 Good morning. I am Dr. Rajnish Sardana. I am a senior consultant cardiology head of pacing and electrophysiology at the Manipal Heart Institute in New Delhi. Heart failure is a condition in which the person's heart is not able to pump adequate blood to meet the requirements of the entire organs of the body. It can be due to feeling defects or it can be per se because the pump has failed. It leads to symptoms of breathlessness, swelling in the body, decreased urine output, dizziness, difficulty in lying down. So, the symptoms can be varied and the diagnosis made by a combination of symptoms, clinical examination and echocardiography which reveals that the heart has become bigger and the pumping efficiency has gone down. It's a serious condition. When a person is told he's got heart failure, literally he feels very bad but heart failure is a medical terminology. It does not mean that the heart has failed. It just means that it's not able to meet the needs of the body. Somewhere in the mid-90s, the prognosis of heart failure was considered very, very bad. Person was doomed. Almost 50% of them would die within five years of the diagnosis of cardiomyopathy or heart failure. Over the time, a lot of medications have come in which have helped a lot in improving the outcome of heart failure. In the recent world, there's been a new new addition of medication. It seems to be even improving the symptoms of patients and also their modalities which delay the onset of progression or the progression of the disease. For end-stage heart failure also now there are solutions which have come in. Heart transplant has become a reality which till sometimes back in India was considered totally on the books but now we have patients who have undergone successful heart transplant have had a survival of ten years and over and most of the cities now the trend is picking up where the donors are coming forward. Before the heart transplant, there are a couple of other things we can do especially a pacemaker specialized pacemaker called CRT. It's a heart failure pacemaker which is given to patients who are suited for it which help a lot in improving or supporting the heart along with medication in improving their symptoms feeling better delaying their onset of of a gross end-stage heart failure and producing a lot of relief also prolonging life. There's something called a L-VAD which is again a pumping it's a half artificial heart I would say which helps assist the left ventricle in pumping which in patients who they it is indicated and who can afford can go a long way and it is picking up but the cost is phenomenal for a L-VAD to the tune of about 50 lakh so the volume in India is still low. All in all I would say the heart failure prognosis is improving patients initially were as I said were destined to die which is no longer the case and we see more and more patients who survive good 15, 20, 25 years despite the diagnosis with the help of medication and these new modalities of treatment. Thank you so much.