3.3 Ten-year trends for heart failure outcomes 157 INTRODUCTION Heart failure (HF) is both a debilitating and costly clinical syndrome, with an expenditure of 346 billion US$ globally.1 Despite medical advancement in the management of acute coronary syndromes, the five-year survival rates for HF is poorer than most cancers.2 Nevertheless, cardiac remodelling and progression to HF can be modified by appropriate preventive strategies and timely effective treatments are available. Estimates on the average prognosis of HF at the population level are important for monitoring changes in healthcare delivery. On the individual patient level, knowing the absolute risks of mortality and readmission enables shared decision-making between health providers and patients when making plans for disease management.3 As it is in high-income countries, HF is already demonstrated to be a major burden in middle-income countries and this is expected to pose an equal, if not greater financial and morbidity impact as some of these countries are still grappling with a concurrent infectious disease burden.4 The amount of data published on the epidemiology of HF from these countries is highly disproportionate compared to developed nations. Relying on data extrapolations from high-income countries is inadequate given the differences in healthcare infrastructure, health spending and demographic composition. The Asian HF registry, which included 11 countries in the region, found that one-year mortality rate was 9.6% among registry patients.5 However, it was also noted that patients enrolled in this registry were mainly treated in academic hospitals with echocardiography expertise and more resources, and hence not necessarily representative of overall hospitalised patients.5 Recent data from Malaysia, a middle-income country in Southeast Asia, has shown a 39% rise in the absolute number of incident HF hospitalisations from 2007 to 2016 (Su Miin Ong, MSc, unpublished data, 2020). This highlights an urgent need to fill the existing gaps on temporal trends for clinical outcomes, specifically for Asia.4 Accordingly, our objective was to estimate the short- and medium-term mortality and readmission outcomes after an incident hospitalisation for HF. We then described the temporal variation in these outcomes by sex and ethnicity in this ethnically diverse country.
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