Reassessing heart failure therapy in Thailand: Patient insights and treatment outcomes from the Thai heart failure registry.

BACKGROUND: This research analyzed the demographics, management, and outcomes of patients with heart failure (HF) in Thailand. METHODS: The Thai Heart Failure Registry prospectively enrolled patients diagnosed with HF from 36 hospitals in Thailand. Follow-up data were recorded at 6, 12, 18, and 24 months. This study primarily focused on two outcomes: mortality and HF-related hospitalizations. RESULTS: The study included 2639 patients aged at least 18. Their mean age was 59.2 ± 14.5 years, and most were male (68.4%). Patients were classified as having HF with reduced ejection fraction (HFrEF, 80.7%), HF with preserved ejection fraction (HFpEF, 9.0%), or HF with mildly reduced ejection fraction (HFmrEF, 10.3%). Guideline-directed medical therapy utilization varied. Beta-blockers had the highest usage (93.2%), followed by mineralocorticoid receptor antagonists (65.7%), angiotensin-converting enzyme inhibitors (39.3%), angiotensin receptor blockers (28.2%), angiotensin receptor-neprilysin inhibitors (16.1%), and sodium-glucose cotransporter-2 inhibitors (8.0%). The study monitored a composite of mortality and HF incidents, revealing incidence rates of 11.74, 12.50, and 8.93 per 100 person-years for the overall, HFrEF, and HFmrEF/HFpEF populations, respectively. CONCLUSIONS: Despite high guideline-directed medical therapy adherence, the Thai Heart Failure Registry data revealed high mortality and recurrent HF rates. These findings underscore limitations in current HF treatment efficacy. The results indicate the need for further investigation and improvements of HF management to enhance patient outcomes.

Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry.

PURPOSE: Hypertension is associated with incident atrial fibrillation (AF) and AF-related complications. We investigated the associations between average systolic blood pressure (SBP) and outcomes in a nationwide cohort of Asian patients with non-valvular atrial fibrillation (NVAF). PATIENTS AND METHODS: A multicenter nationwide registry of patients with NVAF in Thailand was conducted during 2014-2017. Clinical data, including blood pressure, were recorded at baseline and then every 6 months. Average SBP was calculated from the average of SBP from every visit. Cox regression models were used to calculate the rate of clinical outcomes of interest, ie ischemic stroke or transient ischemic attack (TIA), intracerebral hemorrhage (ICH), and all-cause death. Average SBP was categorized into three groups: <120, 120-140, and ≥140 mmHg. RESULTS: A total of 3402 patients were included, and the mean age was 67.4±11.3 years. The mean (±SD) baseline and average SBPs were 128.5±18.5 and 128.0±13.4 mmHg, respectively. The mean follow-up duration was 25.7±10.6 months. The median rate of ischemic stroke/TIA, ICH, and all-cause death was 1.43 (1.17-1.74), 0.70 (0.52-0.92), and 3.77 (3.33-4.24) per 100 person-years, respectively. The rate of ischemic stroke/TIA and ICH was lowest in patients with average SBP <120 mmHg, and highest among those with average SBP ≥140 mmHg. The death rates were consistent with a J-curve effect, being lowest in patients with an average SBP 120-140 mmHg. Sustained SBP control is more important than the SBP from a single visit. CONCLUSION: Sustained control of SBP was significantly associated with a reduction in adverse clinical outcomes in patients with NVAF.

Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation.

PURPOSE: The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF). METHODS: This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥ 65 years) patients with NVAF. RESULTS: Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72 ± 0.26 vs. 0.84 ± 0.20; p < 0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p = 0.006) and taking warfarin (p = 0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p < 0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p < 0.001). CONCLUSIONS: Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.

Implications of diabetes mellitus in patients with STEMI: data from Thai ACS Registry.

BACKGROUND: Data exist on the community-based perspective on the relation of diabetes mellitus (DM) and acute ST elevation myocardial infarction (STEMI) worldwide but no data is available in Thailand. MATERIAL AND METHOD: The Thai Acute Coronary Syndrome Registry (TACSR) is an observational study of patients hospitalized with ACS at 17 hospitals in different regions of Thailand. The present sub-study sample consisted of 3,725 patients with STEMI in a 3-year period. RESULTS: Nearly 40% (37.15%) of them had DM who were older predominantly women, with a greater prevalence of co-morbidities and fewer current smokers. Patients with DM who developed STEMI were at increased risk for heart failure, arrhythmia, bleeding and death. These differences remained after adjustment for potential confounding prognostic factors. CONCLUSION: A considerable proportion of patients with STEMI have DM. This proportion is higher than any other studies published. Diabetic patients who developed STEMI are also at increased risk for adverse outcomes including, heart failure, arrhythmia, bleeding and death compared to patients without DM.

Diabetes mellitus and non-ST elevation myocardial infarction in Thai ACS Registry.

OBJECTIVE: To describe differences in in-hospital morbidity and mortality, presenting characteristics and management practices of diabetic and non-diabetic patients with non-ST elevation myocardial infarction using data from Thai ACS registry. MATERIAL AND METHOD: Thai ACS registry is a multi-center prospective project of nationwide registration in Thailand. RESULTS: The present study consisted of 3,548 patients with non-ST elevation myocardial infarction from 17 hospitals in about a 3-year period. About 50% of the patients with diabetes were more often female, with a greater prevalence of hypertension and dyslipidemia. The diabetic group was at an increased risk for congestive heart failure (adjusted odds ratio 1.84) but not increased risk for cardiac arrhythmia, cardiac mortality, and in-hospital mortality. CONCLUSION: There was a very high prevalence of diabetes in non-ST elevation myocardial infarction from ThaiACS registry. These patients were at increased risk for congestive heart failure as index of hospitalization but were not at increased risk for in-hospital mortality when compared with patients without diabetes.

Effect of un-fractionated heparin and low molecular weight heparin on hospital mortality in patients with non ST elevation acute coronary syndrome (ACS).

BACKGROUND: The Thai ACS registry is a multi-center prospective registration that describes the epidemiology, management practices and in-hospital outcomes of patients with acute coronary syndromes. OBJECTIVE: Study the registry difference in hospital outcomes about cardiac death and length of stay between low molecular weight heparin (LMWH) and un-fractionated heparin (UFH). MATERIAL AND METHOD: This is an observational descriptive study. The authors collected data from the database of the Thai ACS registry. RESULTS: There were 233 of 3963 cases (5.9%) with cardiac death in the present study. Cardiac death in the non-ST elevated myocardial infraction (NSTEMI) group was larger than in the UA group (7.6% vs. 2.4%, p-value < 0.001). The heparin group had more cardiac death than the LMWH group (9.3% vs. 5.2%, p-value < 0.001). NSTEMI with heparin treatment had more cardiac deaths than LMWH treatment (11.8% vs. 6.8%, odd ratio 1.8). UA with heparin treatment had more cardiac deaths than LMWH treatment (4.0% vs. 2.0%, odd ratio 2.0). NSTEMI had a longer length of stay than UA (56.9% vs. 44.7%, p-value = 0.001). The heparin group had a longer stay than LMWH (58.8% vs. 51.7%, p-value < 0.001). CONCLUSION: Low molecular weight heparin had benefit over un-fractionated heparin in reduction of hospital mortality and length of stay in both unstable angina and non-ST elevation myocardial infarction.