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National Cardiovascular Disease Database ( NCVD )  ACS Registry  PCI Registy 2009 Update NHAM ASM 2009 17 April

National Cardiovascular Disease Database ( NCVD )  ACS Registry  PCI Registy 2009 Update NHAM ASM 2009 17 April 2009. Dr SIM Kui-Hian – Chair NCVD Board Dr Robaayah Zambahari – Chair NCVD Board Dr Jeyaindran Tan Sri Sinnadurai – Chair ACS Registry

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National Cardiovascular Disease Database ( NCVD )  ACS Registry  PCI Registy 2009 Update NHAM ASM 2009 17 April

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  1. National Cardiovascular Disease Database (NCVD) ACS Registry  PCI Registy2009 Update NHAM ASM 200917 April 2009 Dr SIM Kui-Hian – Chair NCVD Board Dr Robaayah Zambahari – Chair NCVD Board Dr Jeyaindran Tan Sri Sinnadurai – Chair ACS Registry Dr Hj Azhari Rosman – Chair ACS Registry Dr Rosli Mohd Ali – Chair PCI Registry Dr Wan Azman – Chair Publication

  2. Rationale – NCVD Registries • Are the population & the patients groups in Malaysia similar to those being investigated in the clinical trials? • Are our hospitals following the guidelines set out by the expert committees? • Are we seeing the same results and benefits of implementing evidence-based strategies? • Which strategy will be the best value in terms of cost-effectiveness for the Ministry of Health?

  3. Objectives - NCVD ACS Registry • Determine the number & the time trend of ACS in Malaysia • Determine the socio-demographic profiles of these patients to better identify the high-risk group in our Malaysian population • Determine the efficiency of, and adherence to current treatment guidelines • Determine the cost to the nation by cardiovascular disease and the cost effectiveness of treatment and prevention programs • Stimulate and facilitate research of cardiovascular disease using this database No more ‘guestimate’

  4. Milestones - NCVD Registries • 15 Oct 2005 Approval of MOH-MRG • 9 Dec 2005 1stNCVD – ACS Registry Steering Comm • 1st Jan 2006 eNCVD online data capturing • NCVD piloted in 6 centres • Expanded to nation wide – state government hospitals • 31st March 2006 • Officially launched by Director General of Health Malaysia • @ 10th ASM, National Heart Association of Malaysia • 14 April 2007 1st Annual NCVD @ 11th NHAM ASM • 19 Dec 2007 ACS Report Writing Committee • 4 April 2008 2nd Annual NCVD @ 12th NHAM ASM • 7 Dec 2006 1stNCVD - PCI Registry Steering comm • 3 April 2008 1stNCVD – CABGs Registry Steering Comm

  5. Organization of NCVD ACS registry

  6. Supporting Staff • Clinical Registry Manager Ms S Gunavathy Selvaraj • Clinical Registry Associate Ms Noor Amirah Muhamad Ms Hamimatunnisa Johar • Clinical Epidemiologist Dr Jamaiyah Haniff Ms S Gunavathy Selvaraj • ICT Manager Ms Celine Tsai Pao Chien • Database Administrator Ms Lim Jie Ying • Application Developer Ms Amy R. Porle • Network Administrator Mr Kevin Ng Hong Heng Mr Adlan Ab. Rahman • Webmaster & Publisher Ms Azizah Alimat • Clinical Data Manager Ms Teo Jau Shya • Biostatistics Consultants Dr Hoo Ling Ping Ms Norhafizah Bt. Ab. Manan

  7. eNCVD – real time report • Accessible – Anywhere & Anytime

  8. Key of success COLLABORATION joint sacrifices of Ministry Of Health’s hospitals Ministry of Education’s (university) hospitals Private hospitals Ministry of Health Malaysia

  9. 2006 • 73 CCU in Malaysia • Incidence of ACS admission • 47.1 per 100,000 population • Incidence of coronary heart disease (CHD) • 141 per 100,000 population • Over 4000 ACS being denied admission into its CCU • 30% shortfall in CCU beds

  10. Provision of ACS services in Malaysia ACS admissions • 37 CCUs in MOH hospitals 60% • 3 university hospitals’ CCUs 10% • private sector 27% • economically developed states like Penang, Perak, Selangor/Wilayah Persekutuan have disproportionately large number of ACS admissions • less developed states (Kedah/Perlis, Terengganu, Sabah and Sarawak) were underserved • Patients in private hospitals are more likely to receive invasive coronary interventions (emergency angiogram, PCI and CABG)

