Transcript National Cardiovascular Disease Database (NCVD)

NCVD
Acute Coronary Syndrome (ACS) Registry
An Update
Dato’ Dr Azhari Rosman
Chairman of NCVD ACS Registry
Sentral Accord Room, Hilton Kuala Lumpur
19th April 2009
National Cardiovascular Disease Database (NCVD)
ACS Registry Participating Sites
*HSB
*HTF
*PH
HSJ
*HRPZ II
*QEH
HSNZ
*HI
*HTAA
*IJN
*UMMC
*HKL
*HTAR
*HTJ
*HM
MMC
(2009)
National Cardiovascular Disease Database (NCVD)
*SGH
*HSAJB
* Active sites
Current Activities
1. Report:
NCVD-ACS Registry Annual report year 2006
Downloadable online at http://www.acrm.org.my/ncvd/publications.htm
National Cardiovascular Disease Database (NCVD)
Current Activities
2. NCVD-ACS Registry Annual Report
year 2007
• Currently in the midst of datacleaning stage
National Cardiovascular Disease Database (NCVD)
Current Updates
as of 9th April 2009
(based on unclean data)
National Cardiovascular Disease Database (NCVD)
Acute Coronary Syndrome
(ACS) Registry
National Cardiovascular Disease Database (NCVD)
ACS cases registered online
by Source Data Providers (SDP)
25
22.17
Percentage (%)
20
13.85
15
11.58
10.93
8.31
10
7.78
7.62
4.8
3.44
5
0.97
2.12
2.07
1.95
1.79
0.5
0.11
0
1001
1002
1003
1004
1005
1006
1007
1009
1010
1011
1012
1014
1015
1016
1017
1018
SDP
Results as of 9th April 2009, n= 10,864
Total SDP = 15 sites
National Cardiovascular Disease Database (NCVD)
Patient’s Demographics
Baseline (n= 10,730)
Age
Min, Max
mean + sd
18.33, 99.52 yrs
59.05 + 11.99 yrs
Male
75.31 %
Baseline (n= 10,864)
Ethnic : Malay
47.47 %
Chinese
22.96 %
Indians
23.25 %
Other Malaysian
3.88 %
Foreigner
1.33 %
* Other Malaysians include Punjabi, Iban, Kadazan Dusun, Orang Asli,
Melanau, Murut, Bajau, Bidayuh
** For 121 cases, there are no information on ethnicity
National Cardiovascular Disease Database (NCVD)
Smoking Status
Never
36.25 %
Stopped (quit > 30 days)
21.45 %
Current (within last 30 days)
32.03 %
Not Available
10.27 %
Status of Aspirin use
Used <7 days
10.47 %
Used >7 days
22.06 %
None
51.96 %
Unknown
15.51 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
CV Risk Factors
Dyslipidaemia
32.42 %
Hypertension
57.69 %
Diabetes
40.56 %
Family History of premature CVD
11.16 %
MI history
16.68 %
Documented CAD
16.21 %
New onset angina (< 2 weeks)
48.08%
Chronic angina (onset > 2 weeks ago)
11.29%
Chronic Lung Disease
3.26 %
Renal disease
6.40 %
Peripheral vascular disease
0.75 %
Cerebrovascular disease
3.42 %
Heart Failure
6.46 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Risk Factors:
Malaysian NCVD-PCI
Registry(IJN)
Institut Jantung Negara
National Heart Institute
51%
82%
72%
Number of distinct angina episode within 24hrs
No episode
14.42 %
8
0.02 %
1
36.38 %
9
0.02 %
2
7.52 %
10
0.07 %
3
2.73 %
11
0.02 %
4
0.71 %
12
0.01 %
5
0.38 %
14
0.03 %
6
0.14 %
20
0.01 %
7
0.06 %
NA
37.48 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Clinical Examination
Heart Rate
83.5 beats/min
Systolic BP
139.74 mmHg
Diastolic BP
81.12 mmHg
Killip classification
I
46.27 %
II
16.37 %
III
3.94 %
IV
3.31 %
Not stated/inadequately described
12.73 %
Not available
17.38 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
ECG abnormalities type
Baseline (n= 10,864)
ST-segment elevation ≥ 1mm (0.1mV) in
≥ 2 contiguous limb leads
17.31 %
ST-segment elevation ≥ 2mm (0.2mV) in
≥ 2 contiguous frontal leads or chest leads
31.16 %
ST-segment depression ≥ 0.5mm (0.05mV) in
≥ 2 contiguous leads
24.57 %
T-wave inversion ≥ 1mm (0.1mV)
20.54 %
Bundle branch block (BBB)
4.95 %
Non-specific
5.23 %
None
6.01 %
Not stated / inadequately described
1.86 %
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
ECG abnormalities location
Baseline (n= 10,864)
Inferior leads : II, III, aVF
31.42 %
Anterior leads : V1 to V4
41.96 %
Lateral leads : I, aVL, V5 to V6
30.23 %
True posterior : V1 V2
4.58 %
Right ventricle : ST elevation in lead V4R
3.77 %
None
9.86 %
Not stated / inadequately described
3.89 %
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Percentage of Ischaemic status
by ACS stratum (n=10,864)
ACS stratum
6.74%
26.25%
43.31%
23.7%
STEMI
NSTEMI
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
UA
Missing
Percentage according to TIMI Risk Score
for STEMI (n= 4,705)
25
19.85
20
Percentage (%)
16.54
15
13.71 13.09
10.31
10
6.95
5.95
6.97
5
3.68
1.91
1.4
