. **Ischemic cardiomyopathy** — Repeated ischemic insults lead to progressive LV dysfunction and eventual ADHF. 4. **Earlier age of onset** — Indians develop CAD approximately a decade earlier than Western counterparts, expanding the pool of patients at risk for HF. ### Comparative Causes of HF in India | Cause | Approximate Prevalence | Notes | | --- | --- | --- | | Coronary artery disease | 35–45% | Most common; ischemic cardiomyopathy dominant | | Hypertensive heart disease | 20–30% | Second most common; preventable with BP control | | Dilated cardiomyopathy | 10–15% | Idiopathic or viral etiology | | Rheumatic heart disease | 10–15% | Declining due to improved streptococcal prophylaxis | | Peripartum cardiomyopathy | 5–10% | Unique to women in pregnancy/postpartum | ### Why Other Options Are Less Correct - **Hypertensive heart disease (A):** Significant contributor but ranks second to CAD in contemporary Indian registry data. - **Rheumatic mitral stenosis (B):** Historically important but declining; now accounts for a minority of ADHF cases. - **Dilated cardiomyopathy (C):** A notable but less frequent etiology compared to CAD. **Clinical Pearl:** The epidemiological shift in India mirrors global trends — as rheumatic disease declines and metabolic risk factors rise, CAD-related HF has become the dominant etiology. This is well-documented in Harrison's Principles of Internal Medicine and Indian HF registry data. **High-Yield:** On NEET PG exams set in the contemporary Indian context, CAD is the leading cause of heart failure overall. Rheumatic heart disease remains relevant in younger patients and rural settings, but CAD dominates ADHF hospitalizations in tertiary care series.