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Wang ZS, Yap J, Koh YLE, Chia SY, Nivedita N, Ang TWA, Goh SCP, Lee CS, Tan LLJ, Ooi CW, Seow M, Yeo KK, Chua SJT, Tan NC. Correction to: Predicting Coronary Artery Disease in Primary Care: Development and Validation of a Diagnostic Risk Score for Major Ethnic Groups in Southeast Asia. J Gen Intern Med 2024:10.1007/s11606-024-08684-z. [PMID: 38383944 DOI: 10.1007/s11606-024-08684-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Zhen Sinead Wang
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore.
- Duke-NUS Medical School, Singapore, Republic of Singapore.
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | | | - Shaw Yang Chia
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | - N Nivedita
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Teck Wee Andrew Ang
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Soo Chye Paul Goh
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Cia Sin Lee
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | | | - Chai Wah Ooi
- National Healthcare Group Polyclinics - Geylang Branch, Singapore, Republic of Singapore
| | - Matthew Seow
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Khung Keong Yeo
- Duke-NUS Medical School, Singapore, Republic of Singapore
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Siang Jin Terrance Chua
- Duke-NUS Medical School, Singapore, Republic of Singapore
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
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Tay JCK, Chia SY, Koh SHM, Sim DKL, Chai P, Loh SY, Jaufeerally FR, Guang Lee SS, Yun Lim PZ, Yap J. Clinical characteristics and outcomes in Asian patients with heart failure with mildly reduced ejection fraction. Singapore Med J 2023; 0:377785. [PMID: 37338492 DOI: 10.4103/singaporemedj.smj-2021-096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Introduction Data on heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is still emerging, especially in Asian populations. This study aims to compare the clinical characteristics and outcomes of Asian HFmrEF patients with those of HF patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Methods Patients admitted nationally for HF between 2008 and 2014 were included in the study. They were categorised according to ejection fraction (EF). Patients with EF <40%, EF 40%-49% and EF ≥50% were categorised into the following groups: HFrEF, HFmrEF and HFpEF, respectively. All patients were followed up till December 2016. Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death and/or HF rehospitalisations. Results A total of 16,493 patients were included in the study - HFrEF, n = 7,341 (44.5%); HFmrEF, n = 2,272 (13.8%); and HFpEF n = 6,880 (41.7%). HFmrEF patients were more likely to be gender neutral, of mid-range age and have concomitant diabetes mellitus, hyperlipidaemia, peripheral vascular disease and coronary artery disease (P < 0.001). The two-year overall mortality rates for HFrEF, HFmrEF and HFpEF were 32.9%, 31.8% and 29.1%, respectively. HFmrEF patients had a significantly lower overall mortality rate compared to HFrEF patients (adjusted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.83-0.95; P < 0.001) and a significantly higher overall mortality rate (adjusted HR 1.25, 95% CI 1.17-1.33; P < 0.001) compared to HFpEF patients. This was similarly seen with cardiovascular mortality and HF hospitalisations, with the exception of similar HF hospitalisations between HFmrEF and HFpEF patients. Conclusion HFmrEF patients account for a significant burden of patients with HF. HFmrEF represents a distinct HF phenotype with high atherosclerotic burden and clinical outcomes saddled in between those of HFrEF and HFpEF. Further therapeutic studies to guide management of this challenging group of patients are warranted.
