Yvonne May Fen Chia1, Tiew-Hwa Katherine Teng1, Eugene S J Tan1, Wan Ting Tay1, A Mark Richards1, Calvin Woon Loong Chin1, Wataru Shimizu1, Sang Weon Park1, Chung-Lieh Hung1, Lieng H Ling1, Tachapong Ngarmukos1, Razali Omar1, Bambang B Siswanto1, Calambur Narasimhan1, Eugene B Reyes1, Cheuk-Man Yu1, Inder Anand1, Michael R MacDonald1, Jonathan Yap1, Shu Zhang1, Eric A Finkelstein1, Carolyn S P Lam2. 1. From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.). 2. From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.). carolyn.lam@duke-nus.edu.sg.
Abstract
BACKGROUND: Implantable cardioverter defibrillators (ICDs) are lifesaving devices for patients with heart failure (HF) and reduced ejection fraction. However, utilization and determinants of ICD insertion in Asia are poorly defined. We determined the utilization, associations of ICD uptake, patient-perceived barriers to device therapy and, impact of ICDs on mortality in Asian patients with HF. METHODS AND RESULTS: Using the prospective ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, 5276 patients with symptomatic HF and reduced ejection fraction (HFrEF) from 11 Asian regions and across 3 income regions (high: Hong Kong, Japan, Korea, Singapore, and Taiwan; middle: China, Malaysia, and Thailand; and low: India, Indonesia, and Philippines) were studied. ICD utilization, clinical characteristics, as well as device perception and knowledge, were assessed at baseline among ICD-eligible patients (EF ≤35% and New York Heart Association Class II-III). Patients were followed for the primary outcome of all-cause mortality. Among 3240 ICD-eligible patients (mean age 58.9±12.9 years, 79.1% men), 389 (12%) were ICD recipients. Utilization varied across Asia (from 1.5% in Indonesia to 52.5% in Japan) with a trend toward greater uptake in regions with government reimbursement for ICDs and lower out-of-pocket healthcare expenditure. ICD (versus non-ICD) recipients were more likely to be older (63±11 versus 58±13 year; P<0.001), have tertiary (versus ≤primary) education (34.9% versus 18.1%; P<0.001) and be residing in a high (versus low) income region (64.5% versus 36.5%; P<0.001). Among 2000 ICD nonrecipients surveyed, 55% were either unaware of the benefits of, or needed more information on, device therapy. ICD implantation reduced risks of all-cause mortality (hazard ratio, 0.71; 95% confidence interval, 0.52-0.97) and sudden cardiac deaths (hazard ratio, 0.33; 95% confidence interval, 0.14-0.79) over a median follow-up of 417 days. CONCLUSIONS: ICDs reduce mortality risk, yet utilization in Asia is low; with disparity across geographic regions and socioeconomic status. Better patient education and targeted healthcare reforms in extending ICD reimbursement may improve access. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT01633398. Unique identifier: NCT01633398.
BACKGROUND: Implantable cardioverter defibrillators (ICDs) are lifesaving devices for patients with heart failure (HF) and reduced ejection fraction. However, utilization and determinants of ICD insertion in Asia are poorly defined. We determined the utilization, associations of ICD uptake, patient-perceived barriers to device therapy and, impact of ICDs on mortality in Asian patients with HF. METHODS AND RESULTS: Using the prospective ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, 5276 patients with symptomatic HF and reduced ejection fraction (HFrEF) from 11 Asian regions and across 3 income regions (high: Hong Kong, Japan, Korea, Singapore, and Taiwan; middle: China, Malaysia, and Thailand; and low: India, Indonesia, and Philippines) were studied. ICD utilization, clinical characteristics, as well as device perception and knowledge, were assessed at baseline among ICD-eligible patients (EF ≤35% and New York Heart Association Class II-III). Patients were followed for the primary outcome of all-cause mortality. Among 3240 ICD-eligible patients (mean age 58.9±12.9 years, 79.1% men), 389 (12%) were ICD recipients. Utilization varied across Asia (from 1.5% in Indonesia to 52.5% in Japan) with a trend toward greater uptake in regions with government reimbursement for ICDs and lower out-of-pocket healthcare expenditure. ICD (versus non-ICD) recipients were more likely to be older (63±11 versus 58±13 year; P<0.001), have tertiary (versus ≤primary) education (34.9% versus 18.1%; P<0.001) and be residing in a high (versus low) income region (64.5% versus 36.5%; P<0.001). Among 2000 ICD nonrecipients surveyed, 55% were either unaware of the benefits of, or needed more information on, device therapy. ICD implantation reduced risks of all-cause mortality (hazard ratio, 0.71; 95% confidence interval, 0.52-0.97) and sudden cardiac deaths (hazard ratio, 0.33; 95% confidence interval, 0.14-0.79) over a median follow-up of 417 days. CONCLUSIONS: ICDs reduce mortality risk, yet utilization in Asia is low; with disparity across geographic regions and socioeconomic status. Better patient education and targeted healthcare reforms in extending ICD reimbursement may improve access. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT01633398. Unique identifier: NCT01633398.
Authors: Chanchal Chandramouli; Wan Ting Tay; Nurul Sahiddah Bamadhaj; Jasper Tromp; Tiew-Hwa Katherine Teng; Jonathan J L Yap; Michael R MacDonald; Chung-Lieh Hung; Koen Streng; Ajay Naik; Gurpreet Singh Wander; Jitendra Sawhney; Lieng Hsi Ling; A Mark Richards; Inder Anand; Adriaan A Voors; Carolyn S P Lam Journal: PLoS Med Date: 2019-09-24 Impact factor: 11.069
Authors: Michael R MacDonald; Wan Ting Tay; Tiew-Hwa Katherine Teng; Inder Anand; Lieng Hsi Ling; Jonathan Yap; Jasper Tromp; Gurpreet S Wander; Ajay Naik; Tachapong Ngarmukos; Bambang B Siswanto; Chung-Lieh Hung; A Mark Richards; Carolyn S P Lam Journal: J Am Heart Assoc Date: 2019-12-19 Impact factor: 5.501
Authors: Jasper Tromp; Wan Ting Tay; Wouter Ouwerkerk; Tiew-Hwa Katherine Teng; Jonathan Yap; Michael R MacDonald; Kirsten Leineweber; John J V McMurray; Michael R Zile; Inder S Anand; A Mark Richards; Carolyn S P Lam Journal: PLoS Med Date: 2018-03-27 Impact factor: 11.069