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[2021 Asian Pacific Society of Cardiology Consensus Recommendations on the use of P2Y12 receptor antagonists in the Asia-Pacific Region: Special populations]

Tan WEICHIEHTAN, Chew PCHEW, Tsui LAMTSUI, Tan TAN, Duplyakov DUPLYAKOV, Hammoudeh HAMMOUDEH, et al.

Zhonghua Xin Xue Guan Bing Za Zhi, 2023 Jan 24;51(1):19-31.
PMID: 36655238 DOI: 10.3760/cma.j.cn112148-20220729-00588
Matched MeSH terms: Cardiology*
Fulltext Blood pressure control among diabetic hypertensives under cardiology follow-up at a regional hospital in rural Malaysia

Azarisman SM, Aszrin A, Marzuki AO, Fatnoon NN, Hilmi A, Hadzri MH, et al.

Southeast Asian J. Trop. Med. Public Health, 2010 Jul;41(4):973-81.
PMID: 21073073

Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.

Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,

Matched MeSH terms: Cardiology Service, Hospital
Medicine in Malaysia: cardiology

Robaayah Z

Med J Malaysia, 1995 May;50 Suppl A:S22-8.
PMID: 10968009
Matched MeSH terms: Cardiology/trends*
Fulltext Risk factor awareness and expectations of outpatients attending the Cardiology Clinic, Universiti Kebangsaan Malaysia

Yusoff K, Roslawati J, Almashoor SH

Med J Malaysia, 1992 Sep;47(3):194-9.
PMID: 1491645

One hundred consecutive patients attending the UKM (Universiti Kebangsaan Malaysia) Cardiology Clinic completed a questionnaire enquiring about their own assessment of their knowledge about their illness, their awareness of cardiac risk factors and their expectations in their management. Only 11% of our patients had graduated from tertiary education. 59% of our patients were being treated for ischaemic heart disease. Although only 28% of our patients considered having considerable knowledge of their illness, a majority of our patients were aware of cardiac risk factors. This was independent of the formal education achieved. However this awareness did not necessarily result in appropriate behaviour; 32% of patients admitted to smoking despite being aware of the harmful effects of smoking. 74% of our patients expected a cure from their doctors; only 37% of our patients thought they required medication indefinitely. Thus, patients could be made aware of their illness regardless of their formal educational status. However this may not necessarily result in appropriate behaviour. The high expectations which the patients have of their doctors is unrealistic and may be detrimental to appropriate long-term management of their chronic illness.

Study site: Cardiology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Cardiology Service, Hospital
Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre

Abdul Kader MAS

Med J Malaysia, 2019 08;74(4):355-358.
PMID: 31424052

The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.

Matched MeSH terms: Cardiology Service, Hospital/organization & administration*
It is not asthma! An arcane case of 'Scimitar' syndrome: A case report

Ganapathi P, Nurul Yaqeen ME, Zamzurina AB

Med J Malaysia, 2020 03;75(2):184-185.
PMID: 32281607

'Scimitar' syndrome in adulthood is usually asymptomatic. Significant structural abnormalities symptoms usually manifest early during infancy or young childhood with features of congestive heart failure from significant shunting of the anomalous pulmonary venous drainage. Diagnosis of 'Scimitar' Syndrome in adults is rare and usually an incidental finding on chest radiograph. Here, we report a case of an adult who presented with symptoms in her 40's. This syndrome has never been reported nor discussed in Malaysia. This is the first case report of 'Scimitar' Syndrome in Malaysian literature. The diagnostic dilemma, medical management, and multi-disciplinary management by cardiology, physiotherapy and pulmonary rehabilitation teams are discussed.

Matched MeSH terms: Cardiology
Fulltext Acute myocardial infarction in young Asian women: a comparative study on Chinese, Malay and Indian ethnic groups

Xie CB, Chan MY, Teo SG, Low AF, Tan HC, Lee CH

Singapore Med J, 2011 Nov;52(11):835-9.
PMID: 22173254

There is a paucity of data on acute myocardial infarction (AMI) in young Asian women and of comparative data among various ethnic groups with respect to risk factor profile and clinical outcomes. We present a comprehensive overview of the clinical characteristics of young Asian women with AMI and a comparative analysis among Chinese, Malay and Indian women in a multi-ethnic Asian country.

