Realising the lack of data on heart failure from Asian perspective, Associate Professor Carolyn Lam, Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS) and Professor Mark Richards, Director of the Cardiovascular Research Institute of Singapore (CVRI) at the National University Health System (NUHS) and other researchers aspired to collect quality information of Asian patients with heart failure in a systematic manner. Thus, Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) came to being. It is a multinational study initiated by NUHCS, in partnership with the NHCS and other centres.
With strong interest in cardiovascular health research initiatives, Bayer supports the data collection from Asian patients in order to accelerate the translation of the findings from this study into new treatment for patients.
The ASIAN-HF study is the first prospective multinational study on heart failure patients carried out in Asia. More than 5,000 heart failure patients were recruited from 50 centres in 11 regions in Asia, i.e. China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Philippines, Singapore, Taiwan and Thailand. As the principal investigator of this study, Assoc Prof Carolyn Lam noted, “We wanted to find out the characteristics of heart failure in Asian patients, such as their background risk factors, survival rate, and how the disease was managed in particular countries. We also imaged the size and shape of the patients’ hearts to look at the changes in heart failure. Importantly, the drugs prescribed to patients in different countries and their dosages were also documented. These data are urgently needed to address the large knowledge gaps in this region.”
The study involves the collection of prospective data regarding demographics, risk factors, and outcomes of Asian patients under treatment for heart failure and advances understanding of the burden and predictors of death and hospitalisation among Asian patients. This study aims to deepen our understanding of heart failure in Asians by comparing the three key risk factors of heart failure across geographic regions, regional income levels and ethnicity, and the results will inform and encourage research to improve patient outcomes.
“This study involved a huge combined effort across Asia. We recruited our first patient in 2012, and completed recruitment of our targeted 5,000 patients with heart failure and reduced ejection fraction at the end of 2015. Over the past 3-4 years, one of the major findings is that Asian patients are not just ‘one-type’ – there are huge differences across geographic regions, ethnicities and income levels. Grouping Asians as a whole, the average age of Asian heart failure patients is 60 years old, which is 10 years younger when compared to heart failure patients in U.S. or Europe. Despite being 10 years younger, Asian patients have as many risk factors for heart failure, such as coronary artery disease, hypertension and diabetes.” Assoc Prof Lam personally thinks that individuals can do something to reduce the risk of getting the lifestyle diseases like hypertension and diabetes, for example, by exercising more, eating the right food and coping with stress better. In so doing, they reduce their risk of heart failure.
The observational data of ASIAN-HF is very important to understand the disease in order to provide accurate treatment. This study shows an exciting step towards developing novel treatments that Asian patients may better respond to. Assoc Prof Lam elaborated, “We have a comprehensive questionnaire to take down every detail of a patient’s history. In the study, we recorded all types of medications and drug dosages that the Asian patients are receiving; and we use echocardiograms to look at the structure and function of the heart, and electrocardiograms to look at the electrical activity of the heart.”
Diversity of Asian Heart Failure Patients
Asia has the lion’s share of patients with heart failure in the world, and heart failure accounts for around 6,000 hospitalisations annually in Singapore  alone. Preliminary results of the multinational heart failure study shows high prevalence of coronary artery, hypertension and diabetes in Asian patients. Among the patients from Singapore participating in the study, 62 per cent of them had coronary artery disease, 70 per cent had hypertension and 58 per cent had diabetes.
The Asian patients involved in the study were relatively young with an average age of 60 years old, yet 64 per cent of them had two or more risk factors for heart failure.
Deeper analysis revealed ethnic differences between heart failure patients. For instance, Chinese patients across Asia were more than twice as likely to develop coronary artery disease as the Japanese or South Koreans, and Malay patients had the highest risk of diabetes among all the Asian ethnic groups studied.
The findings also indicated that regional income differences could influence one’s risk of getting heart failure. Indian patients from higher income regions, for example, had five times the risk of developing diabetes than their counterparts from lower income regions.
The research team plans to follow up on the heart failure patients from the study for the next two to three years to observe their prognoses and outcomes. The knowledge gained from the study can be used to plan strategies to better address the unmet and growing clinical needs of patients with cardiovascular disease in Asia.
Fundamental understanding of a disease is important in targeting its root cause. Assoc Prof Lam felt very fortunate and grateful for the support from Bayer to showcase the most recent data relating to heart failure in Asia. She hopes that this like-minded partnership between academia and industry would help accelerate drug development and improve patient outcomes, and create a win-win situation for those afflicted with heart failure in Asia.
The findings are discussed in a recent paper published in the European Heart Journal. The late-breaking data was also presented by Assoc Prof Lam at the European Society of Cardiology-Heart Failure Congress 2016 in Florence, Italy on 23 May 2016.
The ASIAN-HF study is supported by grants from the Boston Scientific Investigator Sponsored Research Program, National Research Foundation Singapore under its Translational and Clinical Research (TCR) Flagship Programme administered by the Singapore Ministry of Health’s National Medical Research Council, the Asian Network for Translational Research and Cardiovascular Trials (ATTRaCT) programme funded by the Agency for Science, Technology and Research, and Bayer.
- Based on the hospital bill sizes for heart failure and heart failure with complications published on the Ministry of Health’s website, www.moh.gov.sg.