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Affiliation(s)
| | - Shaw Yang Chia
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Ping Chai
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Seet Yoong Loh
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | | | | | | | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Tay JCK, Chia SY, Sim DKL, Chai P, Loh SY, Shum AKL, Lee SSG, Lim PZY, Yap J. Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction. Ann Acad Med Singap 2022; 51:473-482. [PMID: 36047522 DOI: 10.47102/annals-acadmedsg.2022113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The impact of sex and diabetes mellitus (DM) on patients with heart failure with mildly reduced ejection fraction (HFmrEF) is not well elucidated. This study aims to evaluate sex differences in the clinical profile and outcomes in Asian HFmrEF patients with and without DM. METHODS Patients admitted nationally for HFmrEF (ejection fraction 40-49%) between 2008 and 2014 were included and followed up until December 2016. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular (CV) death and/or heart failure (HF) rehospitalisations. RESULTS A total of 2,272 HFmrEF patients (56% male) were included. More women had DM than men (60% versus 55%, P=0.013). Regardless of DM status, HFmrEF females were older, less likely to smoke, had less coronary artery disease, narrower QRS and lower haemoglobin compared to men. The odds of having DM decreases in smokers who are women as opposed to men (Pinteraction =0.017). In multivariate analysis, DM reached statistical analysis for all-cause mortality and combined CV mortality or HF rehospitalisation in both men and women. However, the results suggest that there may be sex differences in terms of outcomes. DM (vs non-DM) was less strongly associated with increased all-cause mortality (adjusted hazards ratio [adj HR] 1.234 vs adj HR 1.290, Pinteraction <0.001] but more strongly associated with the combined CV death/HF rehospitalisation (adj HR 1.429 vs adj HR 1.317, Pinteraction =0.027) in women (vs men). CONCLUSION Asian women with HFmrEF had a higher prevalence of DM, with differences in clinical characteristics, compared to men. While diabetes conferred poor outcomes regardless of sex, there were distinct sex differences. These highlight the need for sex-specific management strategies.
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Affiliation(s)
- Julian C K Tay
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Wang ZS, Yap J, Koh YLE, Chia SY, Nivedita N, Ang TWA, Goh SCP, Lee CS, Tan LLJ, Ooi CW, Seow M, Yeo KK, Chua SJT, Tan NC. Predicting Coronary Artery Disease in Primary Care: Development and Validation of a Diagnostic Risk Score for Major Ethnic Groups in Southeast Asia. J Gen Intern Med 2021; 36:1514-1524. [PMID: 33772443 PMCID: PMC8175488 DOI: 10.1007/s11606-021-06701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) risk prediction tools are useful decision supports. Their clinical impact has not been evaluated amongst Asians in primary care. OBJECTIVE We aimed to develop and validate a diagnostic prediction model for CAD in Southeast Asians by comparing it against three existing tools. DESIGN We prospectively recruited patients presenting to primary care for chest pain between July 2013 and December 2016. CAD was diagnosed at tertiary institution and adjudicated. A logistic regression model was built, with validation by resampling. We validated the Duke Clinical Score (DCS), CAD Consortium Score (CCS), and Marburg Heart Score (MHS). MAIN MEASURES Discrimination and calibration quantify model performance, while net reclassification improvement and net benefit provide clinical insights. KEY RESULTS CAD prevalence was 9.5% (158 of 1658 patients). Our model included age, gender, type 2 diabetes mellitus, hypertension, smoking, chest pain type, neck radiation, Q waves, and ST-T changes. The C-statistic was 0.808 (95% CI 0.776-0.840) and 0.815 (95% CI 0.782-0.847), for model without and with ECG respectively. C-statistics for DCS, CCS-basic, CCS-clinical, and MHS were 0.795 (95% CI 0.759-0.831), 0.756 (95% CI 0.717-0.794), 0.787 (95% CI 0.752-0.823), and 0.661 (95% CI 0.621-0.701). Our model (with ECG) correctly reclassified 100% of patients when compared with DCS and CCS-clinical respectively. At 5% threshold probability, the net benefit for our model (with ECG) was 0.063. The net benefit for DCS, CCS-basic, and CCS-clinical was 0.056, 0.060, and 0.065. CONCLUSIONS PRECISE (Predictive Risk scorE for CAD In Southeast Asians with chEst pain) performs well and demonstrates utility as a clinical decision support for diagnosing CAD among Southeast Asians.
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Affiliation(s)
- Zhen Sinead Wang
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore.
- Duke-NUS Medical School, Singapore, Republic of Singapore.
