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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


Background


Where we are…..


Sarawak Heart Centre

2km

H

H♥


National Health and Morbidity Surveys.. (e.1986)


The NCVD Registries (e.2006)

http://www.acrm.org.my/ncvd/aboutUs_overview.php


NCVD PCI Registry

Report 2013-2014


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.


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


N ACS admissions = 14,763


Mean age: 58.5 (12.2) years



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%


Presence of cumulative risk factors (Percentage),

NCVD-ACS Registry, 2011-2013


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


Type of cardiac presentation for patients with ACS (%) by admission,

NCVD-ACS Registry, 2006 - 2013


Age group of patients by ACS stratum


Mean age (SD) for STEMI: 56.2 (12.0); NSTEMI: 60.8 (11.8) and UA: 60.8 (12.0)


Age group of patients by ACS stratum


NSTEMI


Type of treatment among STEMI patients by Age Group ,



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


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


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


Guidelines (and patients) advocate early intervention / invasive strategy! How?


UK and Malaysia

Sarawak 2013 –

Approx. 280 PCI pmp


STEMI reperfusion strategies in UK and Malaysia

Malaysia 2013 –

approx. 70% lytic,

approx 9% PPCI


More local research (….definitely needed!)


... Addressing the problems >3 billion at risk


Regional collaboration – 2016 and beyond


Malaysia CPGs for Acute STEMI


3rd Malaysian CPG for STEMI


Sharing our experience


Thrombolysis in STEMI: developing countries


A recent hit…. with global implications


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



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.


500km in October 2015 – World Heart Day


Sarawak – more than just hornbills

how to benefit from an ncvd registry: the ncvd …vnha.org.vn/upload/hoinghi/dh152016/dr alan...

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