Matched MeSH terms: Cardiology/methods
Fulltext Favourable outcome after peripartum cardiomyopathy: a ten-year study on peripartum cardiomyopathy in a university hospital

Chee KH

Singapore Med J, 2013 Jan;54(1):28-31.
PMID: 23338913

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, affecting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. This study was undertaken to define the prevalence, presentation and outcome of PPCM among women giving birth in a teaching hospital in Malaysia.

METHODS: A retrospective case record analysis was conducted on all patients admitted and diagnosed with PPCM at the University Malaya Medical Centre, Kuala Lumpur, Malaysia, from 1 January 2000 to 31 December 2009. All deliveries were undertaken in the same hospital.

RESULTS: A total of 12 patients were diagnosed with PPCM during the ten-year study period. The prevalence of PPCM was 2.48 in 100,000 (1 in 40,322) live births. Nine women were diagnosed with PPCM within five months of delivery. Three women had twin pregnancies. There was one death in the group (mortality rate 8.3%). The mean left ventricular ejection fraction at the time of diagnosis was 28.9% ± 8.5% (range 15%-40%). Following the index event, left ventricular function normalised in six of the nine patients (66.7%) who underwent subsequent echocardiography one year later. All patients were treated with standard heart failure therapy. Two patients with normalised left ventricular function had subsequent pregnancies - one pregnancy was terminated at seven weeks and the other patient delivered uneventfully at full term.

CONCLUSION: PPCM is uncommon. The outcome in our series was favourable, with 66.7% of patients with PPCM recovering their left ventricular function. The mortality rate was 8.3%.

Matched MeSH terms: Cardiology/methods
Fulltext Pulmonary artery aneurysm associated with severe degenerative aortic stenosis

Ling PK

Singapore Med J, 2009 Oct;50(10):e350-2.
PMID: 19907873

We report a pulmonary artery (PA) aneurysm associated with severe aortic stenosis and an aortic root dilatation occurring in a 59-year-old woman who presented with dyspnoea and chest pain. PA aneurysms are rare, and there are no definitive guidelines on its management. There are contentious opinions on whether such aneurysms should be managed conservatively or surgically. Our patient had associated aortic stenosis and underwent a successful aortic valve replacement and PA aneurysm repair. This case illustrates that concomitant PA repair with other cardiothoracic surgery can be performed safely, even in patients with moderate surgical risks. We also discuss the natural history, prognosis and management of PA aneurysms.

Matched MeSH terms: Cardiology/methods
Fulltext Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients

Murtaza G, Khan MY, Azhar S, Khan SA, Khan TM

Saudi Pharm J, 2016 Mar;24(2):220-5.
PMID: 27013915 DOI: 10.1016/j.jsps.2015.03.009

Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p

Matched MeSH terms: Cardiology
Fulltext A novel hybrid classification model of genetic algorithms, modified k-Nearest Neighbor and developed backpropagation neural network

Salari N, Shohaimi S, Najafi F, Nallappan M, Karishnarajah I

PLoS One, 2014;9(11):e112987.
PMID: 25419659 DOI: 10.1371/journal.pone.0112987

Among numerous artificial intelligence approaches, k-Nearest Neighbor algorithms, genetic algorithms, and artificial neural networks are considered as the most common and effective methods in classification problems in numerous studies. In the present study, the results of the implementation of a novel hybrid feature selection-classification model using the above mentioned methods are presented. The purpose is benefitting from the synergies obtained from combining these technologies for the development of classification models. Such a combination creates an opportunity to invest in the strength of each algorithm, and is an approach to make up for their deficiencies. To develop proposed model, with the aim of obtaining the best array of features, first, feature ranking techniques such as the Fisher's discriminant ratio and class separability criteria were used to prioritize features. Second, the obtained results that included arrays of the top-ranked features were used as the initial population of a genetic algorithm to produce optimum arrays of features. Third, using a modified k-Nearest Neighbor method as well as an improved method of backpropagation neural networks, the classification process was advanced based on optimum arrays of the features selected by genetic algorithms. The performance of the proposed model was compared with thirteen well-known classification models based on seven datasets. Furthermore, the statistical analysis was performed using the Friedman test followed by post-hoc tests. The experimental findings indicated that the novel proposed hybrid model resulted in significantly better classification performance compared with all 13 classification methods. Finally, the performance results of the proposed model was benchmarked against the best ones reported as the state-of-the-art classifiers in terms of classification accuracy for the same data sets. The substantial findings of the comprehensive comparative study revealed that performance of the proposed model in terms of classification accuracy is desirable, promising, and competitive to the existing state-of-the-art classification models.

