Proefschrift

CHAPTER 3.2 118 ABSTRACT Background Almost no country-specific incidence trends data of de novo heart failure (HF) hospitalizations are available for Southeast Asia. This study aimed to determine the trends in incidence of HF hospitalizations and how these differ by age, sex and ethnicity in Malaysia. Methods Using a national hospital discharge database, we estimated and compared the rates of incident HF hospitalizations between 2007 and 2016 by direct standardisation. Quasi-Poisson models were used to estimate the incidence rate ratio (IRR). Results Of 105 399 patients who had incident hospitalizations for HF, 58 866 (55.9%) were men and 67 374 (63.9%) were 60 years and older. Majority (60.9%) were of Malay ethnicity. Women had lower incidence than men after adjusting for age, ethnicity and calendar year (IRR 0.77; 95% confidence interval 0.74-0.80). The absolute incident hospitalizations increased by 52.3%. In contrast, standardised incident HF hospitalizations decreased at an average of 1% per calendar year for both sexes. Agestandardised incidence was highest in the Indian ethnic group. However, this subgroup has also exhibited the highest annual rate of decline compared to other ethnic groups. Of note, Indian women had elevated risk of incident HF hospitalization compared to women of other ethnic groups. Conclusion Incidence of HF hospitalizations has decreased between 2007 and 2016 in Malaysia, irrespective of sex. However, absolute risks of HF hospitalizations remain higher in men and in the Indian ethnic group especially among Indian women. This represents opportunities for public health initiatives by targeting high-risk subgroups to reduce HF hospitalizations.

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