3.3 Ten-year trends for heart failure outcomes 173 disease-modifying therapy such as renin-aldosterone angiotensin system inhibitors and beta-blockers in recent years, as reported in several tertiary centres.37–40 Numerous reports have shown that people of South Asian descent are predisposed to higher risk of ischaemic heart disease compared to the rest of the population.41 Accordingly, our previous study had also found the highest incidence of HF hospitalisations amongst Indians in the Malaysian population. Interestingly though, when it comes to survival, be it short-term or at one-year, Indians had significantly better survival compared to other ethnic groups. This suggests a stronger influence of environmental and behavioural determinants over genetic influences in HF outcomes. Further investigation into use of HF medications and lifestyle factors by ethnic subgroups would hence be warranted. Preventing decompensation is an important therapeutic goal after a diagnosis of HF. To our knowledge, there is no published data on 30-day readmission trends after HF hospitalisation among middle-income countries. The steady annual rise in 30-day readmissions that we have found were comparable to those reported in Spain, but in contrast to a two percent reduction among Veteran’s Affairs hospital admissions in the United States.42,43 It is necessary though, to keep in mind that differences in healthcare financing and infrastructure exist between countries of middle- and high-income economies. Lowering admission threshold for HF is a potential reason for this observed rise in readmission rates in this study. ‘Differential readmission rates by ethnicity were likely related to socioeconomic status and educational level. This is reflected as higher readmission rates among the Chinese and Indians who largely reside in urban locations, whereas greater access and logistical barriers to care exists among Others.44 However, narrowing of the gap in readmission rates between Others and the population average suggests that physical access for Others to secondary care is improving over the last decade. The overall increasing trend in 30-day readmissions observed here deserve attention from researchers and policy makers alike because hospitalisations incur the greatest financial costs to HF health expenditures and about a quarter of these readmissions are preventable.45 Standardised strategies to differentiate the severity of patients who present at the emergency department would be useful for risk stratifying them into those who require admission while the rest may be observed and treated on an outpatient basis. We know that half of these readmissions are due to noncardiovascular causes; therefore, multi-faceted assessments which address all
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