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Republic of Singapore.
| | | | - Shaw Yang Chia
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | - N Nivedita
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Teck Wee Andrew Ang
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Soo Chye Paul Goh
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Cia Sin Lee
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | | | - Chai Wah Ooi
- National Healthcare Group Polyclinics - Geylang Branch, Singapore, Republic of Singapore
| | - Matthew Seow
- Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Khung Keong Yeo
- Duke-NUS Medical School, Singapore, Republic of Singapore
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Siang Jin Terrance Chua
- Duke-NUS Medical School, Singapore, Republic of Singapore
- National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore, Republic of Singapore
- Duke-NUS Medical School, Singapore, Republic of Singapore
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Kiat JTC, Chia SY, Koh SHM, Sim D, Chai P, Loh SY, Jaufeerally FR, Guang SLS, Lim ZYP, Yap J. CLINICAL CHARACTERISTICS AND OUTCOMES IN ASIAN PATIENTS WITH HEART FAILURE AND MID-RANGE EJECTION FRACTION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yap JJ, Tay JC, Ewe SH, Thiagarajan N, Chia SY, Amanullah MR, Lim ST, Chao VT, Ho KW. Impact of Chronic Kidney Disease on Outcomes in Transcatheter Aortic Valve Implantation. Ann Acad Med Singap 2020; 49:273-284. [PMID: 32582904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a significant comorbidity in aortic stenosis (AS) patients. We examined the impact of baseline CKD, postoperative acute kidney injury (AKI) and CKD progression on clinical outcomes in patients who underwent transcatheter aortic valve implantation (TAVI). MATERIALS AND METHODS Consecutive patients with severe AS who underwent TAVI were classified into CKD stages 1-2 (≥60 mL/min/1.72m2), 3 (30-59 mL/min/1.73m2) and 4-5 (<30 mL/min/1.73m2 or dialysis) based on estimated glomerular filtration rate (eGFR). Primary outcome was mortality and secondary outcomes included 1-year echocardiographic data on aortic valve area (AVA), mean pressure gradient (MPG) and aortic regurgitation (AR). RESULTS A total of 216 patients were included. Higher eGFR was associated with lower overall mortality (adjusted hazards ratio [AHR] 0.981, 95% confidence interval [CI] 0.968-0.993, P = 0.002). CKD 4-5 were associated with significantly higher mortality from non-cardiovascular causes (P <0.05). Patients with CKD 3-5 had higher incidence of moderate AR than those with CKD 1-2 (P = 0.010); no difference in AVA and MPG was seen. AKI patients had higher mortality (P = 0.008), but the effect was attenuated on multivariate analysis (AHR 1.823, 95% CI 0.977-3.403, P = 0.059). Patients with CKD progression also had significantly higher mortality (AHR 2.969, 95% CI 1.373-6.420, P = 0.006). CONCLUSION CKD in severe AS patients undergoing TAVI portends significantly higher mortality and morbidity. Renal disease progression impacts negatively on outcomes and identifies a challenging subgroup of patients for optimal management.
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Affiliation(s)
- Jonathan Jl Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Yap J, Keh YS, Shen T, Lam CSP, Chia SY, Jaufeerally FR, Ong W, Sim D, Ching CK. QRS duration and cardiovascular mortality in Asian patients with heart failure and preserved and reduced ejection fraction. Cardiol J 2020; 28:166-169. [PMID: 32207835 DOI: 10.5603/cj.a2020.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/18/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jonathan Yap
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore.
