Insights from a Rheumatic Heart Disease Registry in a Tertiary Centre in Sabah

Introduction Rheumatic heart disease is still endemic in developing countries and among the indigenous population in developed countries. However, there is no comprehensive data on rheumatic heart disease patients in Malaysia. The Cardiology Department of Queen Elizabeth ll Hospital (QEH ll), Sabah started this hospital-based registry in 2010. The objective of this analysis was to report the demographic profile, severity of disease, types of valve involvement and the practice of secondary prophylaxis among these patients. Methods This was a retrospective record review involved a three-year review of patients registered under the rheumatic heart disease registry in QEH ll, Sabah from December 2010 to November 2013. It included patients who attended the cardiology clinic who were diagnosed with rheumatic heart disease. Results A total of 627 rheumatic heart disease patients were registered over a period of three years. Mean age was 41 (16.2) year old, 67.5% were female, and 51.2% of the patients had severe valvular dysfunction with mitral regurgitation as the commonest valve affected (67.3%). There was an increasing trend in the percentage of patients receiving secondary prophylaxis (oral and intra-muscular) from the year 2010 to the year 2013 (23.2% and 67.6% respectively). Abnormal ECG, pulmonary regurgitation and not on any secondary prophylaxis were found to be associated with severe rheumatic heart disease. Conclusions Rheumatic heart disease is prevalent in Sabah. Most patients had severe form of valve dysfunction when diagnosed. Awareness and advocacy on secondary prophylaxis warrant immediate improvement

Trends for Readmission and Mortality After Heart Failure Hospitalisation in Malaysia, 2007 to 2016

BACKGROUND AND OBJECTIVES: Data on population-level outcomes after heart failure (HF) hospitalisation in Asia is sparse. This study aimed to estimate readmission and mortality after hospitalisation among HF patients and examine temporal variation by sex and ethnicity. METHODS: Data for 105,399 patients who had incident HF hospitalisations from 2007 to 2016 were identified from a national discharge database and linked to death registration records. The outcomes assessed here were 30-day readmission, in-hospital, 30-day and one-year all-cause mortality. RESULTS: Eighteen percent of patients (n = 16786) were readmitted within 30 days. Mortality rates were 5.3% (95% confidence interval (CI) 5.1–5.4%), 11.2% (11.0–11.4%) and 33.1% (32.9–33.4%) for in-hospital, 30-day and 1-year mortality after the index admission. Age, sex and ethnicity-adjusted 30-day readmissions increased by 2% per calendar year while in-hospital and 30-day mortality declined by 7% and 4% per year respectively. One-year mortality rates remained constant during the study period. Men were at higher risk of 30-day readmission (adjusted rate ratio (RR) 1.16, 1.13–1.20) and one-year mortality (RR 1.17, 1.15–1.19) than women. Ethnic differences in outcomes were evident. Readmission rates were equally high in Chinese and Indians relative to Malays whereas Others, which mainly comprised Indigenous groups, fared worst for in-hospital and 30-day mortality with RR 1.84 (1.64–2.07) and 1.3 (1.21–1.41) relative to Malays. CONCLUSIONS: Short-term survival was improving across sex and ethnic groups but prognosis at one year after incident HF hospitalisation remained poor. The steady increase in 30-day readmission rates deserves further investigation

Provisional drug-coated balloon treatment guided by physiology on de novo coronary lesion

Although drug-eluting stents (DES) have become the mainstay of percutaneous coronary intervention, late and very late stent thrombosis remains a concern. Drug-coated balloons (DCB) have the advantage of preserving the anti-restenotic benefits of DES while minimizing potential long-term safety concerns. Currently the two methods to ensure successful DCB treatment of a stenotic lesion are angiography or physiology-guided DCB application. This review will evaluate these two methods based on previous evidence and make suggestions on how to perform DCB treatment more efficiently and safely

Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group

Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of thisdisease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the useof metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newergeneration drug eluting stent (DES), patients are still negatively affected by some the inherent limitationsof this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, andthe obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration.Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is notlimited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug whichis coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommendedas the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent.For de novo coronary lesions, the application of DCB treatment is extended further, for conditions suchas small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently,several reports have suggested that fractional flow reserve guided DCB application was safe for largercoronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendationsof the consensus group was to provide adequate guidelines for patients with CAD based on objectiveevidence, and to extend the application of DCB to a wider variety of coronary diseases and guide theirmost effective and correct use in actual clinical practice

Identifying optimal doses of heart failure medications in men compared with women: a prospective, observational cohort study

Background: Guideline-recommended doses of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and β blockers are similar for men and women with heart failure with reduced ejection fraction (HFrEF), even though there are known sex differences in pharmacokinetics of these drugs. We hypothesised that there might be sex differences in the optimal dose of ACE inhibitors or ARBs and β blockers in patients with HFrEF. Methods: We did a post-hoc analysis of BIOSTAT-CHF, a prospective study in 11 European countries of patients with heart failure in whom initiation and up-titration of ACE inhibitors or ARBs and β blockers was encouraged by protocol. We included only patients with left ventricular ejection fraction less than 40%, and excluded those who died within the first 3 months. Primary outcome was a composite of time to all-cause mortality or hospitalisation for heart failure. Findings were validated in ASIAN-HF, an independent cohort of 3539 men and 961 women with HFrEF. Findings: Among 1308 men and 402 women with HFrEF from BIOSTAT-CHF, women were older (74 [12] years vs 70 [12] years, p<0·0001) and had lower bodyweights (72 [16] kg vs 85 [18] kg, p<0·0001) and heights (162 [7] cm vs 174 [8] cm, p<0·0001) than did men, although body-mass index did not differ significantly. A similar number of men and women reached guideline-recommended target doses of ACE inhibitors or ARBs (99 [25%] vs 304 [23%], p=0·61) and β blockers (57 [14%] vs 168 [13%], p=0·54). In men, the lowest hazards of death or hospitalisation for heart failure occurred at 100% of the recommended dose of ACE inhibitors or ARBs and β blockers, but women showed approximately 30% lower risk at only 50% of the recommended doses, with no further decrease in risk at higher dose levels. These sex differences were still present after adjusting for clinical covariates, including age and body surface area. In the ASIAN-HF registry, similar patterns were observed for both ACE inhibitors or ARBs and β blockers, with women having approximately 30% lower risk at 50% of the recommended doses, with no further benefit at higher dose levels. Interpretation: This study suggests that women with HFrEF might need lower doses of ACE inhibitors or ARBs and β blockers than men, and brings into question what the true optimal medical therapy is for women versus men

Socio demographic profiles of Rheumatic Heart Disease (RHD) patients In Sabah

Introduction Rheumatic Heart Disease (RHD) has been thought as a disease of poor socioeconomic status. It is more prevalent in underdeveloped and developing countries than in developed countries. It is also common among the population with multiple social issues such as overcrowded dwellings, undernutrition, poor sanitation and suboptimal medical care. This study was done to review the socio demographic profiles of RHD patients in Hospital Queen Elizabeth (HQE) ll, Kota Kinabalu, Sabah. Methods A secondary data review of all patients registered under the RHD registry in HQE ll for one- year starting from July 2013 to June 2014. Results 204 RHD patients were included. Nearly three quarter (74.0%) were female. The mean age was 40.43 (14.75) years old. 61.1% has completed secondary education. 42.7% were housewives. The mean monthly income was RM 1363.83 (1297.05) which was categorized under the vulnerable income group. When they were categorized under the poverty level and the vulnerable income group, 42.6% and 76.5% of them fell under those categories respectively. The nearest health facilities to their houses were district hospitals (33.3%) with the mean distance of 9.17 km and health clinics (30.8%) with the mean distance of 4.27 km. Only 11.5% of them lived near the specialist hospitals with the mean distance of 21.32 km. Conclusions Results from this review suggested that majority of RHD patients were in the low socioeconomic group with less access to health care facilities with specialist care. They are the most vulnerable groups and need to be prioritized in the specialized care program

Risk for Radiation-Induced Cataract for Staff in Interventional Cardiology: Is There Reason for Concern?

