CHAPTER 3.3 172 quality improvement programs during the study period, therefore we expect the coding of ICD-10 to remain consistent over this duration. In keeping with earlier and recent studies from Western populations,28–30 we have also showed that men had higher risks of mortality and readmission than women after accounting for age, ethnicity and time trends. Poorer survival and higher readmission rates in men after HF hospitalisation may be explained by a predominant heart failure with reduced ejection fraction subtype among men and higher prevalence of macrovascular disease, myocardial ischemia and infarction, which underlie the aetiology of HF in this subgroup.31 Unfortunately, the type of HF and aetiology were not available in the present data. Amidst the overall improvements in short-term mortality, it is necessary to note that striking ethnic differences exists. Others had poorer outcomes than the rest of the population. This difference was apparent even in the presence of underreporting of deaths in East Malaysia, from which the majority of Others reside. Hence, we expect the true estimates to be even higher than what was observed. The health status of this subgroup is known to be poorer compared to the general population and is characterised by lower socioeconomic status, shorter life expectancy, undernutrition, insulin resistance and lack of trust in modern medicine.32 Moreover, accessibility to hospitals remains a challenge for some residents of the interior and remote parts of Sabah and Sarawak and it is also likely that this region has a higher prevalence of rheumatic heart disease which may contribute to poorer outcomes among those hospitalised for HF.33–35 These findings highlight a need to improve access to healthcare and focus resources to narrow the disparities in short-term mortality particularly in Others. For short-term mortality trends, it is reassuring to observe that the largest disparity in mortality outcomes between Others and Malays have been narrowing. The remaining differences in mortality outcomes between ethnicity represents opportunities for health interventions. About 1 in 3 patients hospitalised for HF in this study die within a year and this has remained fairly constant during the study period. Mortality at one year is almost 1.5-fold compared to the European Society of Cardiology Long Term Heart Failure registry, reflecting differences in income per capita, health systems and patient characteristics between Malaysia and the European and Mediterranean countries which participated in this registry.36 Trend-wise, death due to cardiovascular disease has decreased and this could be the result of a higher use of
RkJQdWJsaXNoZXIy MjY0ODMw