| | - Yann Shan Keh
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | - Tong Shen
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | - Shaw Yang Chia
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | | | - Wilson Ong
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | - David Sim
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | - Chi-Keong Ching
- National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
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Kiat JTC, Yap J, Ewe SH, Thiagarajan N, Chia SY, Rizwan M, Lim ST, Chao V, Ho KW. CHRONIC KIDNEY DISEASE IMPACTS OUTCOMES IN TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yap J, Chia SY, Lim FY, Allen JC, Teo L, Sim D, Go YY, Jaufeerally FR, Seow M, Kwok B, Liew R, Lam CS, Ching CK. The Singapore Heart Failure Risk Score: Prediction of Survival in Southeast Asian Patients. Ann Acad Med Singap 2019; 48:86-94. [PMID: 30997477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Numerous heart failure risk scores have been developed but there is none for Asians. We aimed to develop a risk calculator, the Singapore Heart Failure Risk Score, to predict 1- and 2-year survival in Southeast Asian patients hospitalised for heart failure. MATERIALS AND METHODS Consecutive patients admitted for heart failure were identified from the Singapore Cardiac Databank Heart Failure registry. The follow-up was 2 to 4 years and mortality was obtained from national registries. RESULTS The derivation (2008-2009) and 2 validation cohorts (2008-2009, 2013) included 1392, 729 and 804 patients, respectively. Ten variables were ultimately included in the risk model: age, prior myocardial infarction, prior stroke, atrial fibrillation, peripheral vascular disease, systolic blood pressure, QRS duration, ejection fraction and creatinine and sodium levels. In the derivation cohort, predicted 1- and 2-year survival was 79.1% and 68.1% compared to actual 1- and 2-year survival of 78.2% and 67.9%. There was good agreement between the predicted and observed mortality rates (Hosmer-Lemeshow statistic = 14.36, P = 0.073). C-statistics for 2-year mortality in the derivation and validation cohorts were 0.73 (95% CI, 0.70-0.75) and 0.68 (95% CI, 0.64-0.72), respectively. CONCLUSION We provided a risk score based on readily available clinical characteristics to predict 1- and 2-year survival in Southeast Asian patients hospitalised for heart failure via a simple online risk calculator, the Singapore Heart Failure Risk Score.
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Affiliation(s)
- Jonathan Yap
- Department of Cardiology, National Heart Centre, Singapore
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Tan AW, Chia SY, Lee KY, Goh BB, Yeo KK. CORONARY ARTERY DISEASE AND NON-ALCOHOLIC FATTY LIVER DISEASE IN A MULTI-ETHNIC SOCIETY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Khoo CY, Allen JC, Chia SY, Chan LL, Lim CP, Sim D, Ching CK. Mortality outcome and predictive risk factors for death in patients with heart failure and reduced ejection fraction who declined implantable cardioverter defibrillator implantation in Singapore. J Arrhythm 2018; 34:536-540. [PMID: 30327699 PMCID: PMC6174497 DOI: 10.1002/joa3.12106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There have been conflicting data regarding the risk of sudden cardiac death (SCD) in Asian population with reduced left ventricular ejection fraction (LVEF). We aim to study mortality outcome and its risk predictors in patients with reduced LVEF who declined an implantable cardioverter defibrillator (ICD) implantation and assess whether current ICD guidelines for primary prevention are applicable to the population in Singapore. METHODS This prospective observational study involved 240 consecutive patients who fulfilled the ACC/AHA/HRS criteria for ICD implantation for primary prevention of SCD but declined ICD implantation. Baseline characteristics and mortality outcomes through May 2017 were collected via case-note review after a mean follow-up of 44.8 ± 16.6 months. RESULTS Majority of our patients were Chinese (71.3%), followed by Malays (16.2%) and Indians (10.8%). Mean age (±SD) was 61 ± 10 years, and 84% were male. Majority were in New York Heart Association (NYHA) functional classes I (46.7%) and II (46.3%). Over a mean follow-up of 44.8 ± 16.6 months, all-cause mortality rate was 34.6%. Diabetes mellitus (HR = 1.57; 95% CI, 1.01-2.44; P = 0.047) and chronic kidney disease (CKD; HR = 1.95; 95% CI, 1.17-3.23; P = 0.010) were independent predictors of mortality. Patients in NYHA classes II (HR = 2.15; 95% CI, 1.32-3.50; P = 0.002) and III (HR = 2.82; 95% CI, 1.34-5.96; P = 0.007) showed higher risk of death. CONCLUSION The mortality rate was comparable with major primary prevention trials. ICD guideline recommendations for primary prevention may thus be applicable to our local population. Patients with diabetes, CKD, and poorer NYHA status exhibited higher mortality rates.
