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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 MBChBB

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

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

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

N ACS admissions = 14,763

N ACS admissions = 14,763

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)

(onset > 2 weeks ago) 11.0 11.4 9.6 9.4 9.9

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

NCVD-ACS Registry, 2011-2013

Age group of patients by ACS stratum

NCVD-ACS Registry, 2011-2013

NSTEMI

Type of treatment among STEMI patients by Age Group ,

NCVD-ACS Registry, 2011-2013

Outcome at discharge 30-day FU Year Outcome N % N % 2006-2010 Alive 15531 92 14429 86

Outcome at discharge 30-day FU

Physician Centre Cardiologist Centre Physician Centre Cardiologist Centre

2013 Alive Died 11238 934 92.4 7.6 2395 196 92.4 7.6 11064 1108 90.8 9.2 2376 215 91.8 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

3 rd 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

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

500km in October 2015 – World Heart Day

Sarawak – more than just hornbills