Hospital readmission after cardiac surgery imposes substantial clinical and financial burdens, particularly in resource-limited countries such as Nepal. Recurrent readmissions and unnecessary emergency visits create significant emotional, physical, and economic stress for patients and caregivers while increasing healthcare utilization and hospital stay. Inadequate discharge counselling and incomplete understanding of postoperative instructions further contribute to high revisit rates. Structured telephone follow-up may provide a simple and cost-effective strategy to bridge the gap between hospital discharge and recovery. It can reinforce adherence to medications, facilitate early identification of warning signs, and help to prevent avoidable emergency visits. International evidence supports its role in improving patient satisfaction and reducing readmissions. However, evidence from South Asia remains limited. Tailored implementation of structured telephone follow-up may serve as a practical strategy to improve postoperative outcomes after cardiac surgery in Nepal.
Background and Aims: Growing evidence suggests thattraining nurses in echocardiographic screening for latent rheumatic heart disease (RHD) detection could be a promising strategy, especially in settings where cardiologists are often inaccessible. This diagnostic accuracy study evaluated the feasibility and accuracy of nurse-led RHD focused echocardiographic screening in Nepal. Methods: The prospective diagnostic accuracy study consisted of three phases: training, screening and testing. Four nurses were trained in RHD-focused echocardiography for six weeks using a structured training module. Nurses were tested on an enriched, conveniently selected sample of 100 children aged 6-16 years (36 with RHD, 64 without) to ensure adequate statistical power for sensitivity estimates. Findings were compared with standard echocardiographic assessments performed by an expert pediatric cardiologist. Diagnostic accuracy was assessed using sensitivity, specificity, area under the ROC curve (AUC) and Cohen's kappa Results: Among all nurses, mean sensitivity and specificity for any RHD were 87.5% (95% CI: 84.3-90.7%) and 95.3% (95% CI: 93.2-97.4%), respectively, with almost perfect inter-rater agreement (kappa = 0.84, p<0.001). AUC ranged from 0.90 to 0.95. Sensitivity for borderline RHD was markedly lower at 47.9%. The mean time difference between nurses and the cardiologist was modest but statistically significant (00:32 min:sec for RHD-negative, 01:31 for RHD-positive cases; p<0.05). Conclusions: Nurse-performed echocardiographic screening following brief structured training demonstrated acceptable diagnostic accuracy for RHD in school-age children. Within a two-step model (nurse screener followed by cardiologist confirmation), task-shifting represents a scalable and equitable strategy for early RHD detection in resource-limited settings such as Nepal.
Background: The number of coronary arteries involved, the degree of stenosis, and the type of vessel involvement in patients with acute coronary syndrome determine presentation, morbidity and mortality. We aimed to determine angiographic findings in patients with acute coronary syndrome outside Kathmandu Valley. The data regarding angiographic profiles of patients undergoing coronary angiograms outside the valley is limited. This study aims to narrow the gap. Methods: A Descriptive cross-sectional study was conducted in the Unit of Cardiology, Department of Internal Medicine from January 1, 2022, to December 30, 2022, after ethical approval from the Institutional Review Committee (reference number 079/080-161). Convenience sampling was used. Point estimates and 95% confidence intervals were calculated. Results: Among 192 patients, majority of the patients were male with a mean age of 61.29 12.50 years. Triple vessel disease (TVD) was present in 77 (40.10%) patients. Left anterior descending artery (LAD) was most involved which was present in 157 (81.77%) patients. ST-elevated myocardial infarction (STEMI) as present in 134 (69.79%) patients. Diabetes mellitus was present in 122 (63.54%) patients, and it was the most common risk factor Conclusions: In our study, triple vessel disease and involvement of the left anterior descending artery were the most common angiographic findings. Diabetes mellitus was the most common modifiable risk factor, which could be the reason for multiple vessel involvement.
Background: Umbilical venous catheters (UVCs) are essential in neonatal intensive care but can rarely fracture and embolize, causing life-threatening complications. Management traditionally required surgery, but percutaneous retrieval offers a minimally invasive alternative. Case Presentation: We report a 16-day-old preterm male neonate (33 + 4 weeks, 1990 g) with a fractured UVC fragment that migrated from the right atrium across a patent foramen ovale into the left atrial appendage. The initial retrieval attempt was aborted due to bradycardia; however, following stabilization, successful percutaneous retrieval was achieved via the right femoral vein approach using a Judkins guiding catheter and gooseneck snare. Conclusion: Percutaneous retrieval of embolized UVC fragments is feasible and safe, even from unusual locations such as the left atrial appendage, and should be considered the preferred management option.
