Atrial Fibrillation in Singapore and Malaysia: Current Trends and Future Prospects

Abstract

Razali Omar MD FHRS FACC Ã1 , Wee Siong Teo MBBS (NUS) FRCP (Edin) FHRS Ã2 , David Foo MBBS MRCP (UK) FACC Ã3 , Chee Kok Han MBBS MMed FNHAM Ã4 , Ahmad Nizar Jamaluddin MD MRCP (UK) FACC (USA) Ã5 , Lip Ping Low MBBS FRACP FACC Ã6;Ã7 , Tiong Kiam Ong FRCP FACC FESC Ã8Atrial fibrillation (AF) imposes substantial burdens of morbidity and impaired healthrelated quality of life, and significantly increases sufferers' risk of having a cardiovascular event, in particular a stroke. Prevalence of AF in Asia and the associated healthcare costs are likely to have been underestimated and are expected to increase due to greater awareness, population ageing and increasing prevalence of associated risk factors and comorbidities.The AF management paradigm is shifting from a conventional focus on achieving heart rate or rhythm control, towards endeavouring to use the safest agents available to reduce patients' symptoms and improve their quality of life and cardiovascular outcomes. No new anti-AF drugs have been introduced for decades and existing pharmacotherapeutic modalities have potentially serious side effects as well as sub-optimal efficacy in converting to and maintaining normal sinus rhythm and preventing recurrence.There is an unmet need for better anti-arrhythmic drugs that are well tolerated, efficacious, cost-effective and have a more favourable safety profile than current options. Although the perfect agent remains to be discovered, some promising new anti-arrhythmic drugs have the potential to overcome certain limitations of established approaches to AF management. (J Arrhythmia 2011; 27: 171-185)

Prevalence of atrial fibrillation in the Malaysian communities

“…Global burden of AF is predicted to rise in years to come and with the urbanisation in the Asian countries, we may soon see a trend similar to that in developed nations. Physicians in Singapore and Malaysia report that AF patient numbers have increased by approximately 10% over the last 3 years and will continue to rise 31. AF will continue to pose a major burden to the public health cost in years to come with its associated morbidity and mortality.…”

A Real-world Experience of the Safety and Efficacy of Non-vitamin K Oral Anticoagulants Versus Warfarin in Patients with Non-valvular Atrial Fibrillation— A Single-centre Retrospective Cohort Study in Singapore

“…3,4 In Singapore, the overall prevalence of AF has been estimated to be 1.5% for individuals ≥ 55 years old and nearly quadrupled to 5.8% for those ≥ 80 years old. 5,6 Consequently, complications from AF, such as stroke or thromboembolism, impose a substantial burden to the economy and public health sector due to the need for medications, hospitalisations and long-term care. 7 Therefore, initiation of anticoagulation is essential for patients with AF in view of the significant health and economic burden, especially for a society with an ageing population like Singapore.…”