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Sarawak General Hospital
How to benefit from an NCVD Registry:
The NCVD Experience from Malaysia
15th Vietnam Congress of Cardiology, National Convention Centre, Hanoi, 9-11 October 2016;
Dr Alan Fong MBChB(Bristol), MRCP(UK), FRCP (Edin), FACC, FESC, FAPSIC, FNHAM, FAsCC
Consultant Cardiologist, Sarawak General Hospital Heart Centre;
& Head, Clinical Research Centre, Sarawak General Hospital
Sarawak General Hospital
Background
Sarawak General Hospital
Where we are…..
Sarawak General Hospital
Sarawak Heart Centre
2km
H
H♥
Sarawak General Hospital
National Health and Morbidity Surveys.. (e.1986)
Sarawak General Hospital
The NCVD Registries (e.2006)
http://www.acrm.org.my/ncvd/aboutUs_overview.php
Sarawak General Hospital
NCVD PCI Registry
Report 2013-2014
Sarawak General Hospital
Snapshot from the Annual Report of the NCVD-ACS Registry
2011-2013
Suggested citation: W.A. Wan Azman, K.H. Sim. (Eds). Annual Report of the NCVD-ACS Registry, Year 2011-2013. Kuala Lumpur, Malaysia: National Cardiovascular Disease Database, 2015.
Sarawak General Hospital
NCVD-ACS Registry Participating Hospitals
HPP
UMMC IJN HKL
HTAR HS HA
HM
PJHUS
HQEI HQEII
HSA
NCVD-ACS Registry, Malaysia (2011-2013)
HTF
HRPB
HTJ
HRPZ II
HTAA
HSB
Total SDP= 19 hospitals
*Each SDP started to contribute data at different time period
HSNZ
Sarawak General Hospital
N ACS admissions = 14,763
Sarawak General Hospital
Mean age: 58.5 (12.2) years
N ACS admissions = 14,763
Sarawak General Hospital
N ACS admissions = 14,763
Sarawak General Hospital
CV Risk factors 2006-2010
(N=16,866)
2011 (N=4,047)
2012 (N=4,589)
2013 (N=6,127)
2011-2013
(N=14,763)
Dyslipidaemia 33.0 39.2 36.4 37.0 37.4
Hypertension 61.0 67.0 65.6 63.2 65.0
Diabetes 43.0 46.2 46.6 45.0 45.8
Family History of premature CVD
11.0 14.5 13.2 12.4 13.2
MI history 19.0 22.0 20.8 16.2 19.2
Documented CAD 17.0 17.3 20.2 24.4 21.2
New onset angina (< 2 weeks)
55.0 61.4 57.6 56.4 58.2
Chronic angina (onset > 2 weeks ago)
11.0 11.4 9.6 9.4 9.9
Chronic Lung Disease 4.0 3.6 2.8 3.1 3.2
Renal disease 7.0 8.2 7.2 7.8 7.8
Peripheral vascular disease
1.0 1.2 0.8 0.6 0.8
Cerebrovascular disease 4.0 4.2 3.6 3.5 3.8
Heart Failure 7.0 8.6 8.6 5.3 7.2
Current Smoker 33.0 37.6 37.8 38.2 38.0
BMI > 23kgm-2 75.0 75.6 75.0 78.2 76.5
Hypertension 65%
Diabetes 46%
Sarawak General Hospital
Presence of cumulative risk factors (Percentage),
NCVD-ACS Registry, 2011-2013
Sarawak General Hospital
Sarawak General Hospital
Type of cardiac presentation for patients with ACS (%) by admission, NCVD-ACS Registry, 2006 - 2013
2006 2007 2008 2009 2010 2011 2012 2013
N 3,392 3,640 2,839 3,594 3,401 4,047 4,589 6,127
STEMI 42.0 46.0 54.0 47.0 53.0 50.8 52.0 50.0
NSTEMI 34.0 29.0 24.0 29.0 30.0 27.0 25.0 26.2
UA 24.0 24.0 22.0 24.0 17.0 22.2 23.3 23.8
Sarawak General Hospital
Type of cardiac presentation for patients with ACS (%) by admission,
NCVD-ACS Registry, 2006 - 2013
Sarawak General Hospital
Age group of patients by ACS stratum
NCVD-ACS Registry, 2011-2013
Mean age (SD) for STEMI: 56.2 (12.0); NSTEMI: 60.8 (11.8) and UA: 60.8 (12.0)
Sarawak General Hospital
Age group of patients by ACS stratum
NCVD-ACS Registry, 2011-2013
NSTEMI
