August 3, 2017 — The Asian Pacific Society of Cardiology (ASPC) held its first-ever late-breaking clinical trials session at its Annual Congress, July 13-15 in Singapore, highlighted by the ASIAN-HF Registry. The registry was one of six late-breaking clinical trials and 250 abstracts at the meeting attended by over 2,000 delegates from 45 countries.
“The epidemic of cardiovascular disease is rising in Asia, and with this comes the growing realization that the disease phenotype may be different from that of other parts of the world. There are unique risk factors, genetics and public health issues which taken together mean that the findings of studies undertaken in the West may not automatically translate to Asian populations, “said Jack Tan, M.D., the APSC Congress chair. “All this makes it really important to have a platform for Asian cardiovascular research. We hope new opportunities to present research at an Asia centered meeting will encourage more researchers from our region to get involved in clinical trials and registries.”
For example, the ASIAN-HF registry demonstrates how heart failure patients in Asia are younger and have more comorbidities than their western counterparts.
The scientific content of the APSC was enhanced by European Society of Cardiology (ESC) hosted sessions including:
- ESC President Prof. Jeroen Bax chaired a session exploring new ESC guidelines on prevention, atrial fibrillation and heart failure; and
- A second ESC session looked at cutting-edge cardiology including the role of transcatheter aortic valve implantation (TAVI), computed tomography in Imaging and percutaneous coronary intervention for left main disease.
Prof. Carolyn Lam, from the National Heart Centre, Singapore and Duke-National University of Singapore, presented the results of The Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry, which set out to gather real-world data on the demographics, risk factors and outcomes of heart failure patients in Asia.
The prospective registry reviewed clinical characteristics and outcomes of 5,276 patients with heart failure with reduced ejection fraction (HFrEF; EF<40 percent) and 1,204 patients with heart failure with preserved ejection fraction (HFpEF; EF>50 percent). Subjects were recruited from 46 centers across 11 regions (including Hong Kong, Taiwan, China, Japan, Korea, India, Malaysia, Thailand, Singapore, Indonesia and the Philippines). For the study, implantable cardioverter defibrillator (ICD)-eligible patients were defined as those with ejection fractions ≤35 percent and New York Heart Association Class II-III.
Results for the registry showed:
- Among patients with HFrEF, the mean age was 59.6 year (this contrasts with a mean age in the U.S. of 70 years);
- Among patients with HFpEF, the mean age was 68 years (this contrasts with a mean age in the U.S. of 72 year);
- Two-thirds of subjects had two or more co morbidities;
- Having two or more co morbidities increased the odds of HFpEF (vs. HFrEF) by around 50 percent;
- Being a woman increased the odds of HFpEF (vs. HFrEF) threefold;
- At six months, 13.1 percent of patients had died or were hospitalized for HF (13.9 percent in HFrEF; 8.9 percent in HFpEF);
- Among 3,240 ICD-eligible patients only 389 (12 percent) were ICD recipients. Utilization of ICDs varied widely across Asia from 1.5 percent in Indonesia to 52.5 percent in Japan; and
- Over a median follow-up of 417 days, ICD implantation reduced risks of all-cause mortality (HR=0.71, 95 percent CI 0.52-0.97) and sudden cardiac death (HR=0.33, 95 percent CI 0.14-0.79).
“In our registry we are seeing that despite being much younger than patients in the rest of the world, Asian patients with heart failure have a high burden of comorbidities and risk factors, many of which are modifiable,” said Lam.
The study revealed underutilization of potentially life-saving implantable cardiac defibrillators. “This we believe may be due to lack of understanding around the device and cultural resistance to the idea of having a foreign body implanted, which represent opportunities for patient education,” said Lam. The public in Asia, she added, need to be educated to take heart failure more seriously.
The registry, she added, showed that there were distinct differences between Asian and Western patients with heart failure. “The results show that we can’t just extrapolate the characteristics and outcomes of Western patients with heart failure to Asians, and that even within Asia we can’t extrapolate results from one region to another. As cardiologists we need to be conducting more heart failure trials in Asia.”
The registry, said Lam, puts an infrastructure in place that can be extended to clinical trials. “We have shown that despite the language and cultural differences across Asia we can get together to successfully recruit thousands of patients. Our dream is that once we have completed the first observational phase we can move on to become an interventional trial network.”
For more information: www.apscardio.org