Physicians’ Perception of the Patient Care Pathway for Acute Heart Failure in Asian Countries: Implications for Resource Allocation, Preventive Strategies and Clinical Trial Design
Elvira Zenaida Lansang MD,1 David Horsburgh,1 Yun Ning Lee,1 Adeline Sng,1 Ralph Moussalli MSc,1 Karen Wai MBBCh, MBA,1 Inder Anand MD, PhD, FRCP,2 Shu Zhang MD, PhD, FHRS,3 Wataru Shimizu MD, PhD, FJCC,4 Calambur Narasimhan MD, DM, AB,5 Sang Weon Park MD, PhD,6 Cheuk-man Yu MD, FRCP, FACC,7 Tachapong Ngarmukos MD,8 Razali Omar MBBS, M.MED, FHRS,9 Eugene B. Reyes MD, FPCP, FPCC,10 Bambang Budi Siswanto MD, PhD,11 Arthur Mark Richards MD, PhD, FRACP, FRCP, FRSNZ,12 Carolyn S.P. Lam MBBS, MRCP, MS12
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Heart failure (HF) is a growing epidemic in Asia. However, data are scarce regarding the patient care pathway of HF in Asia. We aimed to investigate the HF patient pathways in Asia using a questionnaire-based survey.Methods and Results
Seventy physicians in 12 Asian countries were surveyed using standardized questionnaires regarding patient source, precipitating factors, clinical presentation, referral pattern, and discharge plans for patients with Acute Heart Failure (AHF). Direct self-referral was reported as the most common source of admission. Majority (70%) of patients presented at the emergency department for worsening of chronic HF, with acute coronary syndrome being the most common precipitating factor, and acute pulmonary edema the most common presentation. Patients spent an average of 10 hours in the Emergency Department and majority were admitted to Cardiology Wards. HF with reduced ejection fraction (HFrEF) were the majority of cases except in Hong Kong and Japan. Most patients were discharged home and only 13-15% were enrolled in outpatient HF programs.
This survey highlights the heterogeneity of AHF patient pathways in Asian countries. These findings underscore the need for prospective studies to validate physicians’ reports, evaluate these differences and guide resource allocation and design of AHF clinical trials. Keywords
Cardiovascular - Emergency - Congestive - Referral
Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
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