Acute heart failure – The ‘real’ Malaysian experience: An observational study from a single non-cardiac centre

• Main Authors: Borhan, M.K (Author), Kasim, S. (Author), Raja Shariff, R.E (Author), Yusoff, M.R (Author)
• Format: Article
• Language: English
• Published: SAGE Publications Inc. 2021
• Series: Proceedings of Singapore Healthcare
• Subjects: acetylsalicylic acid; acute heart failure; Acute heart failure; adult; aged; angiotensin receptor antagonist; anticoagulant agent; Article; artificial ventilation; ascites; atrial fibrillation; beta adrenergic receptor blocking agent; blood cell count; cardiomyopathy; central venous pressure; cerebrovascular accident; cholesterol blood level; chronic kidney failure; chronic obstructive lung disease; clopidogrel; cohort analysis; coronary artery disease; crackle; creatinine; cross-sectional study; diabetes mellitus; dialysis; digoxin; dipeptidyl carboxypeptidase; diuretic agent; dopamine; dyslipidemia; dyspnea; echocardiography; electrocardiogram; enkephalinase inhibitor; epidemiology; estimated glomerular filtration rate; fatigue; female; furosemide; glucose level; glyceryl trinitrate; heart arrhythmia; heart block; heart failure; heart function test; heart infarction; heart left ventricle ejection fraction; heart rate; hemoglobin; high density lipoprotein; human; hydroxymethylglutaryl coenzyme A reductase inhibitor; hypertension; hypertensive agent; hypertensive factor; hypervolemia; intubation; ischemia; ischemic heart disease; ivabradine; leukocyte count; limb swelling; lipid fingerprinting; low density lipoprotein; lung congestion; lung edema; major clinical study; male; mean corpuscular volume; middle aged; mortality rate; nitrate; noninvasive ventilation; noradrenalin; observational study; paroxysmal nocturnal dyspnea; percutaneous coronary intervention; potassium; renal replacement therapy; retrospective study; rheumatic heart disease; risk factor; sodium; stress test; systolic blood pressure; thiazide diuretic agent; thorax pain; thrombocyte; triacylglycerol; ultrafiltration; urea; valvular heart disease; warfarin
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 Background: Cardiovascular care in Malaysia adopts a ‘spoke-and-hub’ model, leaving the majority of acute heart failure (AHF) care to non-cardiac centres. Granular data on AHF care are essential and yet remain scarce. Objectives: This study aimed to illustrate the baseline characteristics, management and outcome of AHF patients. Methods: A retrospective, cross-sectional study was conducted on 1307 AHF patients admitted between 1 January 2012 and 31 December 2016. Results: The younger and Malay-predominant population reflects the distribution of ischaemic heart disease in Malaysia, highlighting the need to tackle metabolic risks factors. The majority are precipitated by ischaemia (61.8%). Common co-morbidities include hypertension (70.9%), coronary artery disease (57.8%) and diabetes (62.2%). The majority were of New York Heart Association Class II (31.9%) and Class III (25.6%). A total of 14.5% required inotropes and vasopressors, 12.9% required intravenous nitrates and 8.6% required dialysis. A further 4.9% of patients required intubation and mechanical ventilation, and 25.9% required non-invasive ventilation. Readmission and mortality were extremely high in our population. Short inpatient stays, restricting optimisation of medication, and gaps in the provision of coronary intervention and stress testing are possible contributing factors. When compared to global and regional registries, disparities were noted specifically surrounding mortality rate and optimum use of guideline-directed medical therapy. Conclusion: Although smaller and single centred, our study provides a unique insight into a pure Malaysian-only cohort from a hospital with no cardiology services in-house, which is more reflective of the majority of hospitals in Malaysia, unlike previous studies and registries. © The Author(s) 2020.