Matched MeSH terms: Cardiology/classification; Cardiology/methods
Fulltext What are the determinants for individuals to undergo cardiovascular disease health checks? A cross sectional survey

Cheong AT, Khoo EM, Liew SM, Chinna K

PLoS One, 2018;13(8):e0201931.
PMID: 30092064 DOI: 10.1371/journal.pone.0201931

BACKGROUND: There is a need to improve public's participation in health checks for early identification of individuals at high risk of CVD for prevention. The objective of this study is to identify significant determinants associated with individuals' intention to undergo CVD health checks. These determinants could be used to develop effective strategies to improve CVD health check participation.
METHODS: This was a cross sectional survey using mall intercept interviews. It was carried out in a hypermarket surrounded by housing estates with a population of varying socioeconomic backgrounds. Inclusion criteria were Malaysian nationality and age 30 years and older. The validated CVD health check questionnaire was used to assess participants' intention and the determinants that influenced their intention to undergo CVD health checks.
RESULTS: A total of 413 participants were recruited. The median age of the participants was 45 years (IQR 17 years) and 60% of them were female. Participants indicated they were likely (45.0%) or very likely (38.7%) to undergo CVD health checks while 16.2% were not sure, unlikely or very unlikely to undergo health checks. Using ordinal regression analysis, perception of benefits, drawbacks of CVD health checks, perception of external barriers and readiness to handle outcomes following CVD health checks were the significant determinants of individuals' intention to undergo CVD health checks.
CONCLUSIONS: To improve individuals' participation in CVD health checks, we need to develop strategies to address their perception of benefits and drawbacks of CVD health checks, the perceived external barriers and their readiness to handle outcomes following CVD health checks.

Matched MeSH terms: Cardiology
Optimization of dose and image quality of paediatric cardiac catheterization procedure

Lubis LE, Bayuadi I, Pawiro SA, Ng KH, Bosmans H, Soejoko DS

Phys Med, 2015 Nov;31(7):659-68.
PMID: 26050060 DOI: 10.1016/j.ejmp.2015.05.011

The purpose of this study is to quantify the quality of the available imaging modes for various iodine-based contrast agent concentration in paediatric cardiology. The figure of merit (FOM) was defined as the squared signal to noise ratio divided by a patient dose related parameter. An in house constructed phantom simulated a series of vessel segments with iodine concentrations from 10% or 30 mg/cc to 16% or 48 mg/cc of iodine in a blood plasma solution, all within the dimensional constraints of a paediatric patient. The phantom also used test inserts of tin (Sn). Measurements of Entrance Surface Air Kerma (ESAK) and exit dose rate were performed along with calculations of the signal-to-noise ratio (SNR) of all the objects. A first result showed that it was favourable to employ low dose fluoroscopy mode and lower frame rate modes in cine acquisition if dynamic information is not critical. Normal fluoroscopy dose mode provided a considerably higher dose level (in comparison to low dose mode) with only a slight improvement in SNR. Higher frame rate cine modes should be used however when the clinical situation dictates so. This work also found that tin should not be intended as iodine replacement material for research purposes due to the mismatching SNR, particularly on small vessel sizes.

