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.

Associated factors of blood pressure control and complications of hypertension in hypertensive rural Thai populations of Baan Nayao, Chachoengsao Province.

OBJECTIVE: To assess associated factors of uncontrolled blood pressure and complications of hypertension in hypertensive rural Thai populations. MATERIAL AND METHOD: A cross-sectional study was conducted in hypertensive rural Thai people aged > or =35 years-old in Baan Nayao, Chachoengsao Province, Thailand. Blood pressure (BP) was measured and questionnaires were answered. After 12-hr fasting, blood samples were taken for determining plasma glucose, lipid profiles and serum creatinine. Morning urine samples were collected for microalbuminuria testing and electrocardiography (ECG) was performed to detect left ventricular hypertrophy (LVH). RESULTS: Of the 289 participants (97 males and 192 females) mean duration of hypertension was 4.29 +/- 4.95 years and 61.5% did not achieve target BP control. Among participants who had ECG performed and urine sample investigation, 15.7% demonstrated LVH and 25.3% had microalbuminuria. In uncontrolled BP participants, 20% had LVH and 24.8% had microalbuminuria whereas in controlled BP participants, 7.8% had LVH and 26.1% had microalbuminuria. Uncontrolled BP was associated with males, dyslipidemia, diabetes, abdominal obesity, metabolic syndrome, always having salty food and salts added for seasoning. The independent risks of uncontrolled BP were hypertensive male (OR = 2.48, 95% CI = 1.07-5.76) and metabolic syndrome (OR = 2.59, 95% CI = 1.24-5.40). Males were also at risk for LVH (OR = 2.86, 95% CI = 1.31-6.23) and history of lipid disorders was a risk of microalbuminuria (OR = 3.13, 95% CI = 1.47-6.67). CONCLUSION: Males and metabolic syndrome were independently associated with uncontrolled BP in hypertensive participants. Males had more risk than females to develop LVH and having history of lipid disorders lead to microalbuminuria occurrence. Thus, life style modification may prove beneficial to these rural hypertensive participants.

The efficacy and safety outcomes of cardiac resynchronization therapy in patients with heart failure in Thailand: Phramongkutklao experience.

BACKGROUND: Cardiac resynchronization therapy (CRT) is one of the crucial treatments in patients with symptomatic heart failure reduced ejection fraction. This study aimed to report the efficacy and safety of CRT implantation in treating patients with heart failure. The responders and related outcomes were also analyzed. METHODS: Medical records of all patients with CRT implantation, because of heart failure treatment indication, in Phramongkutklao Hospital between 2008 and 2019 were reviewed. Free from death and heart failure hospitalization were analyzed as composited efficacy outcomes with survival analysis. Follow-up echocardiography was used to define a responder. The safety outcomes were reported using descriptive data. Cox-proportional hazard model analysis was used for the responder as a predictor of outcomes. RESULTS: A total of 152 patients underwent CRT implantation because of heart failure. 77.63% were male, the mean age of 65.9 ± 13.19 years, 59.85% were diagnosed with ischemic cardiomyopathy, mean LVEF of 22.69 ± 7.51%, and QRS duration of 147 ± 21 ms. Mean Follow-up was 41 months. The composited efficacy outcomes were 91.7%, 54.8%, and 35.4% at 1, 5, and 10 years, respectively. CRT-related complications were found in 12 patients (7.89%). 71.30% of patients who were responders had lower death or heart failure hospitalization when compared to non-responders (HR: 0.43, 95% CI: 0.24-0.78). CONCLUSION: The efficacy and safety in CRT treating patients in our center were consistent with the previous randomized and observational studies. The responder rate remained the same as in previous trials but was a strong predictor for better outcomes.

The Clinical Outcomes of Different eGFR Strata and Time in Therapeutic Range in Atrial Fibrillation Patients with Chronic Kidney Disease: A Nationwide Cohort Study.