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Affiliation(s)
- Chun Yuan Khoo
- Department of CardiologyNational Heart CentreSingapore CitySingapore
| | | | - Shaw Yang Chia
- Singapore Cardiac Data BankNational Heart CentreSingapore CitySingapore
| | - Laura Lihua Chan
- Department of CardiologyNational Heart CentreSingapore CitySingapore
| | - Choon Pin Lim
- Department of CardiologyNational Heart CentreSingapore CitySingapore
| | - David Sim
- Department of CardiologyNational Heart CentreSingapore CitySingapore
| | - Chi Keong Ching
- Department of CardiologyNational Heart CentreSingapore CitySingapore
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Wang LK, Chia SY, Allen JC, Yeo KK, Chua SC. P6354Enhanced bedside PCI risk score predicting major adverse cardiovascular events. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L K Wang
- National Heart Centre Singapore, Singapore, Singapore
| | - S Y Chia
- National Heart Centre Singapore, Singapore, Singapore
| | - J C Allen
- Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
| | - K K Yeo
- National Heart Centre Singapore, Singapore, Singapore
| | - S C Chua
- National Heart Centre Singapore, Singapore, Singapore
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Go YY, Chia SY, Ewe SH, Sahlen SA, Sim D, Jaufeerally FR, Ding ZP, Lim TK. P2816Left atrial volume is an independent predictor of outcome in a large asian cohort with acute heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Y Go
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - S Y Chia
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - S H Ewe
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - S A Sahlen
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - D Sim
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | | | - Z P Ding
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - T K Lim
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
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Tan WA, Chia SY, Soh KKG, Zheng Y, Tang HC. OUTCOMES OF HYPERTROPHIC CARDIOMYOPATHY IN A MULTI ETHNIC SOCIETY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Go YY, Sugimoto T, Bulluck H, Acharyya S, Allen JC, Chia SY, Jaufeerally FR, Sim D, Lim TK, Liew R, Lam CSP. Age and ejection fraction modify the impact of atrial fibrillation on acute heart failure outcomes. Eur J Heart Fail 2017; 20:821-822. [PMID: 29148227 DOI: 10.1002/ejhf.1075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium.,Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Tadafumi Sugimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.,Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium
| | | | | | | | - Shaw Yang Chia
- The Singapore Cardiac Databank, National Heart Centre Singapore, Singapore
| | - Fazlur Rehman Jaufeerally
- Duke-National University of Singapore Medical School, Singapore.,Department of Internal Medicine, Singapore General Hospital, Singapore
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Tiong Keng Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Reginald Liew
- Duke-National University of Singapore Medical School, Singapore
| | - Carolyn S P Lam
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore
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Koh AS, Lye WK, Chia SY, Salunat-Flores J, Sim LL, Keng FY, Tan RS, Chua TS. Long-Term Prognostic Value of Appropriate Myocardial Perfusion Imaging. Am J Cardiol 2017; 119:1957-1962. [PMID: 28456317 DOI: 10.1016/j.amjcard.2017.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
Appropriate use criteria (AUC) for single-photon emission computed tomography myocardial perfusion images (SPECT-MPIs) were developed to address the growth of cardiac imaging studies. Long-term prognostic value of AUC in SPECT-MPI has not been tested in existing cohorts. We sought to determine the long-term prognostic value of MPI classified as appropriate. AUC was evaluated in a prospectively designed cohort of patients who underwent clinically indicated MPI. MPI studies were classified based on 2009 AUC for SPECT-MPI. Data regarding downstream coronary angiography (cath), revascularization and all-cause mortality, cardiac death, and nonfatal myocardial infarction (MI) were collected from national registries. Among n = 1,129 MPI scans that received an appropriate grading, 148 all-cause deaths, 109 MIs, 58 cardiac deaths, 152 caths, 113 revascularization procedures occurred over a mean follow-up period of 5.4 ± 1.2 years (0.9% cardiac death rate per year, 1.8% MI rate per year). Most of the scans were low-risk normal MPI scans (summed stress score ≤3; 74.1%). An abnormal scan was associated with higher rates of MI (19.5% vs 6.2%, hazard ratio 1.72, p = 0.017) and cardiac death (13.4% vs 2.3%, hazard ratio 2.12, p = 0.016). In conclusion, MPI scans classified as appropriate have long-term prognostic value, despite a high proportion of low-risk scans. This provides support for clinicians to consider the use of appropriate grading in addition to MPI scan results in patient management.