  11. Age Group for patient with ACS, Malaysia 2006

  12. Age-gender distribution male pts with ACS by ethnic group, Malaysia 2006

  13. Age-gender distribution for female pts with ACS by ethnic group, Malaysia 2006

  14. Age group (years) distribution for pts with ACS by ACS stratum, Malaysia 2006

  15. ACS Gender distribution Malaysia 2006

  16. ACS Ethnic group distribution Malaysia 2006

  17. Overall outcomes for pts with ACS, Malaysia 2006 in-hospital 30 days NCVD-ACS GRACE NCVD-ACS • ACS stratum 7% • STEMI 9% 7% 11% • NSTEMI 7% 6% 8% • UA 3% 3% 4%

  18. Overall outcomes for pts with ACS, Malaysia 2006 in-hospital mortality 30-day mortality • elderly age group 10% 13% • Female patients 8% 10% • male patients 6% 8% • diabetes 7% 10% • without diabetes 5% 6%

  19. Overall outcomes for pts with STEMI ACS, Malaysia 2006 in-hospital mortality 30-day mortality • use of fibrinolysis 7% 9% • No fibrinolysis 13% 16% • PCI 8% 11% • No PCI 9% 11% • Prognostic factors • higher Killip class, higher TIMI risk score, former or current cigarette smoking, family history of premature cardiovascular disease, dyslipidaemia, hypertension and diabetes mellitus. Older age

  20. Report:NCVD-ACS Registry Annual report year 2006Freely downloadable online at http://www.acrm.org.my/ncvd/publications.htm

  21. N C V D ACS Registry Interim Analysis @ 9 April 2009

  22. Patient Demographics : ACS by Age group Results as of 28th October 2008

  23. ACS Patients by Gender Results as of 28th October 2008, n=9,104

  24. ACS Patients by Ethnicity Results as of 28th October 2008, n=9,104

  25. Results as of 28th October 2008, n=9,104

  26. CV Risk factors 2008 (n=6,516) 2009 (n=10,846) GRACE

  27. TIMI Risk Score NSTEMI/UA (n=5,427) Results as of 9th April 2009, n= 10,864

  28. Fibrinolytic Therapy Status Baseline (n= 4,705) Results as of 9th April 2009, n= 10,864

  29. Door to needle time Results as of 28th October 2008, n=9,104

  30. Pharmacological Therapy Results as of 9th April 2009, n= 10,864

  31. Follow Up at 30 days & 12 months 30days (n= 6,550) 1year (n= 3,374) n= 226 n= 78

  32. Cardiovascular readmission 30days (n= 6,550) 1year (n= 3,374)

  33. Outcome at Discharge Results as of 28th October 2008, n=9,104

  34. N C V D PCI Registry Interim Analysis @ 9 April 2009

  35. Patient Demographics : PCI by Age Group Total PCI = 6,441 as of 30th October 2008

  36. PCI by Gender Total PCI = 6,441 as of 30th October 2008

  37. PCI by Ethnicity Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau, Bidayuh, Other Sabahan and Other Sarawakian Total PCI = 6,441 as of 30th October 2008

  38. PCI Status by year Total PCI = 6,441 as of 30th October 2008

  39. Stent Used 2007 2008 Other stents refer to stents other than listed in the Reference Stent List Total Stent, n =10,152 as of 10th of October 2008

  40. Medications at discharge Baseline (n=8,236) Total PCI = 8,236 as of 9th April 2009

  41. Outcome at Discharge of Notification Total PCI = 6,441 as of 30th October 2008

  42. Outcome at Follow up

  43. NCVD Registries Population Public Health Disease Burden/ Risk Factors Communities Rehabilitation Hospital ACS/PCI/CABG My NCDs NCVD ACS Registry PCI Registry CABGs Registry Implantable devices Heart Failure

  44. European Society of Cardiology

  45. American College of Cardiology

  46. www.crc.gov.my www.acrm.org.my/ncvd

  47. Ta & G’day • Acknowledgement • Clinical Research Centre, HKL • Datamed Computing Services Sdn. Bhd. • ClinResearch Sdn. Bhd. • National Heart Association of Malaysia • Ministry of Health Malasyaia • Participating centres – Nurses, Doctors

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