Acute decompensated heart failure in a non cardiology tertiary referral centre, Sarawak General Hospital (SGH-HF)

Abstract

Background Data on clinical characteristics of acute decompensated heart failure (ADHF) in Malaysia especially in East Malaysia is lacking. Methods This is a prospective observational study in Sarawak General Hospital, Medical Department, from October 2017 to September 2018. Patients with primary admission diagnosis of ADHF were recruited and followed up for 90 days. Data on patient’s characteristics, precipitating factors, medications and short-term clinical outcomes were recorded. Results Majority of the patients were classified in lower socioeconomic group and the mean age was 59 years old. Hypertension, diabetes mellitus and dyslipidaemia were the common underlying comorbidities. Heart failure with ischemic aetiology was the commonest ADHF admission precipitating factor. 48.6% of patients were having preserved ejection fraction HF and the median NT-ProBNP level was 4230 pg/mL. Prescription rate of the evidence-based heart failure medication was low. The in-patient mortality and the average length of hospital stay were 7.5% and 5 days respectively. 43% of patients required either ICU care or advanced cardiopulmonary support. The 30-day, 90-day mortality and readmission rate were 13.1%, 11.2%, 16.8% and 14% respectively. Conclusion Comparing with the HF data from West and Asia Pacific, the short-term mortality and readmission rate were high among the ADHF patients in our study cohort. Maladaptation to evidence-based HF prescription and the higher prevalence of cardiovascular risk factors in younger patients were among the possible issues to be addressed to improve the HF outcome in regions with similar socioeconomic background.

Patient profiles on outcomes in patients hospitalized for heart failure: a 10‐year history of the Malaysian population

“…A relatively lower proportion of HFrEF patients was reported in the SGH-HF (51%), UiTM Sungai Buloh (40.8%) and ADHERE-AP (53%) populations, indicating that half of the hospitalized HF patients had HFmrEF and HFpEF. [23][24][25] The proportion of patients with preserved ejection fraction in our analysis was much lower than that observed in the GWTG-HF registry (12.7% vs. 43%, respectively). 28 The higher proportion of HF patients with ischaemic aetiology reported in this study (66%) compared with SGH-HF (41.1%) also explains the observation of a higher prevalence of patients with HFrEF.…”

“…28 Comparable age was observed in all three local single-centre studies, including IJN ADHF registry, SGH-HF and UiTM Sungai Buloh (mean age of 62, 59 and 63, respectively). 24,25 These findings suggest that HF patients in Malaysia are relatively younger, which is not surprising. It has been reported that HF patients from low-income regions had the youngest mean age (Philippines: 54.3 years and Indonesia: 55.8 years), whereas those from high-income regions had the highest mean age (Hong Kong: 67.7 years, Japan: 64.9 years, South Korea: 63.3 years and Taiwan: 63.3 years).…”

“…28 The higher proportion of HF patients with ischaemic aetiology reported in this study (66%) compared with SGH-HF (41.1%) also explains the observation of a higher prevalence of patients with HFrEF. 24 Results from the ASIAN-HF Registry showed that Southeast Asia had the highest prevalence of diabetes mellitus, stroke, hypertension, CKD and CAD, despite a relatively low mean age of patients. 26 Our study showed a similar incidence of CAD and atrial fibrillation (AF) but a higher incidence of hypertension, diabetes and stroke than the Southeast Asian population of the ASIAN-HF Registry, which indicates a higher burden of co-morbidities in Malaysia.…”

Tachycardia and Pre-existing Chronic Kidney Disease Are Predictors of the Worse Clinical Outcomes in Patients Recently Hospitalized With Acute Heart Failure

“…Generally, AHF encompasses a complex syndrome, including various clinical presentations, underlying cardiac problems, trigger factors, comorbidities, and complications, leading to a relatively high mortality rate during hospitalization and after discharge [4]. Therefore, patient-based, rather than disease-based, data might provide essential information to evaluate miscellaneous aspects of hospitalized patients with AHF [5,6]. Consequently, this approach could improve the clinical assessment and management strategy to reduce in-hospital mortality and rehospitalization rates caused by AHF.…”

“…However, similar information is still lacking and less comprehensive in Southeast Asian countries. Multiple factors, including different cultures, less organized systems, limited access to healthcare, poor adherence of patients, limited diagnostic or therapeutic tools, and lack of trained investigators, affect the scarce data provided in most Asian countries, including Indonesia [6,7]. Moreover, this lack of data is a major barrier to participation in global collaboration of the relevant issue [8].…”