Chronic kidney disease (CKD) is associated with increased risk of stroke, major bleeding, morbidity and overall mortality in atrial fibrillation patients. The aim of this study is to demonstrate the effect of different eGFR strata and the TTR on clinical outcomes in AF patients with CKD.NVAF patients were consecutively enrolled from hospitals across Thailand. eGFR were categorized into three different eGFR categories; eGFR >60, 30-59 and <30 mL/min/1.73 m2. TTR values were also categorized into TTR >75%, TTR 60-75 and TTR <60%. We identified 1,739 patients who received warfarin. Among patients who acquired TTR<60, those with eGFR <30 ml/min/1.73 m2 demonstrated the highest stroke/SSE rate of 8.5% (P<0.001). Patients with eGFR <30 ml/min/1.73 m2, in addition to the presence of TTR<60, were at the highest risk to developing major bleeding with the rate of 17.9% (p <0.001). However, intracranial hemorrhage (ICH) appeared towards increasing rate with the combination of eGFR at even <60 ml/min/1.73 m2 and TTR <60. Death was also considerably high with the rate of 17.9% in patients with the combination of TTR <60 and eGFR <30 ml/min/1.73 m2. Severe CKD resulted in higher risks of stroke/SSE, major bleeding and death in patients with low TTR. Patients with TTR >60, especially TTR >75%, is associated with reduced risk of stroke/SSE, major bleeding and death irrespective of eGFR level. The combination of low TTR <60 and eGFR level less than 60 ml/min/1.73 m2 substantially increased risks of all cardiovascular outcomes.

The change of renal functions after nonvitamin K oral anticoagulants in patients with atrial fibrillation.

Oral anticoagulants decreased stroke and mortality in atrial fibrillation patients. There have been cumulative data suggesting that some oral anticoagulants may exert favorable renal outcomes.The aim of this study is to evaluate the renal outcomes in patients with atrial fibrillation who took oral anticoagulant. METHODS: A Retrospective cohort study using hospital electronic database. Serum creatinine and GFR were collected at baseline and at 1 and 2 years. RESULTS: Authors identified 734 patients with non-valvular AF who took oral anticoagulants. At the end of 2-year, the cumulative risk of significant GFR decline (eGFR drop > 30%) was 10.94% in warfarin group and 9.69% in NOACs group.The incidence rate of significant eGFR decline were comparable between NOACs and warfarin group which were 4.82 and 5.34 per 100-patient year respectively(HR 1.01 CI 0.62-1.66 , p- value 0.964).However, the adjusted mean eGFR change per year was significantly lower in NOAC group, especially rivaroxaban (coefficient 7.83 ,CI 4.44 11.22 , p-value < 0.001) and dabigatran (coefficient 6.22 ,CI 2.67-9.77 , p-value = 0.001) at 2 years. CONCLUSIONS: Significant GFR decline was not uncommon in non-valvular AF patients who received anticoagulant. Among these, the proportion of patients who had significant eGFR decline(>30%) were comparable between NOACs and warfarin at 2 years. However, there is a significantly less mean eGFR decline per year in patients who receive NOACs, notably with dabigatran and rivaroxaban, than those who receive warfarin.The findings of this study should be interpreted in the context of patients included in this study.

Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and chronic kidney disease in Asian Population, Data from the COOL-AF Thailand registry.

BACKGROUND AND OBJECTIVES: Patients with AF and chronic kidney disease(CKD) encountered increased risks of stroke, bleeding, morbidity, and overall mortality. Oral anticoagulation in these populations definitely enhances major bleeding but the benefit of stroke reduction remained inconclusive.The aim of this study is to evaluate the effect of oral anticoagulation (OAC) on the 2-year cardiovascular outcomes in patients with AF and CKD. METHOD: NVAF patients were consecutively enrolled from 27 hospitals located all across Thailand.Baseline demographic and clinical data were collected within 6 months from enrollment.GFR was calculated using CKD-EPI formula. CKD patients were defined as GFR less than 60 mL/min/1.73 m2 according to KDOQI of the National Kidney Foundation. Clinical outcomes included ischemic stroke or transient ischemic attack (TIA) and major bleeding. RESULTS: At 25.7 ± 10.6 months of follow up, we identified 2538 patients with complete renal follow-up data. Among these were 1594 patients with CKD (stage 3-5) and 944 patients without CKD. The rate of ischemic stroke in patients with and without CKD were 3.7% and 1.7% respectively (p = 0.004),the rate of major bleeding was 5.6 and 3.5% accordingly (p = 0.015) and, likewise, the death rate was substantially high in patients with CKD (10.0% and 6.5%, p = 0.02). The rate of ischemic stroke/TIA in patients with CKD who were and were not on OAC did not differ significantly, 3.6% and 4.2% respectively (p = 0.602). NOAC and warfarin did not differ significantly in the propensity score-matched rate of both ischemic stroke/TIA (0 and 1.2%, p = 0.554) and major bleeding (3.3% and 7.4%, p = 0.122).The net clinical benefit of NOAC over warfarin was 2.153 per 100-patient years. CONCLUSIONS: COOL AF registry demonstrated that AF patients with CKD had increased risks of ischemic stroke/TIA, major bleeding and death. The benefit of stroke/TIA reduction was not significantly evident for either warfarin or NOAC. However, NOAC was associated with the positive net clinical benefit over no OAC.

