# Heart Failure Polypill in India: A Late-Stage Implementation Strategy

> **NIH HL R00** · WASHINGTON UNIVERSITY · 2026 · $124,758

## Abstract

PROJECT SUMMARY/ABSTRACT
Heart failure (HF) is a leading global public health problem. The burden of HF is increasing in low- and middle-
income countries and clinical outcomes remain poor. Guideline-directed medical therapy (a combination of
distinct medications from disparate drug classes) improves morbidity and mortality in patients with HF with
reduced ejection fraction (HFrEF). Despite this high-quality evidence, guideline-directed medical therapy
remains widely underutilized globally and specifically in India. This gap represents a key target for intervention
to save lives. Dr. Agarwal’s K99/R00 proposal aims to substantially simplify HF management by shifting the
treatment paradigm for undertreated patients with HFrEF from multi-drug therapy with sequential initiation and
titration to a novel late-stage implementation strategy of a HFrEF polypill of guideline-directed medical therapy
including a beta-blocker, angiotensin receptor blocker, and mineralocorticoid receptor antagonist. First, Dr.
Agarwal will conduct formative mixed methods research including a HF treatment consensus meeting and
focus group discussions to guide development of the HFrEF polypill-based strategy in India. Second, she will
evaluate whether, compared to usual care, a HFrEF polypill implementation strategy will reduce cardiovascular
disease mortality and HF hospitalizations at 12 months in adults with HFrEF in India using a multi-center, type I
hybrid randomized clinical trial design. She will also assess the effect of the HFrEF polypill implementation
strategy on important secondary outcomes including medication adherence, markers of HF disease severity,
health-related quality of life, and safety measured by adverse events. Finally, Dr. Agarwal will apply methods of
process evaluation to assess implementation outcomes of the HFrEF polypill in India, a key step in translating
evidence generated into broader use globally. The K99 phase will also provide essential methodological
training 

## Key facts

- **NIH application ID:** 11243527
- **Project number:** 5R00HL157687-04
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** ANUBHA  AGARWAL
- **Activity code:** R00 (R01, R21, SBIR, etc.)
- **Funding institute:** HL
- **Fiscal year:** 2026
- **Award amount:** $124,758
- **Award type:** 5
- **Project period:** 2024-12-09T00:00:00 → 2027-11-30T00:00:00

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11243527

## Citation

> US National Institutes of Health, RePORTER application 11243527, Heart Failure Polypill in India: A Late-Stage Implementation Strategy (5R00HL157687-04). Retrieved via AI Analytics 2026-05-20 from https://api.ai-analytics.org/grant/nih/11243527. Licensed CC0.

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