National Heart Institute, Kuala Lumpur, Malaysia.
ESC Heart Fail. 2022 Aug;9(4):2664-2675. doi: 10.1002/ehf2.13992. Epub 2022 Jun 2.
Heart failure (HF) affects an estimated 38 million people worldwide and is the leading cause of hospitalization among adults and the elderly. Evidence suggests that there may be regional and ethnic differences in the prevalence, outcomes and management of HF. The aim of this study was to understand the disease burden and treatment patterns of patients hospitalized for HF in multi-ethnic Malaysia.
A retrospective, non-interventional study was conducted utilizing 10 years of medical records from the National Heart Institute Malaysia (IJN) from 1 January 2009 to 31 December 2018. Of the 4739 patients in the IJN database, 3923 were eligible and were included in this analysis. The study recorded a high male prevalence (72.3%) with a mean age of 62.0 (±13.26) years. The 30-day and 1-year rehospitalization rate was 6.8% and 24.7%, respectively. In-hospital mortality was 7.2% with 27.0% due to cardiovascular causes and 14.2% non-cardiovascular causes. The 30-day and 1-year rehospitalization rates were significantly higher in patients with lower systolic blood pressure (SBP, P < 0.001 and P = 0.002), diastolic blood pressure (DBP, P < 0.001 and P = 0.017), sodium (P < 0.001 and P = 0.029) and estimated glomerular filtration rate (eGFR, P < 0.001 and P = 0.002) and higher urea (P < 0.001 for both), serum creatinine (P < 0.001 and P = 0.003), and uric acid (P < 0.001 for both), respectively. Risk of hospitalization within 1 year varied significantly by ethnicity and was relatively higher in Indian (28.3%), followed by Malay (24.4%) and Chinese (21.9%; P = 0.008). In-hospital mortality within 1-year post-index date was higher in patients with lower weight (P = 0.002), body mass index (P = 0.009), SBP (P < 0.001), DBP (P < 0.001), sodium (P < 0.001), eGFR (P < 0.001) and higher heart rate (P = 0.039), urea (P < 0.001), serum potassium (P = 0.038), serum creatinine (P < 0.001), and uric acid (P < 0.001). In-hospital mortality within 1-year post-index date was also higher in patients with severe or end-stage chronic kidney disease (CKD) compared with mild/moderate CKD (P < 0.001) and in patients with HF with reduced ejection fraction (HFrEF) compared with those with mid-range or preserved ejection fraction (P < 0.001). The most commonly prescribed HF medications at discharge were loop diuretics (89.2%), β-blockers (68.5%), mineralocorticoid receptor antagonists (56.2%), angiotensin-converting enzyme inhibitors (31.5%), and angiotensin receptor blockers (20.8%).
This study provides a greater understanding of the characteristics, treatment patterns, and outcome of hospitalized HF patients in a leading referral centre in Malaysia and will aid the implementation of meaningful interventions to improve patient outcome for HF patients.
心力衰竭（HF）影响全球约 3800 万人，是成年人和老年人住院的主要原因。有证据表明，HF 的患病率、结局和管理在地域和种族方面可能存在差异。本研究旨在了解马来西亚多民族人群中心力衰竭住院患者的疾病负担和治疗模式。
本研究为回顾性、非干预性研究，使用 2009 年 1 月 1 日至 2018 年 12 月 31 日期间，马来西亚国家心脏研究所（IJN）10 年的医疗记录。在 IJN 数据库的 4739 例患者中，有 3923 例符合纳入标准并纳入本分析。研究记录了较高的男性患病率（72.3%），平均年龄为 62.0（±13.26）岁。30 天和 1 年再住院率分别为 6.8%和 24.7%。院内死亡率为 7.2%，其中 27.0%归因于心血管原因，14.2%归因于非心血管原因。在收缩压（SBP，P<0.001 和 P=0.002）、舒张压（DBP，P<0.001 和 P=0.017）、钠（P<0.001 和 P=0.029）和估算肾小球滤过率（eGFR，P<0.001 和 P=0.002）较低的患者中，30 天和 1 年的再住院率明显更高，而在尿素（P<0.001）、血清肌酐（P<0.001 和 P=0.003）和尿酸（P<0.001）较高的患者中，30 天和 1 年的再住院率也明显更高。1 年内住院风险因种族而异，印度人（28.3%）相对较高，其次是马来人（24.4%）和中国人（21.9%；P=0.008）。在索引日期后 1 年内，因低体重（P=0.002）、体重指数（P=0.009）、SBP（P<0.001）、DBP（P<0.001）、钠（P<0.001）、eGFR（P<0.001）和心率较高（P=0.039）、尿素（P<0.001）、血清钾（P=0.038）、血清肌酐（P<0.001）和尿酸（P<0.001）而导致 1 年内院内死亡率较高。在索引日期后 1 年内，因严重或终末期慢性肾脏病（CKD）导致的院内死亡率也高于轻度/中度 CKD（P<0.001），射血分数降低的心力衰竭（HFrEF）患者高于射血分数中间范围或保留的心力衰竭（P<0.001）。出院时最常开的 HF 药物是袢利尿剂（89.2%）、β受体阻滞剂（68.5%）、盐皮质激素受体拮抗剂（56.2%）、血管紧张素转换酶抑制剂（31.5%）和血管紧张素受体阻滞剂（20.8%）。
本研究更深入地了解了马来西亚领先转诊中心住院心力衰竭患者的特征、治疗模式和结局，将有助于实施有意义的干预措施，以改善心力衰竭患者的预后。
