Trends for Readmission and Mortality After Heart Failure Hospitalisation in Malaysia, 2007 to 2016
Yvonne Mei Fong Lim,
Su Miin Ong,
Stefan Koudstaal,
Wen Yea Hwong,
Houng Bang Liew,
Jeyamalar Rajadurai,
Diederick E. Grobbee,
Folkert W. Asselbergs,
Sheamini Sivasampu,
Ilonca Vaartjes
Affiliations
Yvonne Mei Fong Lim
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL; Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor
Su Miin Ong
Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor
Stefan Koudstaal
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht; Dept of Cardiology, Groene Hart Ziekenhuis, Gouda
Wen Yea Hwong
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht; Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor
Houng Bang Liew
Department of Cardiology, Queen Elizabeth II Hospital, Ministry of Health Malaysia, Sabah
Jeyamalar Rajadurai
Department of Cardiology, Subang Jaya Medical Centre, Selangor
Diederick E. Grobbee
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht; Julius Clinical, Zeist
Folkert W. Asselbergs
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, NL; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London
Sheamini Sivasampu
Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor
Ilonca Vaartjes
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
Background and objectives: Data on population-level outcomes after heart failure (HF) hospitalisation in Asia is sparse. This study aimed to estimate readmission and mortality after hospitalisation among HF patients and examine temporal variation by sex and ethnicity. Methods: Data for 105,399 patients who had incident HF hospitalisations from 2007 to 2016 were identified from a national discharge database and linked to death registration records. The outcomes assessed here were 30-day readmission, in-hospital, 30-day and one-year all-cause mortality. Results: Eighteen percent of patients (n = 16786) were readmitted within 30 days. Mortality rates were 5.3% (95% confidence interval (CI) 5.1–5.4%), 11.2% (11.0–11.4%) and 33.1% (32.9–33.4%) for in-hospital, 30-day and 1-year mortality after the index admission. Age, sex and ethnicity-adjusted 30-day readmissions increased by 2% per calendar year while in-hospital and 30-day mortality declined by 7% and 4% per year respectively. One-year mortality rates remained constant during the study period. Men were at higher risk of 30-day readmission (adjusted rate ratio (RR) 1.16, 1.13–1.20) and one-year mortality (RR 1.17, 1.15–1.19) than women. Ethnic differences in outcomes were evident. Readmission rates were equally high in Chinese and Indians relative to Malays whereas Others, which mainly comprised Indigenous groups, fared worst for in-hospital and 30-day mortality with RR 1.84 (1.64–2.07) and 1.3 (1.21–1.41) relative to Malays. Conclusions: Short-term survival was improving across sex and ethnic groups but prognosis at one year after incident HF hospitalisation remained poor. The steady increase in 30-day readmission rates deserves further investigation.
