Key comorbidities and laboratory findings: insights from first prospective, observational and Multi-Center Malaysia Heart Failure (MYHF) registry

Abstract

Background: In real world settings, factors that may affect prognosis of HF patients include comorbidities, lack of guideline-directed medical therapies (GDMT) and laboratory findings in particular elevated cardiac biomarkers. Purpose: This report aimed to provide insights into these important clinical characteristics in hospitalized HF patients. Methods: MYHF registry is a prospective, observational study of symptomatic HF patients (NYHA II-IV) hospitalized in 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. The key comorbidities, GDMT and natriuretic peptides (NP) utilization in hospitalized HF patients enrolled in MYHF Registry will be analyzed. Results: A total of 2,717 patients, mean age 60.17 years (SD 13.62) and predominantly males (66.8%) were recruited. Mean left ventricular ejection fraction (LVEF) was 36.5% (SD 15.3); with 64.6% HFrEF (LVEF ≤40%), 21.6% HFpEF (LVEF ≥50%) and 11.3% HFmrEF (LVEF 41-49%). Hypertension was the most common comorbidity (71.5%), followed by diabetes (59.8%), ischemic heart disease (55.9%), dyslipidemia (46.6%) and chronic kidney disease (30.9%). At admission, mean SBP was 137.6 mmHg (SD 29), with 5.9% and 42.6% of patients with SBP < 100 mmHg and ≥ 140 mmHg, respectively. Mean HbA1c value was 7.56% (SD 2.0). Mean total cholesterol and LDL-C were 4.30 mmol/L (SD 1.66) and 2.62 mmol/L (SD 1.34), respectively. At admission, mean serum creatinine was 145.76 umol/L (SD 119.64) and 1 out of 2 patients (55.1%) had eGFR <60 mL/min/1.73 m2. Utilization of natriuretic peptide as biomarker was low (16.5%), with NTproBNP being more commonly used (81.5%). Half (49.2%) of patients with NT-proBNP measured had values >=5000 pg/ml. Hospitalization has been known to provide good opportunity for GDMT optimization. Although about two third (59.2%) of patients in this registry had previous history of heart failure hospitalization, only 33.7% of patients were on dual GDMT (ACEi/ARB/ARNI +BB) and 1 out of 10 (13.5%) were on triple GDMT (ACEi/ARB/ARNI+BB+MRA) during admission. Conclusions: Hospitalized HF patients in MYHF registry are generally young, with high prevalence of co-morbidities, worse laboratory findings and had under-utilization of GDMT. The knowledge gained will be crucial for guiding management of HF patients to improve the prognosis.