CHAPTER 3.3 174 comorbidities can be incorporated into early care transition to outpatient clinics, nurse-led home visits and structured telephone monitoring, all of which have shown moderate effectiveness in reducing rehospitalisations.46,47 In this study, we estimated the average prognosis after an index hospitalisation for HF using representative data from a large national database. These findings are generalisable to other middle-income countries with similar government-funded health systems and diverse ethnic composition. While most HF hospitalisation data for middle income countries in literature come from urban tertiary centres4, we have presented here data across a range of hospitals within the public health sector in Malaysia. Unlike patient selection in disease registries, the inclusion of unselected cases of HF hospitalisations here allowed us to make reliable comparisons between sex and ethnic groups. There were several limitations in this study. Complete data were available for only primary discharge diagnoses; therefore, the absolute number of HF hospitalisations was likely underestimated. Nevertheless, the trend data is unlikely to be affected by this underestimation as the selection criteria used was uniform across time points. We explored the use of secondary discharge diagnoses as proxy for underlying disease severity but found that data completeness was not consistent across time. Therefore, it is difficult to draw conclusions on the severity of patients who were hospitalised for HF. Information on HF subtypes (reduced, preserved and mid-range ejection fraction), medical history, treatments and device therapy were not available in the discharge database and thus, does not allow for correlation of these factors with HF outcomes. While this analysis encompassed an average of 83% of annual HF hospitalisations in Malaysia, it is necessary to point out that we have included only HF patients who were hospitalised in MoH hospitals. Thus, these results are not generalisable to patients treated in the community setting or private hospitals. The 30-day and one-year mortality estimates were slightly underestimated due to incomplete death registration in East Malaysia. Lastly, there were some data losses in 2012 and 2013 and imputations were not feasible in this situation because the exact number of missing records was not known. To the best of our knowledge, this is one of the first studies to report national, age-standardised estimates for HF prognosis and trends for hospitalised HF patients in the Southeast Asian region. The declining trend and narrowing of ethnic differences for short-term mortality showed that these outcomes are amenable to
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