Left ventricular dissection is an exceedingly rare and atypical mechanical complication of myocardial infarction with high mortality. It is considered a sub-acute phase of cardiac rupture, which has a subtle presentation and often remains undiagnosed. Presented here is a case report of a 54-year-old female who developed features of acute heart failure 1 month following an anteroseptal wall myocardial infarction and was later diagnosed to have left ventricular dissection on echocardiogram. This case highlights few facts on ventricular dissection, which has been sparsely reported or explained in literature.
Background and Aims: Dietary salt is a modifiable risk factor for hypertension and cardiovascular diseases. The World Health Organisation recommends salt restriction to <5 grams/day, while Nepalese are consuming almost twice the recommended amount of salt. 24-hour urine sodium excretion is the gold standard measure of daily salt intake. However, various equations (eg. INTERSALT, Kawasaki) are used to derive salt intake from spot urine samples. This study aimed to assess dietary salt intake among patients with hypertension and its relationship with blood pressure. Methodology: This is a cross-sectional, observational, multi-centre study among hypertensive patients who came to the medical OPD of Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Centre. Random spot urine sodium, and creatinine were tested to estimate daily salt intake using the INTERSALT and the Kawasaki equation. Results: A total of 222 participants (M = 95, F = 127) were enrolled in the study, with a mean systolic and diastolic blood pressure of 132.46 mmHg and 78.36 mmHg, respectively. Notably, 40.99% of participants had uncontrolled blood pressure. Average daily salt intake was 10.27 +/- 2.60 grams and 10.31 +/- 5.01 grams using the INTERSALT equation and the Kawasaki equation. About 97.1% were consuming higher than the recommended amount. Salt intake had a weak positive correlation with systolic blood pressure (r = 0.266; p < 0.001). Conclusions: Participants were consuming twice the recommended amount of salt daily and had poor blood pressure control.
Background: Ruptured sinus of Valsalva aneurysm (RSOV) is a rare but potentially life-threatening condition traditionally managed with surgery. Transcatheter closure (TCC) has recently emerged as a less invasive alternative. Case Summary: We report two adult patients; a 27-year-old male and a 48-year-old female, with RSOV arising from the non-coronary sinus and rupturing into the right atrium. Both presented with palpitations and dyspnea. Multimodality imaging confirmed the diagnosis. TCC was successfully performed using a Cera duct occluder in the first case and a Cocoon duct occluder in the second. Post-procedure imaging showed optimal device position, preserved aortic valve function, and no significant residual shunt, with no procedural complications. Conclusion: Transcatheter closure of RSOV is a safe and effective alternative to surgery in selected patients.
Background and Aims: Intravascular ultrasound enables better quantitative assessment of the vessel wall. In this study we aim to investigate the patient characteristics, lesion characteristics and outcome of IVUS facilitated coronary angiography and angioplasty in patients with Intermediate coronary lesion. Method: Cross-sectional, Quantitative study done at MCVTC (IOM) for 1 year. Random, Nonprobability sampling was used. All the patients with Intermediate coronary artery disease who underwent IVUS were included in the study. Patient characteristics, lesion characteristics, PCI and outcome were studied. Result: 33 cases who underwent IVUS were included in the study. The mean age was 56 years with 78% being male. On CAG LAD was the most common artery involved with 42% of cases followed by, RCA (30%) and LCx Involvement (21%) while only 7% cases had Left Main artery involvement. 23 (70%) of patient were managed medically and 10 (30%) were managed by PCI. Out of those managed with PCI, 2 (20%) had PCI in LAD, 4 (40%) had PCI in LCX and 4 (40%) had PCI in RCA. The mean MLA of LAD undergoing PCI was 3.8mm2 and % stenosis was 72%. Similarly, MLA in LCx undergoing PCI was 3.7mm2 and % stenosis was 76%. In RCA who underwent PCI mean MLA was 3.5mm2 and % stenosis was 78%. Conclusion: Routine use of IVUS in intermediate coronary artery lesion has a significant impact on identifying anatomically significant lesion which requires revascularization.
