M.K. Mohd Arshad

Prevalence of atrial fibrillation in the Malaysian communities

Background and aim Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. The REDISCOVER (Responding to Increasing Cardiovascular disease prevalence) study is an observational longitudinal community-based study that tracks changing lifestyles, risk factors and chronic disease in urban and rural areas of Malaysia. In this study, we aim to study the prevalence of AF and its associated risk factors. Methods The study was conducted between 2007 and 2014. Participants were required to complete questionnaires on cardiovascular risk factors and medical history, and undergo physical examinations, blood tests, ECG and echocardiography examinations. Demographic variables including weight, height, blood pressure, serum glucose and serum lipid were recorded. Participants with AF were identified from their baseline ECG and at 3-year follow up. Results A total of 10 805 subjects participated in the study. Mean age was 52.6(±11.6) years and 56% were female; 4.4% of subjects had a diagnosis of ischaemic heart disease, 1.3% had a previous stroke, 16.7% had diabetes mellitus and 45.6% had hypertension. There were 53 subjects diagnosed with AF at baseline, giving a prevalence of 0.49%, and 0.54% at 3 years. AF was more prevalent in males (58.5% in the AF group compared to 43.9% in sinus rhythm (SR) subjects; p=0.03) and the older age group. Ischaemic heart disease was more prevalent in AF subjects (22.6%) compared to SR subjects (4.4%) (p<0.001). In the AF group previous stroke had occurred in 1.9% of subjects compared to 1.3% in the SR population (p=0.51), and 24.5% of subjects in the AF group had diabetes compared to 16.6% in the SR group (p=0.12). There was a significant difference in the prevalence of hypertension between the AF group (59.6%) compared to the SR subjects (45.5%) (p=0.04). Conclusions The prevalence of AF in the Malaysian population was low at 0.54% compared to the global average of 1%. We found that AF was associated with older age, male sex, hypertension, and ischaemic heart disease.

Pattern and predictors of outcomes for infective endocarditis in North Kuala Lumpur

Context: Infective endocarditis (IE) still carries significant mortality and morbidity ever since 1835. Despite improvement in medical technologies, mortality outcome remains unchanged. We sought to analyze the pattern of presentation, treatment, and outcomes predictors for patient presenting to our hospital. This study will explore some of the factors that could be associated with the outcome of a patient diagnosed with IE for a better guidance in management. Subjects and Methods: This is a retrospective dual center cohort study from North Kuala Lumpur from January 2012 to December 2013. Fifty patients with definite IE based on modified Dukes criteria were recruited into the study. Clinical presentation, risk factors, biochemical markers, echocardiography, and outcome were obtained through chart review, clinic data, and telephone call. Simple logistic regression was utilized for inferential statistic. Results: A total of 50 patients, 37 (74%) males and 13 (26%) females were included in the study. The mean age was 42 ± 16.4. Most patients (80.39%) were diagnosed within the 1st week of admission. Staphylococcus aureus was the most common pathogen (38%) and the mitral valve was predominantly affected (68%). Complication was common and in-hospital mortality remains high (28%). Nearly 20% of the patients who had surgical intervention survived and discharged alive. Presence of complications predicts poor outcome (odds ratio [OR]: 5.5 P = 0.02), whereas surgical intervention predicts good outcome (OR: 1.56 P = 0.027). Conclusions: Mortality remains relatively high in patient with IE. Those who presented with complications are at 5.5-fold risk of mortality. Surgical intervention showed an association with good outcome within this cohort.

111 CARDIOVASCULAR RISK PROFILE IN NEWLY DIAGNOSED HYPERTENSION

Background: Understanding a patients overall cardiovascular risk factor (CVRF) profile is of great importance in management of hypertension.1 Early diagnosis and treatment of associated risk factors could reduce overall cardiovascular mortality.2 The objective of this study was to determine the CVRF profile among newly diagnosed hypertension (NDHT). Method: This is a community-based study involving 10892 subjects adult subjects carried out in Malaysia between 2005 and 2011. The subjects had waist and hip circumferences measured, mean of two resting blood pressure readings recorded and fasting blood samples drawn for glucose and lipid profiles. Result: Hypertensive (HPT) subjects were older (mean 58.10±9.62 years) compared to NDHT (mean 54.08±11.22 years) and normotensives subjects (mean 47.79±10.65 years). 27% had NDHT with 67% had stage 1 hypertension. Figure 1 and table 1 show NDHT subjects had undesirable CVRF profile compared to normotensives (p<0.0001). Compared to HPT subjects, they had similar CVRF profile except for total cholesterol and low HDL cholesterol. FIGURE 1. CVRF profiles in NDHT, HPT and normotensive subjects Conclusion: NDHT subjects in Malaysia have significant prevalence of co-existing CVRF. This emphasises the importance of early detection of hypertension. Preventive measure and goal of therapy should be aimed at improving multivariate risk profile. References:Kannel WB. Fifty years of Framingham Study contributions to understanding hypertension. J Hum Hypertens 2000 Feb;14(2):83-90Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure related disease, 2001. Lancet 2008 May;371(9623):1513-8

360 STOKING THE FIRE- LOW SECONDARY PREVENTION MEDICATIONS AMONG HIGH RISK PATIENTS IN MALAYSIA

Background and Objective: Beta-blockers, antiplatelets, ACE inhibitors / Angiotensin Receptor Blockers (ACE-i/ARB) and statins are well established secondary prevention drugs for high risk patients, especially those with coronary heart disease (CHD) or stroke. However, often these are not widely used. The objective of this study is to determine their use in Malaysia. Methodology: The Prospective Urban Rural Epidemiology (PURE) study is a community-based world-wide research collaboration involving 154,000 adults (15,617 from Malaysia) to evaluate the impact of urbanization on cardiovascular disease. Demographic, anthropometric, blood pressure and fasting glucose and lipids were obtained using validated questionnaires and standard laboratory methods. Results: PURE involves 6891 rural and 8726 urban dwellers with a mean age 51.13+9.9 years; 55.9% are females. Hypertension, diabetes, overweight (BMI 25-30), obesity (BMI>30), and smokers make up 44.1%, 15.7%, 38.2%, 21.3% and 23.1% respectively. Beta-blockers, antiplatelets, ACE-i/ARB and statins are used in 2.9%, 1.3%, 2.5% and 2.5% respectively. Among CHD or stroke participants, their use is 11.1%, 13.6%, 10.9% and 13.9% respectively; urban dwellers using more Beta-blockers and antiplatelets (14.0% vs 13.4% and 12.9% vs 9.9% respectively) and rural dwellers using more ACEi/ARB and statins (11.5% vs 10.1% and 14.1% vs 13.5% respectively) and their use is more in males than females. Conclusion: Although the Malaysian public health system provides these drugs free, their actual use is abysmally low even among high risk individuals. Improving patient awareness, health education, professional commitment and health delivery system may alter the scenario.