Trends for Readmission and Mortality After Heart Failure Hospitalisation in Malaysia, 2007 to 2016

Lim, Yvonne Mei Fong; Ong, Su Miin; Koudstaal, Stefan; Hwong, Wen Yea; Liew, Houng Bang; Jeyamalar, R; Grobbee, Diederick E.; Asselbergs, Folkert W.; Sivasampu, Sheamini; Vaartjes, Ilonca

doi:10.5334/gh.1108

Cited by 7 publications

(12 citation statements)

References 34 publications

(34 reference statements)

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“…This is not surprising as rates of all-cause mortality in HF patients in Malaysia and southeast Asia are often among the highest in the region, ranging between 7.2 and 49.7% within the first year. [13][14][15]28 Median NT-Pro BNP levels on admission were also resoundingly higher in our patient population, suggestive of a more severe disease state during hospitalisation, as previously proven. 29,30 However, relying on NT-pro BNP levels to determine the severity of congestion in HFpEF has recently been shown to be misleading, and lower or normal levels may, in fact, be associated with more morbid prognosis, highlighting the gap in the utility of NT-pro BNP as a biomarker of diagnosis and prognostication in HFpEF.…”

Section: Discussionsupporting

confidence: 83%

Acute Decompensated Heart Failure with Preserved Ejection Fraction: Do the Asian Phenotypes Fit?

Shariff

Koh

Sulong

et al. 2023

J Asian Pac Soc Cardiol

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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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Section: Discussionsupporting

confidence: 83%

Acute Decompensated Heart Failure with Preserved Ejection Fraction: Do the Asian Phenotypes Fit?

Shariff

Koh

Sulong

et al. 2023

J Asian Pac Soc Cardiol

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“…They will need to travel quite a distance to the tertiary centre to seek medical treatment. In addition, the low accessibility to medical treatment in this population explained that the 30-day HF readmission rate was the lowest among all ethnicities in a study conducted in Malaysia ( 69 ). Furthermore, HF patients from the indigenous ethnicity had fewer PCI done (0 vs. 43.8%, p = 0.001) and received lesser ARNi treatment (0 vs. 45.5%, p = 0.02), than Malay patients.…”

Section: Discussionmentioning

confidence: 92%

Cost analysis of chronic heart failure management in Malaysia: A multi-centred retrospective study

Ong

Low²,

Yew³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEstimation of the economic burden of heart failure (HF) through a complete evaluation is essential for improved treatment planning in the future. This estimation also helps in reimbursement decisions for newer HF treatments. This study aims to estimate the cost of HF treatment in Malaysia from the Ministry of Health’s perspective.Materials and methodsA prevalence-based, bottom-up cost analysis study was conducted in three tertiary hospitals in Malaysia. Chronic HF patients who received treatment between 1 January 2016 and 31 December 2018 were included in the study. The direct cost of HF was estimated from the patients’ healthcare resource utilisation throughout a one-year follow-up period extracted from patients’ medical records. The total costs consisted of outpatient, hospitalisation, medications, laboratory tests and procedure costs, categorised according to ejection fraction (EF) and the New York Heart Association (NYHA) functional classification.ResultsA total of 329 patients were included in the study. The mean ± standard deviation of total cost per HF patient per-year (PPPY) was USD 1,971 ± USD 1,255, of which inpatient cost accounted for 74.7% of the total cost. Medication costs (42.0%) and procedure cost (40.8%) contributed to the largest proportion of outpatient and inpatient costs. HF patients with preserved EF had the highest mean total cost of PPPY, at USD 2,410 ± USD 1,226. The mean cost PPPY of NYHA class II was USD 2,044 ± USD 1,528, the highest among all the functional classes. Patients with underlying coronary artery disease had the highest mean total cost, at USD 2,438 ± USD 1,456, compared to other comorbidities. HF patients receiving angiotensin-receptor neprilysin-inhibitor (ARNi) had significantly higher total cost of HF PPPY in comparison to patients without ARNi consumption (USD 2,439 vs. USD 1,933, p < 0.001). Hospitalisation, percutaneous coronary intervention, coronary angiogram, and comorbidities were the cost predictors of HF.ConclusionInpatient cost was the main driver of healthcare cost for HF. Efficient strategies for preventing HF-related hospitalisation and improving HF management may potentially reduce the healthcare cost for HF treatment in Malaysia.

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“…Previous studies indicate advanced age, severe NYHA class, and CKD (eGFR < 60 mL/min/1.73 m 2 ) as risk factors consistently associated with worse outcomes 12,13,25,26 . Other predictors include LVEF, lower SBP, diabetes mellitus, male gender, lower BMI, lower haemoglobin, and aortic stenosis 27 .…”

Section: Discussionmentioning

confidence: 98%

“…To date, MY-HF Registry is the largest multicentre, prospective cohort of ADHF admission in Malaysia, thus allowing for a more robust data set to be collected and analysed compared with previously reported studies by Ling et al 12,13,24,25 As more than 80% of patients participating in this registry had standard (department) ECHO performed by trained echocardiographers, the registry provides an opportunity to define the different spectrums of HF and evaluate current practice and outcomes in the era of established HF-guided medical treatment.…”

Section: Study Implicationmentioning

confidence: 99%

Characteristics of patients admitted with heart failure: Insights from the first Malaysian Heart Failure Registry

Wan Ahmad,

Abdul Ghapar,

Zainal Abidin

et al. 2023

ESC Heart Failure

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AimsHeart failure (HF) is a growing health problem, yet there are limited data on patients with HF in Malaysia. The Malaysian Heart Failure (MY‐HF) Registry aims to gain insights into the epidemiology, aetiology, management, and outcome of Malaysian patients with HF and identify areas for improvement within the national HF services.Methods and resultsThe MY‐HF Registry is a 3‐year prospective, observational study comprising 2717 Malaysian patients admitted for acute HF. We report the description of baseline data at admission and outcomes of index hospitalization of these patients. The mean age was 60.2 ± 13.6 years, 66.8% were male, and 34.3% had de novo HF. Collectively, 55.7% of patients presented with New York Heart Association (NYHA) Class III or IV; ischaemic heart disease was the most frequent aetiology (63.2%). Most admissions (87.3%) occurred via the emergency department, with 13.7% of patients requiring intensive care, and of these, 21.8% needed intubation. The proportion of patients receiving guideline‐directed medical therapy increased at discharge (84.2% vs. 93.6%). The median length of stay (LOS) was 5 days, and in‐hospital mortality was 2.9%. Predictors of LOS and/or in‐hospital mortality were age, NYHA class, estimated glomerular filtration rate, and comorbid anaemia. LOS and in‐hospital mortality were similar regardless of ejection fraction.ConclusionsThe MY‐HF Registry showed that the HF population in Malaysia is younger, predominantly male, and ischaemic‐driven and has good prospects with hospitalization for optimization of treatment. These findings suggest a need to reassess current clinical practice and guide resource allocation to improve patient outcomes.

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Trends for Readmission and Mortality After Heart Failure Hospitalisation in Malaysia, 2007 to 2016

Cited by 7 publications

References 34 publications

Acute Decompensated Heart Failure with Preserved Ejection Fraction: Do the Asian Phenotypes Fit?

Acute Decompensated Heart Failure with Preserved Ejection Fraction: Do the Asian Phenotypes Fit?

Cost analysis of chronic heart failure management in Malaysia: A multi-centred retrospective study

Characteristics of patients admitted with heart failure: Insights from the first Malaysian Heart Failure Registry

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