Heart failure is one of the fastest-growing cardiovascular challenges worldwide and a major cause of hospital admissions in India. Unlike a heart attack, which is a sudden event, heart failure is a chronic condition that requires lifelong management. Patients often experience repeated episodes of worsening symptoms, leading to hospitalisation.
A recent U.K. clinical trial found that selected patients with worsening heart failure could safely continue diuretic treatment at home using a wearable drug-delivery pump, after initial stabilisation in hospital, allowing them to be discharged earlier without compromising outcomes.
The device used in the study, known as Furosex, delivers the diuretic furosemide through a wearable infusion system. Traditionally, patients developing fluid overload after discharge often require readmission for intravenous diuretic therapy.
Balamurugan S., consultant, interventional cardiology, SRM Prime Hospital, Chennai, says such innovations could be relevant in India as well. “Heart failure is a chronic journey. Preventing readmission is of utmost importance for patients. In carefully-selected stable heart failure patients, these devices may reduce readmission rates, improve patient comfort and lower healthcare costs,” he says.
While the approach is yet to become routine in India, cardiologists say it shows a broader shift underway in heart failure management, one that increasingly relies on advanced medicines, remote monitoring technologies, device therapies and Artificial Intelligence to improve outcomes.
Beyond symptom control
Treatment of heart failure has undergone many changes over the past decade. “Earlier, management was mainly focused on symptom control, but now we have therapies that actually improve survival and reduce hospital admissions,” says Rajeev Thillak Chellasamy, heart failure and transplant surgeon, SIMS Hospital, Chennai.
According to Dr. Balamurugan, one of the biggest advances has been the adoption of guideline-directed medical therapy. Unlike older approaches that primarily relieved symptoms, newer treatments target the disease process itself. Modern heart failure treatment includes four major classes of drugs: beta blockers, renin-angiotensin system inhibitors such as ACE inhibitors, ARBs and ARNIs, mineralocorticoid receptor antagonists, and SGLT2 inhibitors.
Another newer addition to the treatment armamentarium is vericiguat, a soluble guanylate cyclase stimulator that has shown benefits in patients recovering from worsening heart failure. P. Manokar, senior interventional cardiologist and clinical lead of the heart failure and transplant programme, Kauvery Hospital, Chennai, describes vericiguat as the “fifth pillar” of heart failure therapy. The drug, he says, has helped reduce repeat hospital admissions among patients at high risk of recurrent decompensation.
Lifestyle and care
Yet experts emphasise that medicines alone cannot prevent disease progression. “I feel somebody sitting with the patient and talking about fluid restriction, salt restriction and lifestyle changes can go a long way in preventing repeat hospitalisation,” says Dr. Manokar.
He notes that dedicated heart failure nurses and nurse practitioners, who play a central role in many international healthcare systems, could significantly strengthen long-term care in India.
Wearables and remote monitoring
Technology is increasingly enabling doctors to monitor patients long after they leave the hospital. Smartwatches and wearable devices can now track heart rate, rhythm abnormalities, oxygen saturation and, in some cases, blood pressure and weight trends. These measurements can provide early warning signs of worsening heart failure before patients become severely symptomatic.
Dr. Balamurugan says even subtle changes such as sudden weight gain, rising resting heart rate, reduced physical activity or falling oxygen levels can indicate developing congestion.
“The goal is to identify deterioration early and intervene before it results in an emergency admission,” he says. According to Dr. Rajeev, wearable technologies and telemedicine are gradually transforming cardiac care, particularly for patients living outside major cities who may not have easy access to specialised heart centres.
The COVID-19 pandemic accelerated the adoption of remote monitoring. Dr. Manokar notes that patients with implanted cardiac devices demonstrated that important clinical information could be transmitted remotely through digital platforms, reducing the need for frequent hospital visits.
Teleconsultations and virtual follow-ups have since become an important bridge between patients and specialists, particularly for those requiring long-term management. Another emerging innovation is home-based treatment using wearable drug-delivery systems.
Experts believe such approaches could eventually improve patient comfort and reduce pressure on hospital beds, although widespread adoption in India would require decreased costs of these devices, robust monitoring systems, trained personnel and careful patient selection.”Technology should support, not replace, clinical judgement,” says Dr. Rajeev.
Implementation challenges
While innovation in heart failure care is advancing rapidly, experts say implementation remains a major hurdle in India. “The biggest challenge is not innovation itself, but affordability and access,” says Dr. Balamurugan.
Many newer medicines, implantable devices and advanced monitoring systems remain beyond the reach of large sections of the population. Many patients also discontinue medications once symptoms improve, unaware that heart failure requires lifelong treatment and follow-up. In such cases, family members and caregivers often play a crucial role in monitoring medications, dietary restrictions, fluid intake and early warning signs of deterioration.
Experts say stronger follow-up systems, better patient education and improved caregiver support will be essential if advances in treatment are to translate into better outcomes on a population level.
Looking ahead
Experts say concepts such as AI-assisted diagnostics, predictive analytics and digital twins, virtual patient models that simulate how an individual might respond to different treatments could eventually reshape heart failure management. AI systems are already being used to analyse electrocardiograms and echocardiograms, helping detect subtle abnormalities earlier than conventional approaches.
Affordable Indian-made LVAD systems, remote monitoring platforms and AI-enabled diagnostic tools could help ensure that advanced cardiac care reaches a larger population.
But technology alone cannot address the growing burden of heart failure. Ensuring that these advances are accessible and affordable to patients across India remains one of the biggest challenges.
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