Background The burden of heart failure (HF) is immense, from reducing quality of life (QoL) to increasing mortality risks and additional financial implications. The risk of adverse outcomes get higher with each HF hospitalisation (HFH). Purpose To look at predictors of in-hospital mortality outcomes during HFH and the prescription trends in conventional guideline-directed medical therapy (GDMT) for HF. Methods Retrospective analyses were performed for 7405 HFH cases admitted to our cardiology institution from 2009 to 2018, diagnosed based on the signs and symptoms of heart failure with NTProBNP≥300 at presentation. Results Most patients that required HFH were aged <65 years (53.5%), were males (72.8%) and had more diabetes mellitus (66%) and hypertension (75.1%). There were fewer other co-morbidities such as coronary artery disease (CAD) (26.9%), renal insufficiency (33.8%), atrial fibrillation (Afib) (23.9%), dyslipidaemia (40.3%), prior stroke/transient ischaemic attack (TIA) (5.6%), chronic obstructive pulmonary disease (11.6%), current/ex-smokers (45.5%). Most had presenting systolic blood pressure (SBP) >100 mmHg (88.8%), presenting heart rate ≥70 bpm (78.6%) and were in heart failure with reduced ejection fraction (HFrEF) <40% (74.8%). At presentation for HFH, 31.2% had 3 GDMTs (GDMT III) (angiotensin converting enzyme inhibitor / angiotensin receptor blocker / angiotensin receptor neprilysin inhibitor + beta blocker + mineralocorticoid receptor antagonist), 37% had either 2 GDMTs (GDMT II), 25% had only 1 GDMT (GDMT I), while 6.8% had none. The average in-hospital mortality rate was 5.2%. Independent predictors associated with increased in-hospital mortality were males, renal insufficiency, Afib, prior stroke/TIA, SBP ≤100 mmHg, serum sodium <135 mmol/L, uric acid ≥529 μmol/L, NTProBNP ≥6590, inpatient procedures i.e. dialysis, mechanical ventilation and cardiopulmonary resuscitation (CPR). Independent predictors associated with reduced inpatient mortality were hypertension, inpatient cardiac diagnostic procedures and presence of GDMT I, GDMT II and GDMT III at presentation (Figure 1). Throughout the 10 years, the proportion of GDMT prescription were similar; GDMT I (19.1–28.7%), GDMT II (35.1–41.6%), GDMT III (25.2–37.3%). The proportion of GDMT III across the CKD group stages were never more than 50% (Figure 2). Conclusion There remains significant in-hospital mortality risk for HFH. While some of these predictors are not modifiable, others are, especially when it comes to GDMT prescriptions. GDMTs provide better prognosis in patients living with HF. There are growing evidence that simultaneous / rapid sequence initiation of GDMTs are more beneficial than the conventional step wise approach. The analysis findings of GDMT proportions at presentation of HFH and also in the CKD group stages meant that many patients are still receiving suboptimal care for their HF and this clinician inertia mentality has got to change. Funding Acknowledgement Type of funding sources: None.
Aims: There remains a large emphasis on optimisation of guideline-directed medical therapy (GDMT) during the ‘vulnerable phase’ of acute heart failure (HF). Multidisciplinary team heart failure (MDT-HF) clinics have been shown to be beneficial in increasing key GDMT prescriptions. The aim of this study was to report on the authors’ experience running the first Malaysian early, post-discharge MDT-HF clinic. Methods: A retrospective review of the MDT-HF clinic was conducted in Institut Jantung Negara, Malaysia, over a 3-year period (2019–22). Results: A total of 186 patients and 488 clinic encounters were identified. Patients were mainly of New York Heart Association functional class II (45.2%) and had a mean left ventricular ejection fraction of 26.1%. Blood investigations on average were stable, aside from estimated glomerular filtration rate (≤60 ml/min/1.73 m2 in 53.2% of patients) and NT-pro-brain natriuretic peptide (mean of 5,201 pg/ml). Common comorbidities included diabetes (60.0%), hypertension (60.0%), dyslipidaemia (46.2%) and chronic kidney disease (38.2%). A high proportion of new prescriptions and uptitration of medication were for key GDMTs, while the majority of downtitrations were for diuretics. A substantial number of patients were on three or four GDMTs (37.6% and 49.5%, respectively). Counselling provided during the MDT-HF clinic was also analysed, which included education on self-care and medication management, and lifestyle counselling. Conclusion: MDT-based services offer evidence-based, holistic care to HF patients. Hopefully, this description of the establishment of the first MDT-HF clinic should encourage the development of similar services across the region.
Background: There is sparsity in regional data surrounding heart failure with preserved ejection fraction (HFpEF)-related acute decompensated heart failure (ADHF) admissions in southeast Asia. This study aims to describe the characteristics, clinical parameters and outcomes related to HFpEF-linked ADHF admissions. Methods: A retrospective, observational study was conducted in a major cardiac tertiary centre in Malaysia over a 10-year period (2009–2018). A total of 4,198 patients were identified, of which 632 had HFpEF. Results: HFpEF patients were significantly older (mean 67.6 years) and female (52.2%). A high proportion of HFpEF patients had hypertension (73.4%), diabetes (58.1%), coronary artery disease (57.9%) and ischaemic cardiomyopathy (50.8%), although this remains significantly lower versus non-HFpEF patients. Atrial fibrillation (AF) was more common among HFpEF patients (34.7%). HFpEF patients in the study population appeared relatively stable, compared to non-HFpEF patients, supported by better blood results (suggestive of less congestion) on admission, shorter duration of inpatient stay, lower use of emergency cardiac procedures, lower in-hospital mortality rates and lower rates of HF readmission and all-cause mortality. However, when compared to other registries, specifically the ASIAN-HF cohort, HF readmission and all-cause mortality within the first year were higher in the present study cohort (37.9%, versus 12.1–23.6%). Conclusion: The present study highlights key characteristics of HFpEF patients in Malaysia and challenges the notion of the five major phenotypes of HF proposed by previous studies. Therefore, granularity in data collection and analysis is key, especially in a heterogenous condition like HFpEF, and efforts should be improved to obtain more information on local HFpEF patients.
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