Background: Vitamin K antagonists (VKAs), particularly warfarin, remain the cornerstone of oral anticoagulation therapy in Nepal due to the high burden of rheumatic heart disease. Effective anticoagulation with VKAs requires meticulous monitoring of prothrombin time and international normalized ratio (PT/INR). However, significant variability exists in INR monitoring frequency, dose adjustment practices, laboratory standardization, and perioperative management across Nepal. Objective: To develop standardized, practical, and Nepal-specific consensus recommendations for PT/INR monitoring and warfarin management using a structured modified Delphi process. Methods: A three-round modified Delphi methodology was conducted among a multidisciplinary panel of clinicians involved in anticoagulation management in Nepal. Round 1 collected open-ended qualitative inputs to identify key thematic areas. In Round 2, structured consensus statements were developed and rated on a Likert scale. Statements with incomplete agreement were refined and re-evaluated in Round 3. Consensus thresholds were predefined, and recommendations were categorized accordingly. Results: Following three rounds of the modified Delphi process, 15 consensus recommendations were endorsed. Strong consensus was reached on recommendations related to therapeutic INR targets, dose-adjustment strategies, INR re-testing intervals, drug-drug interactions, perioperative management, and monitoring strategies for unstable patients. Consensus was not reached for select recommendations concerning routine reversal strategies in asymptomatic supratherapeutic INR and prolonged INR monitoring intervals. Final consensus recommendations addressed INR monitoring, warfarin management, and context-specific strategies for resource-limited and rural settings. Conclusion: This consensus provides a practical framework for PT/INR monitoring and warfarin management tailored to Nepal’s healthcare context. Adoption of these recommendations may help standardize practice, reduce preventable complications, and guide future research and policy development.
Background and aims: Advances in percutaneous coronary intervention (PCI) have improved procedural safety, enabling consideration of shorter hospital stays after uncomplicated procedures. However, evidence supporting early discharge strategies in low- and middle-income countries remains scarce. This study evaluated the safety and feasibility of overnight discharge following elective PCI in a tertiary cardiac center in Nepal. Methods: In this prospective observational study, 375 consecutive patients undergoing uncomplicated elective PCI were enrolled. All patients were monitored overnight and discharged the following day if clinically stable. The primary outcome was the incidence of major adverse cardiovascular events (MACE) within 30 days. Results: The mean age of the study population was 9.4 = 9.6j years, withmales comprising 75.7% (n = 284) Transradial access was utilized in 85.6% (n = 321) of procedures. At 30-day follow-up, no major adverse cardiovascular events (MACE) or hospital readmissions were observed. Minor bleeding events (BARC 1-2) occurred in 62 patients (16.5%), while no major bleeding complications were recorded. Conclusions: Overnight discharge following uncomplicated elective PCI appears feasible with low observed event rates in carefully selected low-risk patients in a resource-limited setting.
Background and aim: Diabetes mellitus (DM) is a major contributor to cardiovascular morbidity and mortality worldwide. Patients with DM undergoing cardiac surgery with cardiopulmonary bypass (CPB) experience higher rates of perioperative complications. National data describing the burden of diabetes and associated outcomes among cardiac surgical patients in Nepal remain limited. Methods: A retrospective observational study was conducted at a tertiary cardiac center in Kathmandu. Consecutive adult patients undergoing cardiac surgery with CPB between June 2022 and June 2023 were included. Demographic, clinical, and perioperative variables were collected and analyzed descriptively, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, glycated hemoglobin (HbA1c), type of surgery, acute kidney injury (AKI), surgical site infection (SSI), length of intensive care unit (ICU) stay, re-exploration, in-hospital mortality. Results: Type II DM was identified in 86 of 406 patients (21.2%). %). The median age was 60.5 years in diabetic patients and 51.5 years in non-diabetic patients, and BMI distributions were descriptively analyzed for both groups. Coronary artery bypass grafting (CABG) was performed in 73 diabetic patients (84.8%). In the diabetic cohort, acute kidney injury (AKI) was observed in 32.6% (vs. 27.5% in non-diabetics), surgical site infection in 4.7% (vs. 0%), re-exploration in 17.4% (vs. 15.9%), and in-hospital mortality in 22.1% (vs. 14.1%). The median glycated hemoglobin level (HbA1c) among diabetic patients was 7.0% (IQR, 6.0-7.8). Conclusion: This study outlines the specific clinical distribution of diabetes mellitus in this cohort. The descriptive data support establishing routine screening pathways to optimize perioperative care.
