3.3 Ten-year trends for heart failure outcomes 159 a case was considered an incident hospitalisation if the patient had no admission for HF within the previous two years.11,12 Study outcomes and definitions The main outcomes of this study were trends on 30-day readmission, in-hospital and 30-day mortality rates and lastly, mortality at one-year. In addition, we compared the crude and adjusted differences in these trends by sex and ethnicity. Lastly, we tabulated ICD-10 coded causes of death and readmission. Deaths from any cause up to one year from date of HF admission were reported for years 2007 to 2016 while readmission data were only available till 2015. A readmission was defined as an admission for any cause within 30 days after discharge from an index HF hospitalisation while in-hospital mortality was defined as death which occurred during the index hospital admission. Information on ICD-10 coded causes of death was available only for seven years, 2007 till 2013. To examine temporal changes in HF admission criteria, we estimated trend changes in the average number of admissions per patient within one year from the index admission. Information on age at incident HF hospitalisation, sex and ethnicity were available within the Hospital Discharge Register. In 2016, the Malaysian population is comprised of three major ethnic groups, in which there were 68.6% Bumiputera (made up of mainly Malays and Indigenous groups), 23.4% Chinese, 7.0% Indians and 1.0% other ethnicities.13 In the medical records, ethnicity was self-reported and categorised into four groups as follows: (i) Malay, (ii) Chinese, (iii) Indian and (iv) Others which include Peninsular Malaysia Indigenous groups, Sabah and Sarawak Indigenous groups such as Bajau, Kadazan, Murut, Melanau, Kedayan, Iban, Bidayuh as well as non-Malaysian nationalities.14 Because we anticipate a majority of Others to come from East Malaysia (consisting of two states, Sabah and Sarawak), which is known to have lower hospital densities and healthcare staff per population, and more remote communities than West Malaysia, we sought to determine the relative percentages of ethnicities by these two geographical regions.15 Ethical considerations Ethics approval was obtained from the Medical Research and Ethics Committee, MOH (NMRR-19-1108-47994). A waiver of informed consent was granted as the analyses was done using observational data from routine clinical care. All data
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