المؤلفون: Tan, Eugene S J, Tay, Wan Ting, Teng, Tiew-Hwa Katherine, Sim, David, Leong, Kui Toh Gerard, Yeo, Poh Shuan Daniel, Ong, Hean Yee, Jaufeerally, Fazlur, Ng, Tze Pin, Poppe, Katrina, Lund, Mayanna, Devlin, Gerard, Troughton, Richard W, Ling, Lieng Hsi, Richards, Arthur Mark, Doughty, Robert N, Lam, Carolyn S P

المصدر: Heart; 2019, Vol. 105 Issue: 11 p842-847, 6p

مستخلص: ObjectiveEthnic differences in the prevalence of atrial fibrillation (AF) in heart failure (HF) remain unclear. We compared the prevalence and clinical correlates of AF among different ethnicities in an Asian-Pacific population with HF.MethodsPatients with validated HF were prospectively studied across Singapore and New Zealand (NZ).ResultsAmong 1746 patients with HF (62% Asian, 26% women, mean age 66 (SD 13) years, mean ejection fraction (EF) 37 (SD 16%), 39% had AF. The prevalence of AF was markedly lower in Singapore-Asians than NZ-Europeans (24% vs 63%; p<0.001), even after adjusting for age, clinical and echocardiographic covariates, regardless of EF group (pinteractionfor EF=0.39). Patients with AF were older, had higher body mass index and were more likely to have a history of hypertension, stroke, peripheral vascular disease, renal disease, chronic respiratory disease and increased alcohol intake, but less likely to have diabetes. Clinical correlates were similar for Asians and NZ-Europeans, except diabetes: Asian diabetic patients with HF had less AF compared with Asian patients without diabetes (OR 0.66, 95% CI 0.50 to 0.88), whereas among NZ-Europeans there was no significant association between diabetes and AF (OR 1.22, 95% CI 0.85 to 1.75) (pinteractionfor ethnicity=0.01). AF was associated with a higher crude composite outcome of mortality and HF hospitalisations at 2 years (HR 1.19, 95% CI 1.02 to 1.38).ConclusionThere is a strikingly lower prevalence of AF among Asian compared with NZ-European patients with HF. The underlying mechanisms for the lower prevalence of AF among Asians, particularly in the presence of diabetes, deserve further study.Trial registration numberACTRN12610000374066.

المؤلفون: Liang, Lin, Bin-Chia Wu, David, Aziz, Mohamed Ismail Abdul, Wong, Raymond, Sim, David, Leong, Kui Toh Gerard, Wei, Yong Quek, Tan, Doreen, Ng, Kwong

المصدر: Journal of Medical Economics; February 2018, Vol. 21 Issue: 2 p174-181, 8p

مستخلص: AbstractBackground:Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care.Aims:To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective.Methods:A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I–IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalaprilResults:Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively.Conclusions:At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering therapy.

المؤلفون: Leong, Kui Toh Gerard¹, Walton, Antony², Krum, Henry³

المصدر: Annual Review of Medicine. 2014, Vol. 65 Issue 1, p349-365. 20p.

مصطلحات موضوعية: *THERAPEUTICS, *HYPERTENSION, *DENERVATION, *POLYPHARMACY, *PATHOLOGICAL physiology, *CLINICAL trials, *HEART failure, *HEALTH status indicators

مستخلص: Resistant hypertension poses significant health concerns. There are strong demands for new and safe therapies to control resistant hypertension while addressing its common causes, specifically poor compliance to lifelong polypharmacy, lifestyle modifications, and physician inertia. The sympathetic nervous system plays a significant pathophysiological role in hypertension. Surgical sympathectomy for blood pressure reduction is an old but extremely efficacious therapeutic concept, now abandoned with the dawn of a safer contemporary pharmacology era. Recently, clinical studies have revealed promising results for safe and sustained blood pressure reduction with percutaneous renal sympathetic denervation. This is a novel, minimally invasive, device-based therapy, specifically targeting and ablating the renal artery nerves with radiofrequency waves without permanent implantation. There are also reported additional benefits in related comorbidities, such as impaired glucose metabolism, renal impairment, left ventricular hypertrophy, heart failure, and others. This review focuses on how selective renal sympathetic denervation works, its present and potential therapeutic indications, and its future directions. [ABSTRACT FROM AUTHOR]

المؤلفون: Lee, Sheldon, Khurana, Roht, Leong, Kui Toh Gerard

المصدر: European Heart Journal Supplements: Journal of the European Society of Cardiology; February 2012, Vol. 14 Issue: Supplement 1 pA51-A52, 2p

مستخلص: Heart failure (HF) is the final pathway of multiple cardiac diseases. It exerts its clinical burden globally. In this brief review, its epidemiology in Asia is described, followed by an overview of the evolution of past therapies to present strategies available in Asia, and finally, future challenges are identified.

المؤلفون: Leong, Kui Toh Gerard, Lim, Benji, Tan, Kenneth, Tan, Kee Tung, Chai, Sc, Tan, Vs, Chow, Jeremy, Goh, Ping Ping

المصدر: CVD Prevention & Control; May2009 Supplement 1, Vol. 4, pS63-S64, 0p