Background: Coronary artery disease (CAD) remains the most prevalent cause of morbidity and mortality worldwide.1 The triglyceride glucose (TyG) index is a simple and surrogate marker of insulin resistance (IR) which has been linked to the severity of CAD in multiple international studies.2 Nevertheless, its correlation with angiographic severity of coronary artery disease (CAD) in the Nepalese population has not been established so far. This study aimed to evaluate the relationship between the TyG index and CAD severity quantified by the Gensini score in patients who underwent coronary angiography for ischemic heart disease. Methods: This is a cross-sectional observational study conducted in the Department of Cardiology, NAMS Bir Hospital, Kathmandu. One hundred and one consecutive patients (mean age 64.17 +/- 10 years; 55.4% male) undergoing coronary angiography for ischemic heart disease were enrolled. Fasting venous blood samples were taken for determination of glucose and triglyceride levels. The TyG index was calculated as ln (fasting triglycerides [mg/dL] & times; fasting glucose [mg/dL] / 2). Coronary angiograms were assessed with Gensini scoring system. Spearman's correlation test was employed to assess correlation between variables. Statistical significance was set at p < 0.05. Results: Demography of the patients was analyzed (mean age 64.17 +/- 10 years; 55.4% male); the majority belonged to the middle-aged group (54 patients, 53.5%). Hypertension was the most prevalent comorbidity (60.4%), followed by diabetes (33.7%) and smoking (25.7%). On coronary angiography, 43 patients (42.6%) had normal coronaries, 17 (16.8%) had minor coronary artery disease (CAD), 16 (15.8%) had single vessel disease, 17 (16.8%) had double vessel disease, and 8 (7.9%) had triple vessel disease. A statistically significant positive correlation was observed between the TyG index and the Gensini score (r = 0.208, p = 0.037). A similarly significant positive correlation was found between the TyG index and the presence of CAD (r = 0.217, p = 0.029). Conclusions: The TyG index was significantly associated with the severity of CAD as measured by the Gensini score, but this association was modest. This simple and cost-effective biomarker may help clinicians stratify risk for patients with ischemic heart disease, especially in resource-limited settings where advanced metabolic testing is unavailable. Further prospective studies in Nepal are warranted to validate these findings and to establish population specific TyG cutoff values.
Cardiovascular disease is increasingly affecting the younger population in Nepal, representing a dual burden of rheumatic and lifestyle-related disorders. Rheumatic heart disease continues to impose significant morbidity among school-aged children, particularly in underserved regions, while premature ischemic heart disease is rising among young adults due to smoking, stress, physical inactivity, and poor dietary habits. Early, integrated prevention is essential to address this evolving epidemic. Strengthening school-based screening and prophylaxis programs for rheumatic disease, promoting healthy lifestyle behaviors, and incorporating regular cardiovascular risk assessment in educational and occupational settings are key strategies. National policies aligned with WHO noncommunicable disease targets can enhance coordination and sustainability of these efforts. Protecting young heart health is not only a medical responsibility but a national imperative vital for preserving the productivity and future of Nepal’s youth.
Background: Nepal has a high prevalence of rheumatic heart disease and many patients undergo metallic valve replacement. Most of the time, the replaced valve is the mitral valve. It is more prone to getting stuck than a prosthetic aortic valve. It also requires a higher INR value to maintain the patient in the therapeutic range. There is limited data regarding patients' time in the therapeutic range (TTR). This study will help better manage such patients and know the shortcomings in management. Methods: A total of 70 mitral valve replacement patients fulfilling the inclusion criteria having at least 3 months regular visit for INR underwent Rosendaal method to estimate TTR. Results: The study conducted at Shahid Gangalal National Heart Centre, Janakpurdham, showed that only 58.5% of patients were within the INR therapeutic range. The most frequent dose was approximately 6 mg with almost all patients requiring dose variation not in whole numbers but in decimals as daily warfarin dose. Conclusions: A significant proportion of patients remain outside the therapeutic range. Dosing of warfarin is in decimal. This suggests a need for lower-dose warfarin formulations like 0.5mg to help patients staying in therapeutic INR. For uniform INR report throughout country, national level thromboplastin has to be introduced. Genetic study inclusion in warfarin dose will help in accuracy of dosage. A separate INR clinic will further improve patient care.