Objectives: To examine the prevalence of radiation-associated lens opacities among interventional cardiologists and nurses and correlate with occupational radiation exposure. Background: Interventional cardiology personnel are exposed to relatively high levels of X-rays and based on recent findings of radiation-associated lens opacities in other cohorts, they may be at risk for cataract without use of ocular radiation protection. Methods: Eyes of interventional cardiologists, nurses, and age-and sex-matched unexposed controls were screened by dilated slit lamp examination and posterior lens changes graded using a modified Merriam-Focht technique. Individual cumulative lens X-ray exposure was calculated from responses to a questionnaire and personal interview. Results: The prevalence of radiation-associated posterior lens opacities was 52% (29/56, 95% CI: 35-73) for interventional cardiologists, 45% (5/11, 95% CI: 15-100) for nurses, and 9% (2/22, 95% CI: 1-33) for controls. Relative risks of lens opacity was 5.7 (95% CI: 1.5-22) for interventional cardiologists and 5.0 (95% CI: 1.2-21) for nurses. Estimated cumulative ocular doses ranged from 0.01 to 43 Gy with mean and median values of 3.4 and 1.0 Gy, respectively. A strong dose-response relationship was found between occupational exposure and the prevalence of radiation-associated posterior lens changes. Conclusions: These findings demonstrate a dose dependent increased risk of posterior lens opacities for interventional cardiologists and nurses when radiation protection tools are not used. While study of a larger cohort is needed to confirm these findings, the results suggest ocular radio-protection should be utilized. (C) 2010 Wiley-Liss, Inc

Clinical recommendations to diagnose and monitor patients with transthyretin amyloid cardiomyopathy in Asia

10.1002/clc.23882Clinical Cardiolog

Clinical Outcomes of Drug-Coated Balloon Treatment After Successful Revascularization of de novo Chronic Total Occlusions

BackgroundThe safety and efficacy of drug-coated balloon (DCB) treatment for de novo coronary chronic total occlusion (CTO) remain uncertain. The aim of this study was to evaluate the outcomes of DCB only treatment for de novo CTO. MethodsIn this retrospective study, 101 vessels with de novo CTO lesions dilated by balloon angioplasty with thrombolysis in myocardial infarction flow grade 3 were included. Among them, 93 vessels successfully treated with DCB only treatment were analyzed. The study endpoint was major adverse cardiac events (MACE) at 2 years, a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and target vessel thrombosis. The secondary endpoint was late lumen loss (LLL) on follow-up coronary angiography. ResultsAll 84 patients were followed up clinically, and 67 vessels underwent scheduled coronary angiography after 6 months. There were no procedural complications, and three vessels required bailout-stenting. The median follow-up was 720 days (interquartile range [IQR]; 406-1,268 days). MACE occurred in 8.3% of the patients after 1 year, including cardiac death (1.2%), TVR (7.1%), and no non-fatal MI and target vessel thrombosis. Two years after treatment, MACE occurred in 16.7% of the patients, including cardiac death (2.4%), non-fatal MI (3.6%), TVR (13.1%), and no target vessel thrombosis. The mean LLL was 0.03 +/- 0.53 mm. Binary restenosis occurred in 14.9% of the treated vessels, and 3.0% of the vessels had late re-occlusion on follow-up coronary angiography. ConclusionsIf the result of revascularization using balloon angioplasty is good, the clinical outcomes of DCB only treatment of de novo CTOs at the 2-year follow-up are encouraging, with a low rate of hard endpoints and acceptable MACE rates (Clinical Trial Registration Information; Impact of Drug-coated Balloon Treatment in de novo Coronary Lesion; NCT04619277)