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.
Background Heart failure (HF) and atrial fibrillation (AF) commonly co-exist, each, predisposing the other. AF may inflict haemodynamic disturbances, leading to reduced cardiac output and hence acute decompensation. Ultimately mortality risk is further increased. Identifying contributing factors is thus vital lest increasing risk of poor outcome. Purpose Identify predictors of all-cause mortality in AF patients after admission for acute decompensation HF (ADHF) at admission, 1 and 3 years. Methods A retrospective observational study of 810 AF patients" first admission from 2009 to 2018, analysed using descriptive, ROC curve and Cox regression. Results Mortality at admission, 1 and 3 years following ADHF were 5.1%, 14.4% and 40.5% respectively. Majority of AF patients were male (64.7%) but there was no significant statistical difference between gender with associated mortality during those timelines. Using multivariate analysis, predictors associated with increased in-hospital mortality were Hyponatraemia, Na < 135mmol/L (adjusted Odds Ratio, aOR 2.49; 95% Confidence Interval, CI 1.91-5.20; p0.015), Uric Acid ≥ 675 (aOR 2.75; CI 1.31-5.79; p0.008), Ejection Fraction, EF < 40% (aOR 3.93; CI 1.63-9.49; p0.002). Medications on admission associated with reduced inpatient mortality were Angiotensin Converting Enzyme inhibitor (ACEi) / Angiotensin Receptor Blocker (ARB) + Beta Blocker (BB) + Mineralocorticoid Receptor Antagonist (MRA) (aOR 0.07; CI 0.02-0.30; p < 0.001). At 1 year, multivariate analysis showed an associated increase in mortality when NTProBNP ≥ 7500pg/ml (adjusted Hazard Ratio, aHR 1.64; CI 1.02-2.65; p0.042) and Urea > 7mmol/L (aHR 1.86; CI 1.04-3.32, p0.036). Medications on discharge comprising ACEi/ARB + BB + MRA were the only combination that showed a reduction in mortality (aHR 0.23; CI 0.09-0.60; p0.003). At 3 years, background coronary artery disease (aHR 1.72; CI 1.09-2.71; p0.02), hypernatraemia, Na > 145mmol/L (aHR 14.89; CI 3.17-69.86; p0.001), EF < 40% (aHR 2.00; CI 1.28-3.12; p0.002) were associated with increased mortality. Medications on discharge namely ACEi/ARB (aHR 0.14; CI 0.03-0.70; p0.013), BB (aHR 0.23; CI 0.10-0.51; p < 0.001), ACEi/ARB + BB (aHR 0.16; CI0.06-0.41; p < 0.001), ACEi/ARB + MRA (aHR 0.34; CI 0.14-0.85; p0.021), BB + MRA (aHR 0.38; CI 0.17-0.83; p0.016), ACEi/ARB + BB + MRA (aHR 0.193; CI 0.09-0.43; p < 0.001) showed an associated reduction in mortality. Conclusions In this single centre study, patients with AF who presented with ADHF had a variety of mortality predictors that influence at different timelines. They had higher risk of inpatient mortality with hyponatraemia, hyperuricaemia and EF < 40%. Elevated NTProBNP and Urea levels seemed to have more effect on mortality at 1 year compared to 3 years. Having 3 disease-modifying heart failure medications at discharge exerted the most benefit up to 3 years of follow up. Abstract P252 Figure.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.