Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.

Although cardiovascular care has improved in the last decade in the low-and middleincome countries (LMICs) in South-East Asia Region; these countries, particularly Indonesia, are still encountering a number of challenges in providing standardized healthcare systems. This article aimed to highlight the current state of cardiology practices in primary and secondary care, including the novel cardiovascular risk factors, recommendations for improving the quality of care, and future directions of cardiovascular research in limited settings in South-East Asia. We also provided the most recent evidence by addressing our latest findings on cardiovascular research in Indonesia, a region where infrastructure, human, and financial resources are largely limited. Improving healthcare policies to reduce a nations' exposure to CVD risk factors, providing affordable and accessible cardiovascular care both at primary and secondary levels, and increasing capacity building for clinical research should be warranted in the LMICs in South-East Asia.

BackgroundPremature ventricular complex (PVC) is the etiology of cardiomyopathy known as PVC-induced cardiomyopathy. Various studies have shown certain characteristics that predispose to cardiomyopathy. Present study was the first community-based study conducted to determine the characteristics and prevalence of PVC in certain population, especially Makassar City.MethodsThis study used a cross-sectional study method conducted from June 2017 to May 2018 using data from Telemedicine Electrocardiogram (ECG) at Hasanuddin University Hospital. The characteristics of PVC were QRS PVC duration, coupling interval (CI), PVC morphology in lead V1.ResultsWe calculated 8,847 ECGs, and found 98 ECGs with PVC (1.1%). Incidence of PVC was higher in women than men (52%). Characteristics of PVC with QRS duration include < 140 ms (45.9%); 140 - 159 ms (31.6%); and > 160 ms (22.4%), respectively; and PVC with CI < 300 ms (2%), CI 300 - 599 ms (88%), and CI > 600 ms (10%). Left bundle branch block (LBBB) and right bundle branch block (RBBB) morphology were found in (76.5%) and (19.4%) subjects in turn. Statistically, QRS PVC duration and PVC morphology showed significant differences based on age group (sequentially, P = 0.012 and P = 0.014). While gender only showed a significant difference in QRS PVC duration (P = 0.030).ConclusionsThe prevalence of PVC in the population of Makassar City is similar to the prevalence in other general populations. There are differences in the distribution and prevalence of PVC based on their characteristics according to age group and gender.

ObjectiveTo provide a detailed description of characteristics at hospital admission and clinical outcomes at 30-day and 6-month follow-up in patients hospitalised with coronary artery disease (CAD) in a poor South-East Asian setting.DesignProspective observational cohort study.SettingFrom February 2013 to December 2014, in Makassar Cardiac Center, Indonesia.Participants477 patients with CAD (acute coronary syndrome and stable CAD).Outcome measuresAll-cause mortality and major adverse cardiovascular events (MACE).ResultsOut of 477 patients with CAD, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure and 75.1% had previous hypertension. Out of 211 patients with STEMI, only 4.7% had been treated with primary percutaneous coronary intervention (PCI) and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 (IQR 10.0–48.0) hours, and 19.1% of all patients had undergone either PCI or coronary artery bypass graft. The survival rate at 6 months was 78.9%. The rates of all-cause mortality at 30 days and 6 months were 13.4% and 7.3%, respectively; the rate of composite MACE at 30 days was 26.2% and 18.0% at 6 months.ConclusionsPatients with CAD from a poor South-East Asian setting present themselves with predominantly unstable conditions of premature CAD. These patients show relatively severe illness, have significant time delay from symptom onset to admission or intervention, and most do not receive the guidelines-recommended treatment. Awareness of symptoms, prompt initial management of acute CVD, well-established infrastructures and resources both in primary and secondary hospital for CVD should be improved to reduce the high rates of 30-day and 6-month mortality and adverse outcomes in this population.

ObjectiveTo measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting.MethodsFrom February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality.ResultsFrom hospital admission, patients were followed over a median of 18 (IQR 6–36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88).ConclusionsPatients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.

In South-East Asian populations and particularly in Indonesia, access to coronary angiography (CAG) is limited. We aimed to assess the adherence for undergoing CAG for indicated patients, according to the guideline recommendations. We then examined whether this adherence would have an impact on patients’ short- and medium-term mortality and morbidity. We consecutively enrolled 474 patients with acute and stable coronary artery disease who had indication for CAG at Makassar Cardiac Center, Indonesia from February 2013 to December 2014. We found that adherence to CAG recommendation in poor South-East Asian setting is low. Of 474 recommended patients, only 273 (57.6%) underwent the procedure. Factors for not undergoing CAG were: older age, female gender, low educational and socio-economic status, and insurance type. While reasons for patients refusing CAG and subsequent intervention included fear, symptoms reduction, and lack of trust concerning the procedure benefit. During follow-up (median 19 (IQR 6–39.3) months), 155 (32.7%) patients died, and 259 (54.6%) experienced at least one adverse event. Adherence to CAG recommendation was associated with a significantly lower short- and medium-term mortality, independent of revascularization and other potential confounders. In sub-group analysis, adhered patients “with revascularization” had significantly better outcomes compared to the “non-revascularization” and “not adhere” groups.

Medical devices are often expensive, so people in low-income countries cannot afford them. This paper presents the design of a low-cost wearable medical device to measure vital signs of a patient including heart rate, blood oxygen saturation level (SpO2) and respiratory rate. The wearable medical device mainly consists of a microcontroller and two biomedical sensors including airflow thermal sensor to measure respiratory rate and pulse oximeter sensor to measure SpO2 and heart rate. We can monitor the vital signs from a smartphone using a web browser through IEEE802.11 wireless connectivity to the wearable medical device. Furthermore, the wearable medical device requires simple management to operate; hence, it can be easily used. Performance evaluation results show that the designed wearable medical device works as good as a standard SpO2 device and it can measure the respiratory rate properly.  The designed wearable medical device is inexpensive and appropriate for low-resource settings. Moreover, as its components are commonly available in the market, it easy to assembly and repair locally.

Background: Assessment of functional capacity prior to discharge can help identify patients at risk for readmissions in heart failure patients. This research aims to conduct a study in order to assess the distance traveled in the six-minute walk test (6-MWT) as a predictor of readmission rates in patients with congestive heart failure.Methods: This type of research is a quantitative correlational study with a prospective cohort study experimental design. Data were collected when the patient was treated at the Integrated Cardiac Center of Wahidin Sudirohusodo Hospital with a diagnosis of heart failure. The research was conducted from June 2019 to December 2019 after obtaining clearance from the institutional ethical committee. 6-MWT measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6-MWD. To see the correlation between the components of 6-MWT the readmission using one-way anova. To determine the cut-off point, sensitivity and specificity of each component of the 6-MWT to rehospitalization using the receiver operating characteristic (ROC) curve. Statistical analysis was carried out using SPSS and SAP programs.Results: Out of the 93 samples, the 6-MWD has a significant p<0.001 for the readmission incidence≤30 days, meaning that the higher the 6-MWT value, it correlates with the decrease in the number of readmission incidents. In the ROC curve analysis for the 6-MWD parameter, it was found that the 6-MWD had a good predictability of readmission events in≤30 days (C=0.781, p<0.001).Conclusions: 6-MWD can be used to predict readmissions in≤30 days in heart failure patients. The lower the 6-MWD with a cut off of 183 meters, the higher the risk of readmission in≤30 days of heart failure patients. By knowing the cut off value, 6-MWD can be used as a reference to create a comprehensive treatment flow for heart failure patients to prevent increased readmission rates. In the end, it can reduce the burden of treatment costs on heart failure patients.