0.15
0.09
0.04
11
12
13
0
0
1
2
3
4
5
6
7
8
9
10
TIMI Risk Score
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Percentage according to TIMI Risk Score
for NSTEMI/UA (n=5,427)
30
25.76
23.55
Percentage (%)
25
20
17.36
14.09
15
11.72
10
6.06
5
1.29
0.17
0
0
1
2
3
4
5
6
7
TIMI Risk Score
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Fibrinolytic Therapy Status
Baseline (n= 4,705)
Given at this centre
60.81 %
Given at another centre prior to transfer
12.41 %
Not given - proceeded directly to primary
angioplasty
7.25 %
Not given - Missed Thrombolysis
12.48 %
Not given - patient refusal
0.17 %
Not given - Contraindicated
4.21 %
Not Applicable
2.67 %
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Fibrinolytic Drug Used (n=2,861)
Streptokinase
91.68 %
Others
2.31 %
Missing
6.01 %
Door to needle time (mins)
94.36 + 145.24
Baseline (n= 10,864)
Cardiac Cathetherization
Yes
19.00 %
No
60.73 %
No - transferred to another centre
2.31 %
Missing
17.95 %
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
PCI on this admission
Yes (n=1,588)
14.62 %
Yes – for STEMI
42.1 %
No
55.56 %
Not Applicable
12.08 %
Missing
17.75 %
Door to balloon time (mins)
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
233.77 + 292.63
Pharmacological Therapy
Drug used/given during admission (%)
Drug
Preadmission
During
After
discharge
ASA
52.26
85.98
69.78
ADP Antagonist
20.50
60.53
47.08
GP Receptor inhibitor
0.52
2.90
Unfrac Heparin
1.29
11.36
LMWH
9.75
50.64
Beta Blocker
24.51
61.73
52.40
ACE Inhibitor
18.87
53.57
45.08
Angiotensin II receptor blocker
4.60
7.35
6.32
Statin
30.03
83.97
69.31
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Pharmacological Therapy
Drug used/given during admission (%)
Preadmission
During
After
discharge
Other Lipid Lowering Agent
2.34
5.40
4.41
Diuretics
12.56
28.68
17.04
Calcium Antagonist
9.89
14.28
11.17
Oral Hypoglycaemic Agent
19.40
24.98
25.03
Insulin
6.93
23.38
8.17
Anti-arrhythmic Agent
2.22
6.66
3.55
Drug
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
In-hospital Clinical Outcome
Outcome (%)
Discharged
85.65
Transferred
1.98
Died
6.91
NA
5.55
Cause of Death (%)
CVD
74.57
Non-CVD
4.39
Other
2.26
Missing
18.77
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
In-hospital Clinical Outcome
Final Diagnosis at Discharge (%)
Q Wave MI
35.76
Non-Q Wave MI
19.89
Unstable Angina
24.96
Stable Angina
1.20
Non-cardiac
1.45
Missing
16.74
Bleeding Complication (TIMI Criteria) (%)
Major
0.49
Minor
1.58
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Follow up at
30days & 1year
National Cardiovascular Disease Database (NCVD)
Overall Follow Up Management
Type of FU
30days FU
1year FU
Total
Expected visits
N
9650
%
N
7604
%
FU Done
Missed FU
6493
3157
67.28
32.72
3352
4252
44.08
55.92
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Overall Follow Up done at 30days & 1year
12000
Expected visits
9650
FU done
Number of FU done
10000
7604
8000
6493 (67% )
6000
3352 (44% )
4000
2000
0
30days FU
1year FU
Type of Follow Up
National Cardiovascular Disease Database (NCVD)
Follow Up done at 30days & 1year by SDP
100
93
94
83
90
78
Percentage of FU done (%)
1year FU
84
30days FU
84
76
74
80
70
88
78
61
60
60
54
60
49
50
44
40
37
40
30
25
23
17
20
8
10
2
0
0
0
0
1
0
0
10
17
10
16
10
15
10
14
10
12
10
11
10
10
10
09
10
07
10
06
10
05
10
04
10
03
10
02
10
01
0
SDP
Total 30days FU = 6,493 (as of 9th April 2009)
Total 1year FU = 3,352 (as of 9th April 2009)
National Cardiovascular Disease Database (NCVD)
Cardiovascular readmission
30days (n= 6,550)
1year (n= 3,374)
3.89 %
2.07 %
14.51 %
14.90 %
53.73 %
16.86 %
12.86 %
7.14 %
61.43 %
11.43 %
Heart Failure
0.49 %
0.53%
Revascularization
5.15 %
3.11%
PCI
87.54 %
78.09 %
CABG
9.79 %
15.24 %
0.11 %
0.06 %
ACS
STEMI
NSTEMI
UA
Missing
Stroke
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Outcome at 30 days & 12 months
30days (n= 6,550)
1year (n= 3,374)
Alive
85.39 %
84.53 %
Death
3.45 %
2.31 %
Lost to FU
8.98 %
10.58 %
Transferred
0.58 %
0.18 %
Missing
1.6 %
2.4 %
30days (n= 226)
1year (n= 78)
CVD
55.31 %
47.44 %
Non CVD
10.62 %
8.97 %
Others
13.27 %
21.79 %
Missing
20.80 %
21.80 %
Outcome
Cause of Death
Results as of 9th April 2009, n= 10,864
National Cardiovascular Disease Database (NCVD)
Thank you
National Cardiovascular Disease Database (NCVD)