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Yong VS, Yen CH, Saharudin S, Tan SL, Kaukiah NF, Liew HB. A real-world experience of a prescribing policy for SGLT2-inhibitors in HFrEF in a Malaysian public tertiary cardiac centre. Med J Malaysia 2024; 79:237-239. [PMID: 38553932] [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: 04/02/2024]
Abstract
A prescribing policy for SGLT2-inhibitors was implemented in a local public tertiary cardiology centre in Sabah to improve access for heart failure (HF) patients. The study evaluated 169 HF patients with reduced ejection fraction (HFrEF) who met the policy criteria. After starting SGLT2- inhibitors, a significant proportion of patients experienced decreased NTproBNP levels, indicating a positive response. HF hospitalisation rates within 1 year were lower compared to the previous year. No adverse events were reported, suggesting that the treatment is safe. Findings demonstrates the benefits of implementing prescribing policies to enhance treatment accessibility and generate valuable real-world data at the local healthcare level..
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Affiliation(s)
- V S Yong
- Hospital Queen Elizabeth II, Clinical Research Centre, Sabah, Malaysia
| | - C H Yen
- Hospital Queen Elizabeth II, Clinical Research Centre, Sabah, Malaysia
| | - S Saharudin
- Hospital Queen Elizabeth II, Clinical Research Centre, Sabah, Malaysia
| | - S L Tan
- Hospital Queen Elizabeth II, Pharmacy Department, Sabah, Malaysia
| | - N F Kaukiah
- Hospital Queen Elizabeth II, Clinical Research Centre, Sabah, Malaysia
| | - H B Liew
- Hospital Queen Elizabeth II, Clinical Research Centre, Sabah, Malaysia
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2
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Albart SA, Yusof Khan AHK, Wan Zaidi WA, Muthuppalaniappan AM, Kandavello G, Koh GT, Leong MC, Liew HB, Ong BH, Viswanathan S, Hoo FK, Looi I, Yap YG, Law WC. Management of patent foramen ovale in embolic stroke of undetermined source patients: Malaysian experts' consensus. Med J Malaysia 2023; 78:389-403. [PMID: 37271850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION About 20 to 40% of ischaemic stroke causes are cryptogenic. Embolic stroke of undetermined source (ESUS) is a subtype of cryptogenic stroke which is diagnosed based on specific criteria. Even though patent foramen ovale (PFO) is linked with the risk of stroke, it is found in about 25% of the general population, so it might be an innocent bystander. The best way to treat ESUS patients with PFO is still up for discussion. MATERIALS AND METHODS Therefore, based on current evidence and expert opinion, Malaysian expert panels from various disciplines have gathered to discuss the management of ESUS patients with PFO. This consensus sought to educate Malaysian healthcare professionals to diagnose and manage PFO in ESUS patients based on local resources and facilities. RESULTS Based on consensus, the Malaysian expert recommended PFO closure for embolic stroke patients who were younger than 60, had high RoPE scores and did not require long-term anticoagulation. However, the decision should be made after other mechanisms of stroke have been ruled out via thorough investigation and multidisciplinary evaluation. The PFO screening should be made using readily available imaging modalities, ideally contrasttransthoracic echocardiogram (c-TTE) or contrasttranscranial Doppler (c-TCD). The contrast-transesophageal echocardiogram (c-TEE) should be used for the confirmation of PFO diagnosis. The experts advised closing PFO as early as possible because there is limited evidence for late closure. For the post-closure follow-up management, dual antiplatelet therapy (DAPT) for one to three months, followed by single antiplatelet therapy (APT) for six months, is advised. Nonetheless, with joint care from a cardiologist and a neurologist, the multidisciplinary team will decide on the continuation of therapy.