Background and Aims: Paediatric cardiac conditions are significant contributors to morbidity and mortality in childhood. Our main aim was systematic collection, storage, analysis, interpretation and reporting of data on paediatric cardiac patients to assess their burden classified by age, gender, residence, ethnicity, diagnosis and treatment and to assess the quality of hospital services. Methods: A quantitative prospective cohort study was performed from January 2024 to June 2024. All children less than 16 years admitted to Shahid Gangalal National Heart Center were included in the study. Information collected in a structured proforma was carefully analysed. Results: Of 656 patients, 374(52.4%) were admitted in medical and 282 (47.6%) in surgery wards. Nearly 19.0% of total admissions were for either consolidation of diagnosis or diagnostic catheterization prior to the subsequent stage of treatment, 403 (61.4%) patients benefited and overall mortality was 69 (10.6%). Acyanotic heart disease was the most common congenital while Rheumatic Heart Disease was the most frequent acquired heart diseases among admitted children. Children with median age 7 months and with Persistent Pulmonary Hypertension, Arterial switch operation and BTT or Central Shunt had higher mortality among others. Conclusions: This study highlights the need for implementation of registry to identify measures to improve paediatric cardiac patients' care, like routine assessment for malnutrition, proper vaccination, regular audits, staff training, multidisciplinary meetings and recruiting specialists. This study could be a starting point for numerous follow-up studies that are essential for continuous progress.
Background: Heart failure with reduced ejection fraction (HFrEF) is a significant global healthcare burden. However, limited data exists on management patterns and outcomes in heart failure in the Nepalese healthcare context. This study aimed to evaluate the baseline characteristics, guideline-directed medical therapy (GDMT) utilization, shortcomings and treatment outcomes in HFrEF patients at a tertiary care center in Nepal. Methods: This was a prospective observational study conducted on 96 consecutive patients diagnosed with HFrEF. Demographic characteristics, clinical presentation, drug prescriptions, dosing patterns and treatment outcomes were systematically analyzed. Optimal dosing was defined according to current international guidelines. Results: The study population had a mean age of 61.6 +/- 12.9 years (range 20-90 years) with male predominance (64.6%). Most patients were middle-aged (41.7%) or elderly (41.7%), with 69.8% residing outside Kathmandu metropolitan area. Atrial fibrillation was present in 13.5% of patients. Two-thirds had been receiving treatment for heart failure for more than three months. The majority of patients presented in NYHA functional class II and III. GDMT prescription rates were high: beta-blockers 97.9% (metoprolol succinate 80.2%), RAAS inhibitors 81.25% (ARBs preferred over ACEi, 38.5% vs 24%), mineralocorticoid receptor antagonists 79.2% (spironolactone exclusively), and SGLT2 inhibitors 73.9% (dapagliflozin 51%, empagliflozin 22.9%). Loop diuretics were prescribed in 77% of patients (furosemide 64.6%). Anticoagulation with NOACs was used in 9.3% of patients, with no warfarin prescriptions. Despite high prescription rates, optimal dosing was achieved in a minority of patients. No patient received optimal doses of all GDMT components. Only 51% of patients achieved optimal dosing of two medications, while 30.2% achieved optimal dosing of one medication. Spironolactone demonstrated the highest optimal dosing rate (75%) followed by SGLT-2 inhibitors. Betablockers showed universal suboptimal dosing. Primary barriers to optimization included ongoing uptitration process (45.8%), hemodynamic unsuitability (16.6%), and physician inertia (10.4%). Clinical improvement was observed in 72.9% of patients, while 19.7% experienced clinical deterioration. The remaining patients maintained stable clinical status throughout the treatment period. Conclusions: This study unveils a paradox in HFrEF management in Nepal: excellent GDMT prescription rates coupled with universal suboptimal dosing. High utilization of evidence-based therapies, including rapid adoption of SGLT-2 inhibitors, is commendable. The systematic underdosing represents a critical quality gap prompting the healthcare system for the gap between guideline recommendations and clinical practice in the Nepalese healthcare setting.
