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National Cardiovascular Disease Database National Cardiovascular Disease Database ((NCVDNCVD)) ACS Registry PCI Registy
2009 Update 2009 Update
NHAM ASM 2009NHAM ASM 200917 April 200917 April 2009
Dr SIM Kui-Hian – Chair NCVD Board Dr Robaayah Zambahari – Chair NCVD Board
Dr Jeyaindran Tan Sri Sinnadurai – Chair ACS RegistryDr Hj Azhari Rosman – Chair ACS Registry
Dr Rosli Mohd Ali – Chair PCI Registry
Dr Wan Azman – Chair Publication
Rationale – NCVD Registries
Are the population & the patients groups in
Malaysia similar to those being investigated in
the clinical trials?
Are our hospitals following the guidelines set out
by the expert committees?
Are we seeing the same results and benefits of
implementing evidence-based strategies?
Which strategy will be the best value in terms of
cost-effectiveness for the Ministry of Health?
Objectives - NCVD ACS Registry
Determine the number & the time trend of ACS in
Malaysia
Determine the socio-demographic profiles of these
patients to better identify the high-risk group in our
Malaysian population
Determine the efficiency of, and adherence to
current treatment guidelines
Determine the cost to the nation by cardiovascular
disease and the cost effectiveness of treatment and
prevention programs
Stimulate and facilitate research of cardiovascular
disease using this database
No more‘guestimate’
Milestones - NCVD Registries 15 Oct 2005 Approval of MOH-MRG
9 Dec 2005 1st NCVD – ACS Registry Steering Comm
1st Jan 2006 eNCVD online data capturing
NCVD piloted in 6 centres
Expanded to nation wide – state government hospitals
31st March 2006 Officially launched by Director General of Health Malaysia
@ 10th ASM, National Heart Association of Malaysia
14 April 2007 1st Annual NCVD @ 11th NHAM ASM
19 Dec 2007 ACS Report Writing Committee
4 April 2008 2nd Annual NCVD @ 12th NHAM ASM
7 Dec 2006 1st NCVD - PCI Registry Steering comm
3 April 2008 1st NCVD – CABGs Registry Steering Comm
Organization of NCVD ACS registry
Sponsor
Governance Board
Expert Panel
NCVD Registry Office
Source Data Providers
Users group
Supporting Staff
Clinical Registry Manager Ms S Gunavathy Selvaraj Clinical Registry Associate Ms Noor Amirah Muhamad
Ms Hamimatunnisa Johar Clinical Epidemiologist Dr Jamaiyah Haniff
Ms S Gunavathy Selvaraj ICT Manager Ms Celine Tsai Pao Chien Database AdministratorMs Lim Jie Ying Application Developer Ms Amy R. Porle Network Administrator Mr Kevin Ng Hong Heng
Mr Adlan Ab. Rahman Webmaster & Publisher Ms Azizah Alimat Clinical Data Manager Ms Teo Jau Shya Biostatistics Consultants Dr Hoo Ling Ping
Ms Norhafizah Bt. Ab. Manan
eNCVD – real time report
Accessible – Anywhere & Anytime
Key of success
COLLABORATION
joint sacrifices of
Ministry Of Health’s hospitals
Ministry of Education’s (university) hospitals
Private hospitals
Ministry of Health Malaysia
• 2006
• 73 CCU in Malaysia
• Incidence of ACS admission
• 47.1 per 100,000 population
• Incidence of coronary heart disease (CHD)
• 141 per 100,000 population
• Over 4000 ACS being denied admission into its CCU
• 30% shortfall in CCU beds
Provision of ACS services in Malaysia ACS admissions
37 CCUs in MOH hospitals 60%
3 university hospitals’ CCUs 10%
private sector 27%
economically developed states like Penang, Perak,
Selangor/Wilayah Persekutuan have disproportionately large
number of ACS admissions
less developed states (Kedah/Perlis, Terengganu, Sabah and
Sarawak) were underserved
Patients in private hospitals are more likely to receive invasive
coronary interventions (emergency angiogram, PCI and CABG)
Age group, no. % (N = 3422)
20 - <30 23 (1)
30 - <40 143 (4)
40 - <50 621 (18)
50 - <60 1054 (31)
60 - <70 881 (26)
70 - <80 571 (17)
80 129 (4)
Age Group for patient with ACS,Malaysia 2006
Age-gender distribution male pts with ACS by ethnic group, Malaysia 2006
% o
f pa
tient
s
Male patients
0
10
20
30
40
Malay Chinese Indian Others*
20-<30 30-<40 40-<50 50-<60 60-<70 70-<80 >=80
Age-gender distribution for female pts with ACS by ethnic group, Malaysia
2006 N
o. o
f pa
tient
s
Female Patients
0
30
60
90
120
150
Malay Chinese Indian Others*
20-<30 30-<40 40-<50 50-<60 60-<70 70-<80 >=80
Age group (years) distribution for pts with ACS by ACS stratum, Malaysia 2006
% o
f pa
tien
ts
Age group0
10
20
30
STEMI NSTEMI UA
20-<30 30-<40 40-<50 50-<60 60-<70 70-<80 >=80
Gender, no. % (N=3422)
Male 2569(75)
Female 853 (25)
ACS Gender distribution Malaysia 2006
75%
25%
MaleFemale
49.2
23.0 23.3
1.4 1.1 1.1 0.8 0.1 0.0 0.0 0.0 0.00
10
20
30
40
50
60
Malay
ChineseIndian
Iban
Other Malaysia
n
Foreigner
Bidayuh
Kadazan
MelanauMurut
Bajau
Orang Asli
Ethnicity
% o
f pa
tien
tsACS Ethnic group distribution
Malaysia 2006
Overall outcomes for pts with ACS, Malaysia 2006
in-hospital 30 days
NCVD-ACS GRACE NCVD-ACS
ACS stratum 7%
STEMI 9% 7% 11%
NSTEMI 7% 6% 8%
UA 3% 3% 4%
Overall outcomes for pts with ACS, Malaysia 2006
in-hospital mortality 30-day
mortality
elderly age group 10% 13%
Female patients 8% 10%
male patients 6% 8%
diabetes 7% 10%
without diabetes 5% 6%
Overall outcomes for pts with STEMI ACS, Malaysia 2006
in-hospital mortality 30-day
mortality
use of fibrinolysis 7% 9%
No fibrinolysis 13% 16%
PCI 8% 11%
No PCI 9% 11%
Prognostic factors higher Killip class, higher TIMI risk score, former or current cigarette
smoking, family history of premature cardiovascular disease,
dyslipidaemia, hypertension and diabetes mellitus. Older age
Report:NCVD-ACS Registry Annual report year 2006
Freely downloadable online at http://www.acrm.org.my/ncvd/publications.htm