Sarawak General Hospital
Sarawak General Hospital
Sarawak General Hospital
Type of treatment among STEMI patients by Age Group ,
NCVD-ACS Registry, 2011-2013
Sarawak General Hospital
Outcome at discharge 30-day FU
Year Outcome N % N %
2006-2010 Alive 15531 92 14429 86 Died 1335 8 2437 14
2011 Alive 3729 92.2 3681 91.0 Died 318 7.8 366 9.0
2012 Alive 4234 92.2 4173 91.0 Died 355 7.8 416 9.0
2013 Alive 5670 92.6 5586 91.2 Died 457 7.4 541 8.8
2011-2013 Alive 13633 92.4 13440 91.0 Died 1130 7.6 1323 9.0
NCVD ACS In-Hospital Mortality and 30-day Follow up: 2006-2010 VS 2011-2013
Outcome at discharge is similar but 30 day outcomes improved significantly
Sarawak General Hospital
Sarawak General Hospital
Outcome at discharge 30-day FU
Physician Centre
Cardiologist Centre
Physician Centre
Cardiologist Centre
Year Outcome N % N % N % N %
2006-2010
Alive 5163 92 10368 92 4905 87 9524 85
Died 454 8 881 8 712 13 1725 15
2011 Alive 2839 92.2 890 92.0 2801 91.0 880 91.0
Died 241 7.8 77 8.0 279 9.0 87 9.0
2012 Alive 3368 92.2 866 92.6 3315 90.8 858 91.8
Died 286 7.8 69 7.4 339 9.2 77 8.2
2013 Alive 5031 92.6 639 92.8 4948 91.0 638 92.6
Died 407 7.4 50 7.2 490 9.0 51 7.4
2011-2013
Alive 11238 92.4 2395 92.4 11064 90.8 2376 91.8
Died 934 7.6 196 7.6 1108 9.2 215 8.2
30-day outcome is better at cardiologist centre
Sarawak General Hospital
STEMI: comparison between NCVD and TIMI developmental dataset
An Asian Validation of the TIMI risk score for ST-Segment Elevation Myocardial Infarction: Results and
Implications for Cardiac Care in a Developing Country. Sharmini Selvarajah, Alan Fong Yean Yip, Gunavathy
Selvaraj, Jamaiyah Haniff, Cuno S.P.M. Uiterwaal, Michiel L. Bots, PLoS One 2012;7(7):e40249
Sarawak General Hospital
Guidelines (and patients) advocate early intervention / invasive strategy! How?
Sarawak General Hospital
UK and Malaysia
Sarawak 2013 –
Approx. 280 PCI pmp
Sarawak General Hospital
STEMI reperfusion strategies in UK and Malaysia
Malaysia 2013 –
approx. 70% lytic,
approx 9% PPCI
Sarawak General Hospital
More local research (….definitely needed!)
Sarawak General Hospital
... Addressing the problems >3 billion at risk
Sarawak General Hospital
Regional collaboration – 2016 and beyond
Sarawak General Hospital
Malaysia CPGs for Acute STEMI
Sarawak General Hospital
3rd Malaysian CPG for STEMI
Sarawak General Hospital
Sharing our experience
Sarawak General Hospital
Thrombolysis in STEMI: developing countries
Sarawak General Hospital
A recent hit…. with global implications
Sarawak General Hospital
Summary: how the NCVD has helped us….
Systematic collection of local data important
Better understanding of the local disease burden
Strategies to improve therapeutic protocols
Addressing the evidence gap by research
Translating research into guidelines
Sarawak General Hospital
Sarawak General Hospital
Disclaimer
Research/Educational Grants/Lecture Honoraria from Ministry of Health Malaysia, Astra Zeneca,
Boehringer Ingelheim, B.Braun, Medtronic, Merck AG, MSD, Novartis AG, Orbus Neich, Pfizer Ltd,
Roche Diagnositics, Siemens Diagnositics, Sanofi-Aventis. St Jude Medical.
Sarawak General Hospital
500km in October 2015 – World Heart Day
Sarawak General Hospital
Sarawak – more than just hornbills