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Affiliation(s)
- S A Albart
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Pulau Pinang, Malaysia
| | - A H K Yusof Khan
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Neurology, Serdang, Selangor, Malaysia.
| | - W A Wan Zaidi
- Hospital Canselor Tuanku Muhriz (HCTM), Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - G Kandavello
- Institut Jantung Negara, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - G T Koh
- Hospital Serdang, Paediatric Cardiology Unit, Kajang, Selangor, Malaysia
| | - M C Leong
- Institut Jantung Negara, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - H B Liew
- Hospital Queen Elizabeth II, Department of Cardiology, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - B H Ong
- Kedah Medical Centre, Alor Setar, Kedah, Malaysia
| | - S Viswanathan
- Hospital Kuala Lumpur, Department of Neurology, Ministry of Health Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - F K Hoo
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Neurology, Serdang, Selangor, Malaysia
| | - I Looi
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Pulau Pinang, Malaysia
| | - Y G Yap
- Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia
| | - W C Law
- Hospital Umum Sarawak, Department of Medicine, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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Wan Azman WA, Abdul Ghapar AK, Abdul Kader MASK, Ross NT, Loch A, Ramli AW, Che Hassan HH, Kumar S, Zainal Abidin HA, Karthikesan D, Mohd Amin NH, Ong TK, Liew HB, Wan Isa WYH, Mohd Ghazi A. Heart failure (MYHF) registry: shedding light on lipid profiles and in-hospital outcome of heart failure patients. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.046] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Novartis Corporation Sdn Bhd
Background
Heart failure is a debilitating disease associated with multiple comorbidities and poor prognosis. Dyslipidemia, is the top 5 most common comorbidities, including HF patients. Nonetheless, the lipid profiles in HF population is scarcely available and poorly understood.
Purpose
This report aimed to describe the lipid profiles and in-hospital outcome of hospitalized HF patients.
Methods
MYHF registry is a prospective, observational study of symptomatic HF patients (NYHA II-IV) hospitalized in 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. Lipid profiles will be described, and in-hospital outcome will be analyzed using univariate and multivariate models.
Results
In MYHF registry, 1 out of 2 hospitalized HF patients (55.7%) had ischemic heart disease, significantly higher in patients with HFrEF and HFmrEF, as compared to HFpEF (p<0.001). Similarly, 1 in 2 (46.6%) patients had dyslipidemia as comorbidity but was comparable across EF subgroups (p=0.365). Statin utilization at discharge increased by 20% from admission (from 62.2% to 74.6%), indicating that hospitalization provides good opportunity for statin initiation in indicated HF patients. At admission, the mean total cholesterol, LDL-C, HDL, and TG levels were 4.30 mmol/L (SD 1.66), 2.62 mmol/L (SD 1.34), 1.05 (SD 0.46), and 1.37 (SD 1.08), respectively. Of those with measured LDL-C level, only 31.4% achieved LDL-C goal of <1.8 mmol/L and 39.8% of patients had LDL-C ≥2.6 mmol/L. With univariate analysis, patients with LDL-C goal of ≥ 1.8 mmol/L had lesser risk of in-hospital mortality [OR 0.42 (0.21,0.86), p-value = 0.018], indicating LDL-C paradox. Further analysis with multivariate model revealed that patients with LDL-C goal of ≥ or < 1.8 mmol/L did not differ in in-hospital mortality outcome (p-value = NS).
Conclusion
Dyslipidemia is highly common in general population and in HF patients. With statin therapy, only 31.4% achieved LDL-C < 1.8 mmol/L at admission. The finding highlights the unmet need for combination lipid lowering therapies to get patient to LDL-C target goal. Hospitalization also provided good opportunity of statin therapy initiation. The knowledge gained will be crucial for guiding management of HF patients with common comorbidity like dyslipidemia.