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Zeng W, Chia SY, Chan YH, Tan SC, Low EJH, Fong MK. Factors impacting heart failure patients’ knowledge of heart disease and self-care management. Proceedings of Singapore Healthcare 2016. [DOI: 10.1177/2010105816664537] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Heart failure (HF) contributes significantly to the morbidity and mortality of the ageing population and is one of the leading causes of re-hospitalization in Singapore. Studies have shown that patient education covering HF and self-care management can lead to greater compliance with treatment regimens, resulting in lower re-hospitalization rates. This study aimed to measure HF patients’ knowledge on the disease and self-care management, and to explore factors influencing their knowledge level. Methods: A questionnaire adapted from the Dutch Heart Failure Knowledge Scale (DHFKS) was completed by 187 patients who were recruited from a tertiary center’s outpatient HF clinic. Data from the survey were analyzed using SPSS (version 22). Results: Knowledge of HF in general had the highest score and that of HF symptoms/recognition of HF symptoms the lowest. The knowledge deficit identified was mainly on therapeutic regimens and HF symptoms/recognition of HF symptoms. The respondents’ knowledge was significantly related to their educational level and whether they had received HF education. Conclusion: For HF patient education to be effective, the program has to be customized to cater to different target groups and individuals. There is a need to develop patient teaching materials and a program with consideration to the patients’ educational levels, demographic, and comorbidity backgrounds.
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Affiliation(s)
- Wenying Zeng
- Nursing Department, National Heart Centre Singapore, Singapore
| | - Shaw Yang Chia
- Singapore Cardiac Data Bank, National Heart Centre Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, National University of Singapore, Singapore
| | - Suan Choo Tan
- Nursing Department, National Heart Centre Singapore, Singapore
| | | | - Meng Kum Fong
- Nursing Department, National Heart Centre Singapore, Singapore
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18
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Lam CSP, Chang P, Chia SY, Sim LL, Gao F, Lee FL, Chai P, Wong RCC, Seow SC, Leong GKT, Yeo PSD, Sim D, Chua T, Kwok BWK. Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure. ACTA ACUST UNITED AC 2014; 22:8. [PMID: 26316666 PMCID: PMC4544470 DOI: 10.7603/s40602-014-0008-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: To study sex differences in clinical characteristics and outcomes among multi-ethnic Southeast Asian patients with hospitalized heart failure (HHF). Background: HHF is an important public health problem affecting man and women globally. Reports from Western populations suggest striking sex differences in risk factors and outcomes in HHF. However, this has not been studied in a multi-ethnic Asian population. Methods: Using the population-based resources of the Singapore Cardiac Data Bank, we studied 5,703 consecutive cases of HHF admitted across hospitals in the Southeast Asian nation of Singapore from 1st January, 2008 through 31st December, 2009. Results: Women accounted for 46% of total admissions and were characterized by older age (73 vs. 67 years; p<0.001), higher prevalence of hypertension (78.6 vs. 72.1%; p<0.001) or atrial fibrillation (22.2 vs. 18.1%; p<0.001), and lower prevalence of coronary artery disease (33.8 vs. 41.0%; p<0.001) or prior myocardial infarction (14.9 vs. 19.8%; p<0.001). Women were more likely than men to have HHF with preserved ejection fraction (42.5% versus 20.8%, p < 0.001). Women were less likely than men to receive evidencebased therapies at discharge, both in the overall group and in the sub-group with reduced ejection fraction. Women had longer lengths of stay (5.6 vs. 5.1 days; p<0.001) but similar in-hospital mortality and one-year rehospitalization rates compared to men. Independent predictors of mortality or rehospitalization in both men and women included prior myocardial infarction and reduced ejection fraction. Among women alone, additional independent predictors were renal impairment, atrial fibrillation, and diabetes. Prescription of beta-blockers and ACE-inhibitors at discharge was associated with better outcomes. Conclusion: Among multi-ethnic Asian patients with HHF, there are important sex differences in clinical characteristics and prognostic factors. These data may inform sex-specific strategies to improve outcomes of HHF in Southeast Asians.
