Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; <40%) versus preserved EF (≥50%). Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P <0.001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

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Background: The literature review on the implementation of care pathways is very diverse, there are active implementation and passive implementation. Therefore, the best strategy of implementation of the care pathway is still unclear. Objective: This literature review aimed to identify the component of the development and implementation of the care pathway. Methods: The research was conducted on five research databases. To optimize the research strategy, keywords used were identified via the medical subject headings (Mesh terms), their synonyms, and using operators such as truncation, wildcard, and Boolean operators. For quantitative studies, JBI Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) was utilized to assess the quality of studies. Furthermore, the quality assessment of qualitative studies was based on JBI Qualitative Assessment and Review Instrument (QARI). Results: The search revealed 1015 articles. Of these, 11 articles met the inclusion criteria for this review. One randomized controlled trial was reported. The majority of these articles reported baseline and post-implementation pathway. The studies emerged from the United Kingdom, the United States, Singapore, the Netherlands, Canada, and Australia. The implementation process is completed through four phases. The planning phase assesses the current practice and determines whether the provided health care is in compliance with the guidelines, a crucial step before implementing care pathways. The reviewed studies reported different methods: site visiting, preaudit chart, structured questionnaire. The design phase begins with the selection of an appropriate clinical condition, then an agreement about the components of care pathways which based on the questionnaire and Delphi. The majority of reviewed studies reported that the implementation phase is based on the education of staff. However, specific details related to the education sessions of the care pathways were not discussed. Finally, the evaluation phase was used audit charts, questionnaire and focus group. Inadequate reliability and validity of the questionnaire were noted. Conclusions: Existing data demonstrate there is agreement on four mean phases when applying care pathways, however, there are still a diversity of key factors of each phase.

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Background: Paclitaxel-coated balloons (PCBs) are a preferred treatment option for coronary in-stent restenosis. To date, data from randomized trials of alternative drug coatings are lacking. The aim of the randomized Malaysian and German-Swiss randomized trials was to investigate a novel sirolimus-coated balloon (SCB) compared with a PCB in in-stent restenosis. Methods: One hundred one patients with drug-eluting stent in-stent restenosis were enrolled in 2 identical randomized trials comparing the novel SCB (SeQuent SCB, 4 μg/mm²) with the clinically proven PCB (SeQuent Please, 3 μg/mm²). Primary end point was angiographic late lumen loss at 6 months. Secondary end points included procedural success, major adverse cardiac events, and individual clinical end points such as stent thrombosis, cardiac death, target lesion myocardial infarction, clinically driven target lesion revascularization, and binary restenosis. Results: Quantitative coronary angiography revealed no differences in baseline parameters. After 6 months, in-segment late lumen loss was 0.25±0.57 mm in the PCB group versus 0.26±0.60 mm in the SCB group. Mean difference between SCB and PCB was 0.01 (95% CI, -0.23 to 0.24). Noninferiority at a predefined margin of 0.35 was shown. Clinical events up to 12 months did not differ between the groups. Conclusions: This first-in man comparison of a novel SCB with a crystalline coating showed similar angiographic and clinical outcomes in the treatment of coronary drug-eluting stent in-stent restenosis compared with PCB. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02996318, NCT03242096.