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Affiliation(s)
- W A Wan Azman
- University Malaya Medical Centre (UMMC), Department of Cardiology , Kuala Lumpur , Malaysia
| | | | | | - N T Ross
- Hospital Kuala Lumpur, Medical Department , Kuala Lumpur , Malaysia
| | - A Loch
- University Malaya Medical Centre (UMMC), Department of Cardiology , Kuala Lumpur , Malaysia
| | - A W Ramli
- Sultanah Nur Zahirah Hospital, Department of Cardiology , Kuala Terengganu , Malaysia
| | - H H Che Hassan
- Universiti Kebangsaan Malaysia Medical Centre, Unit of Cardiology , Kuala Lumpur , Malaysia
| | - S Kumar
- Novartis Corporation (Sdn Bhd) , Kuala Lumpur , Malaysia
| | - H A Zainal Abidin
- University of Technology Mara (UiTM), Department of Cardiology, Faculty of Medicine , Kuala Lumpur , Malaysia
| | - D Karthikesan
- Hospital Sultanah Bahiyah, Department of Cardiology , Kuala Lumpur , Malaysia
| | - N H Mohd Amin
- Hospital Raja Permaisuri Bainun Ipoh, Department of Cardiology , Ipoh , Malaysia
| | - T K Ong
- Sarawak Heart Center , Sarawak , Malaysia
| | - H B Liew
- Queen Elizabeth Hospital, Department of Cardiology , Kota Kinabalu, Sabah , Malaysia
| | - W Y H Wan Isa
- Hospital Universiti Sains Malaysia, Cardiology Unit , Kota Bahru , Malaysia
| | - A Mohd Ghazi
- Institut Jantung Negara , Kuala Lumpur , Malaysia
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Foo JH, Chong WL, Azizan Bin Abdullah MOHD, Yen CH, Liew SF, Chu CM, Ma KF, Ng KC, Liew HB. P3129Rheumatic heart diseases screening in Bornean Malaysia: a pilot echocardiography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0204] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rheumatic heart disease is a major public health issue in developing countries including Malaysia. RHD is a preventable disease. Early detection and appropriate treatment may decrease the disease burden to the society. Rheumatic heart disease screening using portable echocardiography may improve early detection among school children in vulnerable community. This is a pilot study of rheumatic heart disease screening using Vscan among primary school students in the Bornean state of Sabah Malaysia.
Purpose
To evaluate the resources required for RHD screening, prevalence of RHD among school children and awareness among the parents and teachers.
Methods
A cohort of 211 students from a primary school were recruited in 2017–2018. Parental consents were obtained. Seven sessions were conducted at the school. Echocardiography was performed by 2–3 experienced ultrasonographers. Image interpretation as per the 2012 WHF RHD echocardiographic diagnostic criteria.
Results
Of the 211 students, 50% female, age range 7–12 year-old. Ethnic groups include Kadazandusun (87%), Rungus (2.4%), Lundayeh (2%), Chinese (2%). Overall, the average number of student scanned was 4.6 students/device/hour. There was a learning curve observed, whereby initial session only scanned 2 students/device/hour which improved to a maximum of 5.9 students/device/hour. Preliminary findings noted probable RHD among 36% (n=76) of screened subjects. Incidental diagnosis of congenital heart disease among 5 students. The suspected RHD cases were referred for formal echocardiography in the tertiary centre for confirmation. Thus far, 12 students were diagnosed with borderline RHD; the main diagnostic criteria in these cases were at least two morphological features of RHD of the MV without pathological MR or MS. Secondary prophylaxis with antibiotic, dental hygiene and patient education were given.
Conclusion
This is a pilot RHD screening using portable Vscan echocardiography among primary school students in Malaysia. Our study showed it is feasible to conduct RHD screening in the field using portable Vscan. The number of students screened improved with practice. Our preliminary finding suggest RHD is prevalent in this population in Sabah, Malaysia.