Poor Time in Therapeutic Range Control is Associated with Adverse Clinical Outcomes in Patients with Non-Valvular Atrial Fibrillation: A Report from the Nationwide COOL-AF Registry.

BACKGROUND: Warfarin remains the most commonly used oral anticoagulant (OAC) in Thailand for stroke prevention among patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to investigate the relationship between time in therapeutic range (TTR) after warfarin initiation and clinical outcomes of NVAF. METHODS: TTR was calculated by the Rosendaal method from international normalized ratio (INR) data acquired from a nationwide NVAF registry in Thailand. Patients were followed-up every six months. The association between TTR and clinical outcomes was analyzed. RESULTS: There was a total of 2233 patients from 27 hospitals. The average age was 68.4 ± 10.6 years. The average TTR was 53.56 ± 26.37%. Rates of ischemic stroke/TIA, major bleeding, ICH, and death were 1.33, 2.48, 0.76, and 3.3 per 100 person-years, respectively. When patients with a TTR < 65% were compared with those with TTR ≥ 65%, the adjusted hazard ratios (aHR) for the increased risks of ischemic stroke/TIA, major bleeding, ICH, and death were 3.07, 1.90, 2.34, and 2.11, respectively. CONCLUSION: Poor TTR control is associated with adverse clinical outcomes in patients with NVAF who were on warfarin. Efforts to ensure good TTR (≥65%) after initiation of warfarin are mandatory to minimize the risk of adverse clinical outcomes.

Rate of anticoagulant use, and factors associated with not prescribing anticoagulant in older Thai adults with non-valvular atrial fibrillation: A multicenter registry.

OBJECTIVES: To investigate the rate of anticoagulant use, the reasons for not prescribing anticoagulant, and the factors associated with non-prescription of anticoagulant in older Thai adults with non-valvular atrial fibrillation. METHODS: A multicenter registry of patients with non-valvular atrial fibrillation was conducted during 2014 to 2017 in Thailand. Demographic, medical history, antithrombotic medication, non-antithrombotic medication, and laboratory data were collected and analyzed. Data were compared between the older adult (≥ 65 years) and younger adult (< 65 years) groups. The reasons why anticoagulant was not prescribed were collected, and predictive factors were identified. RESULTS: A total of 3218 patients (1873 males) with an average age of 67.3 ± 11.3 years were included. Almost two-thirds (61.0%) of patients were in the older adult group. Anticoagulant was prescribed in 2422 patients (75.3%): 81.4% in the older adult group and 65.7% in the younger adult group. The three main reasons for not prescribing anticoagulant were already taking antiplatelets, patient refusal, and bleeding risk. These reasons were more common in older adults as compared to younger adults. Multivariate analysis revealed current use of antiplatelets to be the most important factor that predict the non-prescription of anticoagulant in older population. CONCLUSIONS: The prevalence of anticoagulant prescription among older Thai adults with atrial fibrillation is 81.4%. Taking antiplatelet drugs was found to be the strongest reason that predicts the non-prescription of anticoagulant in this patient population. A guideline should be developed to optimize the use of anticoagulant and antiplatelet in older adults.

Prevalence, risk factors, and mortality outcome in the drug reaction with eosinophilia and systemic symptoms patients with cardiac involvement.

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous drug reaction that can affect multiple internal organ systems. Cardiac involvement in DRESS syndrome (CiDs) is uncommon but can be life-threatening. OBJECTIVE: To determine the prevalence, risk factors, and mortality outcome of CiDs. MATERIAL AND METHODS: Forty-one patients who were diagnosed with probable and definite DRESS syndrome according to the RegiSCAR criteria were recruited. Cardiac involvement was evaluated by two independent cardiologists. RESULTS: The cardiac involvement was found in 8/41 (19.5%) patients. Specifically, myocardial involvement was found in five patients, while three patients had pericardial involvement. The majority of culprit drugs were antibiotics followed by anti-epileptic medications. The hemoglobin and albumin levels were significantly lower in the patients with CiDs when compared to the patients without CiDs (P-value = 0.005 for both factors). The mortality rate at 30 and 90 days was significantly higher among CiDs patients, that is, 3/8 (37.5%) versus 2/28 (6.1%); P-value = 0.02 and 4/8 (50.0%) versus 2/33 (6.1%); P-value = 0.002 respectively. CONCLUSION: Our study showed the prevalence of CiDs was as high as 19.5% with high mortality rate. We suggest a thorough cardiac evaluation in all DRESS patients with RegiSCAR score ≥4. The patients with CiDs had significantly lower hemoglobin and albumin levels, which might imply poor health condition, when compared to those without CiDs.