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Fulltext Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective

Rajadurai J, Tse HF, Wang CH, Yang NI, Zhou J, Sim D

J. Card. Fail., 2017 Apr;23(4):327-339.
PMID: 28111226 DOI: 10.1016/j.cardfail.2017.01.004

Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices.
Fulltext Supporting the Management of Patients with Heart Failure within Asia-Pacific, Middle East, and African Countries: A Toolbox for Healthcare Providers

Kabbani S, Al Habeeb W, Liew HB, Mohan JC, Ogola E, Sim D, et al.

Cardiology, 2019;142 Suppl 1:1-10.
PMID: 30947179 DOI: 10.1159/000496663

OBJECTIVES: The management of heart failure (HF) is most effective when established treatment guidelines and recommendations are followed. We aimed to develop a "Toolbox" of resources to facilitate the care of patients with acute HF and chronic HF with reduced ejection fraction delivered by healthcare professionals across Asia-Pacific, the Middle East and Africa (henceforth referred to as the "Region").
METHODS: We convened a group of cardiologists from across the Region to develop a set of checklists, algorithms, and other practical resources. These resources are based on our experiences, current evidence, and international guidelines.
RESULTS: The HF Toolbox comprises three simplified sets of resources for use in the Emergency Room (ER), hospital and outpatient settings. Resources include admission and discharge checklists, treatment algorithms, recommendations for forming a multidisciplinary team, patient education, and self-management materials, and key performance indicators to monitor whether standards of care are met or maintained, or should be improved.
CONCLUSIONS: The HF Toolbox provides practical resources to simplify the management of patients with HF and to support the formation of HF programs in the Region. The Toolbox is aligned with current guideline recommendations and can support the management of patients from presentation in the ER, through hospital admission to outpatient care.
Fulltext Angiotensin receptor-neprilysin inhibitor improves New York Heart Association class and N-terminal-pro B-type natriuretic peptide levels: initial experience in a Singapore single-centre cohort

Koh N, Goh VJ, Teoh CK, Hon JS, Teo LLY, Lim CP, et al.

Singapore Med J, 2021 Jul;62(7):359-361.
PMID: 34409482 DOI: 10.11622/smedj.2021092
Fulltext A scoping review of digital workplace wellness interventions in low- and middle-income countries

Thai YC, Sim D, McCaffrey TA, Ramadas A, Malini H, Watterson JL

PLoS One, 2023;18(2):e0282118.
PMID: 36854022 DOI: 10.1371/journal.pone.0282118

INTRODUCTION: Digital technology-based interventions have gained popularity over the last two decades, due to the ease with which they are scalable and low in implementation cost. Multicomponent health promotion programmes, with significant digital components, are increasingly being deployed in the workplace to assess and promote employees' health behaviours and reduce risk of chronic diseases. However, little is known about workplace digital health interventions in low- and middle- income countries (LMICs).
METHODS: Various combinations of keywords related to "digital health", "intervention", "workplace" and "developing country" were applied in Ovid MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Scopus and Cochrane Library for peer-reviewed articles in English language. Manual searches were performed to supplement the database search. The screening process was conducted in two phases and a narrative synthesis to summarise the data. The review protocol was written prior to undertaking the review (OSF Registry:10.17605/OSF.IO/QPR9J).
RESULTS: The search strategy identified 10,298 publications, of which 24 were included. Included studies employed the following study designs: randomized-controlled trials (RCTs) (n = 12), quasi-experimental (n = 4), pilot studies (n = 4), pre-post studies (n = 2) and cohort studies (n = 2). Most of the studies reported positive feedback of the use of digital wellness interventions in workplace settings.
CONCLUSIONS: This review is the first to map and describe the impact of digital wellness interventions in the workplace in LMICs. Only a small number of studies met the inclusion criteria. Modest evidence was found that digital workplace wellness interventions were feasible, cost-effective, and acceptable. However, long-term, and consistent effects were not found, and further studies are needed to provide more evidence. This scoping review identified multiple digital health interventions in LMIC workplace settings and highlighted a few important research gaps.
Synthesis of tapioca starch/palm oil encapsulated urea-impregnated biochar derived from peppercorn waste as a sustainable controlled-release fertilizer