Background and aim: Coronary Angioplasty is the preferred method of revascularization in Acute ST Elevation Myocardial Infarction (STEMI) and selected cases of Non-ST Elevation Myocardial Infarction (NSTEMI) and chronic coronary syndrome (CCS). This study was aimed to evaluate clinical and angiographic profile and procedural outcomes in patients undergoing percutaneous coronary intervention (PCI) at Dhulikhel Hospital, Nepal. Methods: This is a retrospective, observational, single center study conducted at Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal. All patients who underwent PCI for Acute Coronary Syndrome (ACS) and CCS in our hospital between April 1st, 2022 to March 31st, 2024, were included in the study. Data including clinical and angiographic profile, procedure and periprocedural complications, and in-hospital outcomes of these patients were analyzed. Results: A total of 189 patients (mean age 62.39 +/- 11.05 years) with 57.15% males and 42.85% females were included in the study. Hypertension and smoking were the most common risk factors, present in 79.36% and 76.19% patients respectively. Diabetes mellitus and dyslipidemia were observed in 47.62% and 35.45% patients respectively. STEMI ACS was the most common mode of presentation in 51.85% followed by NSTEMI in 32.80% and stable angina in 15.34%. Single Vessel Disease (SVD) was most common angiographic pattern, observed in 50.79% of patients, followed by Double Vessel Disease (DVD) in 63 patients (33.33%), and Triple Vessel Disease (TVD) in 30 patients (15.87%). Left anterior descending artery (LAD) was the most frequently involved vessel (63.49%). Elective PCI was performed in 53.96% and Primary PCI was done in 46.04 % patients. Radial route was used in the majority (90.47%) cases. Drug eluting stents were deployed in all the cases. Periprocedural complications occurred in 22.75%. There were 3 deaths, all after Primary PCI accounting for in-hospital mortality rates of 1.58%. Conclusion: This study provides an overview of the salient features of Coronary Artery Diseases and the characteristics of PCIs performed with their outcomes in a semi-urban tertiary care center of Nepal. This study shows that PCI done in resource-limited settings like Nepal is also safe, effective and has low in hospital mortality and complications, which is comparable to High-income countries.
Background: Coronary artery dissection is a rare and life-threatening event resulting after blunt trauma especially in setting of high-speed motor vehicle collision. It can result in acute coronary syndrome due to subsequent thrombus formation, propagation of dissection, and total occlusion of coronary artery. Case: A thirty-year-old male sustained high speed motorbike collision resulting in closed right sub-trochanteric fracture and right mid clavicle fracture. While being evaluated for surgery, he developed heart failure and further cardiac evaluation was done. Coronary computed tomography angiography was done which revealed dissection of proximal left anterior descending artery and percutaneous coronary intervention (PCI) was attempted in view of refractory ventricular tachycardia. After unsuccessful PCI, off-pump coronary artery bypass grafting was done with successful revascularization and electrical stabilization. Conclusion: This highlights the importance of considering coronary artery dissection in patients with blunt chest trauma.
Background and Aim: Ischemic heart disease (IHD) is a leading global cause of disability and mortality, yet systematic epidemiological analyses in Nepal remain scarce. This study aimed to analyze trends in IHD incidence and mortality in Nepal and project future burdens to inform evidence-based interventions. Methods: Data from the Global Burden of Disease Study 2021 were analyzed. Joinpoint regression identified trends in age- standardized incidence (ASIR) and mortality rates (ASMR), calculating the annual percent change (APC) and the average annual percent change (AAPC). Age-period-cohort (APC) models disentangled age, period, and cohort effects, while Bayesian APC models projected trends from 2022 to 2036. Risk factors were assessed via attributable mortality analysis. Results: From 1990 to 2021, Nepal experienced an increase in IHD incident cases from 49,265 to 116,482, with males consistently having higher ASIR than females. Recent trends (2015-2021) showed rising ASIR in both males and females, contrasting with global declines. ASMR declined in females (AAPC=-0.74%) but increased in males (AAPC=0.32%). Age effects revealed a steep increase in risk from 40-44 years, peaking at 7420.64/100,000 in the 95+ age group. Notably, post- 2007 birth cohorts showed a resurgent IHD incidence risk, representing an emerging threat to younger populations. Projections forecast ASIR rising to 466/100,000 (females) and 726/100,000 (males) by 2036, with male ASMR projected to increase to 260/100,000. For males, high systolic blood pressure; for females, solid fuel pollution were primary sex-specific IHD risk factors. Conclusion: Nepal's IHD burden exhibits gender and age disparities, including a paradoxical rise in male mortality and resurgent risks in younger populations. Stratified intervention strategies are required, targeting gender-specific risks (hypertension management and tobacco control for males; clean fuel promotion and smoke-control cooking appliances for females) and age-specific needs (geriatric monitoring and intervention in primary healthcare and early health education for youth), alongside modifiable risk factors.