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Affiliation(s)
- J H Foo
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | - W L Chong
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | | | - C H Yen
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | - S F Liew
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | - C M Chu
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | - K F Ma
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | - K C Ng
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
| | - H B Liew
- Sabah Heart Centre, Kota Kinabalu Sabah, Malaysia
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Shu FEP, Nor Hanim MA, Said A, Ho KH, Tan CT, Koh KT, Oon YY, Voon CY, Cham YL, Khiew NZ, Fong AYY, Ong TK, Liew HB. P4690Impact of myocardial viability assessed by delayed enhancement cardiovascular magnetic resonance on clinical outcomes in real world practice. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4690] [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: 11/12/2022] Open
Affiliation(s)
- F E P Shu
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | | | - A Said
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - K H Ho
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - C T Tan
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - K T Koh
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - Y Y Oon
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - C Y Voon
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - Y L Cham
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - N Z Khiew
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - A Y Y Fong
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - T K Ong
- Sarawak Heart Centre, KOTA SAMARAHAN, Malaysia
| | - H B Liew
- Hospital Queen Elizabeth II, Cardiology, Kota Kinabalu, Malaysia
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Ciraj-Bjelac O, Rehani M, Minamoto A, Sim KH, Liew HB, Vano E. Radiation-induced eye lens changes and risk for cataract in interventional cardiology. Cardiology 2012; 123:168-71. [PMID: 23128776 DOI: 10.1159/000342458] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 08/01/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies have reported a significant increase in eye lens opacities among staff in the cardiac catheterization laboratory but indicated further studies are needed to confirm the findings. OBJECTIVE To evaluate the prevalence of opacities in eyes of cardiologists, radiographers and nurses working in interventional cardiology. METHODS The eyes of 52 staff in interventional cardiology facilities and 34 age- and sex-matched unexposed controls were screened in a cardiology conference held in Kuala Lumpur by dilated slit-lamp examination, and posterior lens changes were graded. Individual cumulative lens X-ray exposures were calculated from responses to a questionnaire in terms of workload and working practice. RESULTS The prevalence of posterior lens opacities among interventional cardiologists was 53%, while in nurses and radiographers it was 45%. Corresponding relative risks were 2.6 (95% CI: 1.2-5.4) and 2.2 (95% CI: 0.98-4.9), for interventional cardiologists and support staff, respectively. CONCLUSIONS This study confirms a statistically significant increase in radiation-associated posterior lens changes in the eyes of interventional cardiology staff.
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Affiliation(s)
- O Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
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Liew HB, Rosli MA, Wan Azman WA, Robaayah Z, Sim KH. The foundation of NCVD PCI Registry: the Malaysia's first multi-centre interventional cardiology project. Med J Malaysia 2008; 63 Suppl C:41-44. [PMID: 19230246] [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: 05/27/2023]
Abstract
The National Cardiovascular Database for Percutaneous Coronary Intervention (NCVD PCI) Registry is the first multicentre interventional cardiology project, involving the main cardiac centres in the country. The ultimate goal of NCVD PCI is to provide a contemporary appraisal of PCI in Malaysia. This article introduces the foundation, the aims, methodology, database collection and preliminary results of the first six-month database.
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Affiliation(s)
- H B Liew
- Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, 93586 Kuching, Sarawak, Malaysia
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Ong K, Chin SP, Chan WL, Liew CK, Seyfarth MT, Liew HB, Rapaee A, Sim KH. Feasibility and accuracy of 64-row MDCT coronary imaging from a centre with early experience: a review and comparison with established centres. Med J Malaysia 2005; 60:629-36. [PMID: 16515115] [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: 05/06/2023]
Abstract
The accuracy of multi-detector computed tomographic (MDCI) coronary angiography (CTA) is dependant on image quality as well as the experience of the operator. Established centers have reported negative predictive values of over 95%. The aim of our study was to investigate the accuracy and feasibility of CTA for the assessment of haemodynamically significant coronary stenosis in a center with very early experience (<6 months) utilizing the improved spatial and temporal resolutions of the latest generation 64-row MDCI scanner. One hundred and twenty eight patients (93 male, 35 female; mean age 56.2 +/- 9.5 years) with suspected or known coronary artery disease underwent both CIA and conventional coronary angiographv (CCA). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for stenoses > or =50% by CIA compared to CCA were 70%, 97%, 70% and 97% respectively. Evaluation of main and proximal segments in patients with good quality images (78% of patients) produced values of 94%, 95%, 74% and 99% respectively. The improved spatial and temporal resolutions of 64-row MJ) CT provided a high negative predictive value in assessing significant coronary artery stenosis even in a centre with very early experience. However, new centers embarking on CTA might not be able to reproduce the results reported by more experienced centers.
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Affiliation(s)
- K Ong
- Department of Cardiology, Sarawak General Hospital
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