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Affiliation(s)
- Carolyn S P Lam
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Peter Chang
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Shaw Yang Chia
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Ling Ling Sim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Fong Ling Lee
- Khoo Teck Puat Hospital, Department of Cardiology, Singapore, Singapore
| | - Ping Chai
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Raymond Ching-Chiew Wong
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Swee Chong Seow
- National University Health System, Cardiac Department, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | | | - Poh Shuan Daniel Yeo
- Tan Tock Seng Hospital, Department of Cardiology, Singapore, Singapore ; Singapore Cardiac Data Bank, Apex Heart Clinic, Gleneagles Hospital, Singapore, Singapore, Singapore
| | - David Sim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - Bernard W K Kwok
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
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19
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Chang P, Chia SY, Sim LL, Gao F, Lee FL, Chai P, Wong RCC, Seow SC, Leong GKT, Yeo PSD, Sim D, Chua T, Kwok BW, Lam CS. Erratum to: Impact Of Sex On Clinical Characteristics And In-Hospital Outcomes In A Multi-Ethnic Southeast Asian Population Of Patients Hospitalized For Acute Heart Failure. Asean Heart J 2014. [PMCID: PMC5550545 DOI: 10.7603/s40602-014-0011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Unfortunately, some tables and figures were missing in the original version. The missing tables and figures are presented below.
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Affiliation(s)
- Peter Chang
- Cardiac Department, National University Health System, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Shaw Yang Chia
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Ling Ling Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Fei Gao
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Fong Ling Lee
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Ping Chai
- Cardiac Department, National University Health System, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Raymond Ching-Chiew Wong
- Cardiac Department, National University Health System, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | - Swee Chong Seow
- Cardiac Department, National University Health System, 1E Kent Ridge Road, 119228 Singapore, Singapore
| | | | - Poh Shuan Daniel Yeo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
- Apex Heart Clinic, Singapore Cardiac Data Bank, Gleneagles Hospital, Singapore, Singapore
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Terrance Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Bernard W.K. Kwok
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Carolyn S.P. Lam
- Cardiac Department, National University Health System, 1E Kent Ridge Road, 119228 Singapore, Singapore
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20
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Go YY, Allen JC, Chia SY, Sim LL, Jaufeerally FR, Yap J, Ching CK, Sim D, Kwok B, Liew R. Predictors of mortality in acute heart failure: interaction between diabetes and impaired left ventricular ejection fraction. Eur J Heart Fail 2014; 16:1183-9. [DOI: 10.1002/ejhf.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 03/09/2014] [Accepted: 05/02/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yun Yun Go
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | | | | | | | | | - Jonathan Yap
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - Chi Keong Ching
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - David Sim
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - Bernard Kwok
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - Reginald Liew
- Duke-NUS Graduate Medical School Singapore; Singapore
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21
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Yang S, Chia SY, Chuah KL, Eng P. Tracheobronchial amyloidosis treated with rigid bronchoscopy and stenting. Surg Endosc 2003; 17:658-9. [PMID: 12574930 DOI: 10.1007/s00464-002-4260-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2002] [Accepted: 09/12/2002] [Indexed: 11/30/2022]
Abstract
Tracheobronchial amyloidosis (TBA) is an uncommon disease that can cause airway obstruction. We present a case of TBA in a 20-year-old man that was treated successfully with rigid bronchoscopy and stenting. The patient presented with progressive dyspnea despite having had a tracheostomy fashioned at another institution. Airway obstruction secondary to TBA was found distal to the tracheostomy. The amyloid protein subtype was AA, which is uncommon and is seldom of clinical significance in the respiratory tract. The patient underwent rigid bronchoscopy to remove the amyloid protein causing the airway obstruction. A Dumon silicone stent was then inserted to alleviate the obstruction. Thereafter, he recovered well and was discharged without a tracheostomy. This report shows that in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion.
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Affiliation(s)
- S Yang
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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