Matched MeSH terms: Cardiology
Fulltext Determinants of sick leave duration among employees with the first episode of acute coronary syndrome

Sahrol Nizam Abu Bakar, Bachok Norsa’adah, Zurkurnai Yusof, Mansor Yahya, Mohd Nazri Shafei

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):32-36.
MyJurnal

Introduction: Information on sick leave duration among employees with the first episode of acute coronary syndrome (ACS) throughout the world was limited. The aims of the study were to determine the sick leave duration and its predictive factors among employees diagnosed with the first episode of ACS. Methods: A cohort study was conduct- ed among employees who were admitted to the cardiology centre in the public hospitals in northeastern Malaysia. Data was collected using a designed proforma. The respondents were interviewed, and their medical records were reviewed on the second day of hospital admission. Information on sick leave duration was obtained from sick leave book in the wards. Multiple linear regression analysis was applied to determine the predictive factors for sick leave duration. Results: A total of 78 respondents participated in this study. The mean (SD) age of the respondents was
47.5 (7.31) year old. The majority were male (92.3%), married (94.9%) and had a low level of education (62.8%). The sick leave duration ranged from 4 to 180 days with the median (IqR) of 35.5 (32) days. The predictive factors for sick leave duration were smoking (Adjusted b=20.1, 95% CI: 7.4, 32.8), not attending cardiac rehabilitation after discharge (Adjusted b=19.9, 95% CI: 6.7, 33.6) and presence of complication during admission (Adjusted b=28.6, 95% CI: 15.1, 42.0). Conclusion: The sick leave duration was relatively low and being a smoker, having a complica- tion during admission and not attending cardiac rehabilitation after discharged predicts a longer sick leave duration.

Matched MeSH terms: Cardiology
Fulltext Perceived learning needs Among Coronary Artery Disease patients: a study in a tertiary hospital

Suriani Yaacob, Noor Hanita Zaini, Khatijah Lim Abdullah, Nor Zehan Ahmad, Vimala Ramoo, Nazar Mohd Zabadi Mohd Azahar, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):10-15.
MyJurnal

Introduction: Determination of learning needs is central for holistic patient education, to sustain behavior changes and to control patient’s risk factor. However, patients often sense that their learning needs are unmet and informa- tion provided was too general. Thus, this study aimed to determine the perceived learning needs and their level of importance among Coronary Artery Disease (CAD) patients. Methods: The current investigation is a descriptive, cross-sectional study for which all CAD patients were selected using the cencus method. The data was collected us- ing Cardiac Patients Learning Needs Inventory. The questionnaire was delivered to 140 CAD patients who had their follow-up in a cardiology clinic. The instrument is reliable with a Cronbach’s alpha coefficient of 0.96. The study design followed STROBE cross-sectional design process guideline. Results: Participants’ mean age was 58.96 ± 9.42 years. More than half of the participants were males (62.9%), employed (52.0%) and had attained secondary level education (69.3%). Around two-thirds (60.7%) of the patients perceived to have high learning needs. Gender and highest educational achievement were significantly associated with perceived learning needs. The most significant perceived learning needs were medication information, risk factors for CAD, information on diet, physical activity, anatomy and physiology, and other related information. Conclusion: This study has identified the important domains of learning needs among CAD patients. Findings from the present study will provide important input for future cardi- ac educational strategies to reduce the rate of hospital readmission and death.

Matched MeSH terms: Cardiology
Fulltext Developing the cost for uncomplicated acute ST Elevated Myocardial Infarction (STEMI primary percutaneous coronary intervention) using step down and activity based costing at UKMMC

Aniza, I., Syafrawati, Saperi, S., Zafar, M., Amrizal, M.N., Ika Fazura, M.N.

Malaysian Journal of Community Health, 2011;17(1):26-31.
MyJurnal

Background: Cardiovascular disease is the number one cause of death globally and is projected to remain the leading cause of death. If the trend is allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly because of myocardial infarction and strokes). The number of cardiovascular disease cases in Malaysia has increased to 14% in five years from 96,000 cases in 1995 to 110,000 cases in 2000.

Methods: The cost to treat patients admitted to Universiti Kebangsaan Malaysia Medical Center (UKMMC) Malaysia, diagnosed with Acute Uncomplicated ST Elevated Myocardial Infarction (STEMI) was calculated by using two different methodologies, namely step down costing methodology and activity based costing using clinical pathway.