Sim DHH, Tan IAW, Lim LLP, Lau ET, Hameed BH

Waste Manag, 2024 Jan 01;173:51-61.
PMID: 37977096 DOI: 10.1016/j.wasman.2023.11.006

Nutrient leaching and volatilization cause environmental pollution, thus the pursuit of developing controlled-release fertilizer formulation is necessary. Biochar-based fertilizer exhibits slow-release characteristic, however the nutrient release mechanism needs to be improved. To overcome this limitation, the approach of applying encapsulation technology with biochar-based fertilizer has been implemented in this study. Black peppercorn waste was used to synthesize urea-impregnated biochar (UIB). Central composite design was used to investigate the effects of pyrolysis temperature, residence time and urea:biochar ratio on nitrogen content of UIB. The optimum condition to synthesize UIB was at 400 °C pyrolysis temperature, 120 min residence time and 0.6:1 urea:biochar ratio, which resulted in 16.07% nitrogen content. The tapioca starch/palm oil (PO) biofilm formulated using 8 g of tapioca starch and 0.12 µL of PO was coated on the UIB to produce encapsulated urea-impregnated biochar (EUIB). The UIB and EUIB pellets achieved complete release of nitrogen in water after 90 min and 330 min, respectively. The nutrient release mechanism of UIB and EUIB was best described by the Higuchi model and Korsmeyer-Peppas model, respectively. The improvement of water retention ratio of UIB and EUIB pellets was more significant in sandy-textural soil as compared to clayey-textural soil. The EUIB derived from peppercorn waste has the potential to be utilized as a sustainable controlled-release fertilizer for agriculture.
Fulltext Heart failure across Asia: Same healthcare burden but differences in organization of care

Reyes EB, Ha JW, Firdaus I, Ghazi AM, Phrommintikul A, Sim D, et al.

Int J Cardiol, 2016 Nov 15;223:163-167.
PMID: 27541646 DOI: 10.1016/j.ijcard.2016.07.256

A gap in the knowledge on the status of heart failure (HF) in Asia versus other regions led to the creation of a working group of Asian experts from 9 countries or regions (Hong Kong, Indonesia, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam). Each expert sought the best available data from local publications, registries, or clinical practice. The prevalence of HF in Asia was generally similar to global values (1% to 3%), but with some outliers. There were substantial variations in healthcare spending, and the average cost of HF hospitalization varied from 813 US$ in Indonesia to nearly 9000 US$ in South Korea. Comorbidities were frequent, particularly hypertension, diabetes mellitus, and dyslipidemia. Modifiable risk factors such as smoking were alarmingly common in some countries. Asian HF patients spent between 5 and 12.5days in hospital, and 3% to 15% were readmitted for HF by 30days. The pharmacological treatment of Asian patients generally followed international guidelines, including renin-angiotensin-aldosterone system inhibitors (61% to 90%), diuretics (76% to 99%), beta-blockers (32% to 78%), and digoxin (19% to 53%), with some room for improvement in terms of life-saving therapies. Our review supports implementation of a more comprehensive and organized approach to HF care in Asia.
Fulltext Cognitive impairment in Asian patients with heart failure: prevalence, biomarkers, clinical correlates, and outcomes

Dong Y, Teo SY, Kang K, Tan M, Ling LH, Yeo PSD, et al.

Eur J Heart Fail, 2019 05;21(5):688-690.
PMID: 30938010 DOI: 10.1002/ejhf.1442
Fulltext Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes

Tan JWC, Sim D, Ako J, Almahmeed W, Cooper ME, Dalal JJ, et al.

Eur Cardiol, 2021 Feb;16:e14.
PMID: 33976709 DOI: 10.15420/ecr.2020.52

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease.
Asian Pacific Society of Cardiology Consensus Recommendations on the Use of MitraClip for Mitral Regurgitation

Yeo KK, Tan JWC, Muller DW, Walters DL, Lindenfeld J, Lee MKY, et al.

Eur Cardiol, 2021 Feb;16:e25.
PMID: 34163538 DOI: 10.15420/ecr.2021.01

Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted 'agree' or 'neutral'. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.