Results: Cost for each stay per day at the cardiology ward using the step down methodology is RM596.42. The treatment cost is estimated from RM1, 789.26 to RM 4,771.36. The average cost per episode for STEMI care with the average length of stay for 5.6 days is RM3, 340(SD ±596.42. The cost of coronary PCI procedure in step costing is RM 13,950.00. Hence, the total cost incurs for STEMI with PCI is RM 17,290.00(SD ±596.42) by using step down method. (an average cost per episode is RM3,340, plus the cost of coronary procedure of RM 13,950.00 . However by using the ABC the cost of STEMI (PCI) with an average length of stay for 5.6 days is RM 20,431.39. The study showed the ABC method was higher by 15.3% than the step down costing.

Conclusion: The cost in managing STEMI (PCI) with the average length of stay of 5.6 days was calculated by using two different methodologies, namely step down costing methodology and activity based costing. Cost of treatment calculated by using activity based costing are higher because all resources used are incorporated in detail. The ABC method was higher by 15.3% than the step down costing. The difference is within 80-20 rules and the biggest percentage of cost in both methodsis procedure or PCI cost.

Matched MeSH terms: Cardiology
Fulltext Revascularization strategy in patients with acute ST-elevation myocardial infarction amid COVID-19 pandemic

Kow CS, Hasan SS

J Formos Med Assoc, 2021 01;120(1 Pt 3):772-773.
PMID: 32798030 DOI: 10.1016/j.jfma.2020.07.041
Matched MeSH terms: Cardiology*
Fulltext ICDTag: a prototype for a web-based system for organizing physician-written blog posts using a hybrid taxonomy-folksonomy approach

Batch Y, Yusof MM, Noah SA

J Med Internet Res, 2013;15(2):e41.
PMID: 23470419 DOI: 10.2196/jmir.2353

Medical blogs have emerged as new media, extending to a wider range of medical audiences, including health professionals and patients to share health-related information. However, extraction of quality health-related information from medical blogs is challenging primarily because these blogs lack systematic methods to organize their posts. Medical blogs can be categorized according to their author into (1) physician-written blogs, (2) nurse-written blogs, and (3) patient-written blogs. This study focuses on how to organize physician-written blog posts that discuss disease-related issues and how to extract quality information from these posts.

Matched MeSH terms: Cardiology
Fulltext Comparison of guidelines for the management of hypertension: Similarities and differences between international and Asian countries; perspectives from HOPE-Asia Network

Chia YC, Turana Y, Sukonthasarn A, Zhang Y, Shin J, Cheng HM, et al.

J Clin Hypertens (Greenwich), 2021 03;23(3):422-434.
PMID: 33634570 DOI: 10.1111/jch.14226

Guidelines on the management of hypertension have been developed by various professional bodies and institutions to primarily address the issues of diagnosis, treatment, and control in order to rationalize and improve the management of hypertension. Hypertension guidelines across the world have recently been updated following the new and controversial lower blood pressure threshold of ≥130/80 mmHg for the diagnosis of hypertension adopted by the Americans. While there are differences between the major as well as between the Asian national guidelines, there were also many similarities. This paper discusses and highlights the differences and similarities between the major international guidelines of the American College of Cardiology/American Heart Association, of the European Society of Cardiology/European Society of Hypertension, and of the International Society of Hypertension and also compares them with the Asian guidelines.

Matched MeSH terms: Cardiology*
History and Current Status of Cardiac Anesthesia in Singapore

Phoon PHY, MacLaren G, Ti LK, Tan JSK, Hwang NC

J Cardiothorac Vasc Anesth, 2019 Dec;33(12):3394-3401.
PMID: 30131218 DOI: 10.1053/j.jvca.2018.07.018

Singapore is a small Southeast Asian island city-state located at the tip of the Malay peninsula with a population of 5.61 million people. It was a former British colony that went on to become a part of Malaysia before gaining independence in 1965. Since then, Singapore has developed tremendously from a small fishing village into the region's medical hub. This article will explore the roots of cardiac anesthesia in Singapore and how it has developed into a subspecialty today.

Matched MeSH terms: Cardiology/history*

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