ASIAN HF Registry, A Prospective Observational Study
Condition: Heart Failure
MeSH terms: Heart Failure
Study type: Observational

Summary: 
      The ASIAN HF Registry is the first prospective multinational Asian registry of patients with
      symptomatic HF (stage C) including both HFrEF (ejection fraction <40%) and HFpEF (ejection
      fraction ≥50%), with the broad purpose of determining the mortality (incidence) burden of HF
      in Asian patients, and more specifically to define the burden and risk factors of Sudden
      Cardiac Deaths (SCD), as well as the sociocultural barriers to preventive device therapy. The
      study further aim to study the genetic variants associated with HFrEF versus HFpEF in our
      large Asian cohort.

      This proposed registry is expected to advance fundamental understanding of the burden and
      predictors of preventable death among Asian patients with HF. The knowledge gained will be
      critical for guiding resource allocation and planning preventive strategies to address the
      unmet and growing clinical needs of patients with cardiovascular disease in Asia.
    

Detailed description: 
      Heart failure (HF) is a major public health problem worldwide. As the final common pathway of
      a myriad of heart diseases, HF burden increases with increasing prevalence of cardiovascular
      disease in a community, as patients survive their acute cardiac conditions (such as heart
      attacks) and progress to chronic HF. Further, HF is a debilitating and deadly condition with
      high rehospitalization rates and dismal survival rates comparable to most cancers. In
      Singapore alone, the age-adjusted HF admission rate rose by ~40% over the last decade,1
      making HF the commonest cardiac cause of hospitalization (representing ~24% of all cardiac
      admissions), and the 5-year survival rate in patients with HF is only 32%. These alarming
      statistics reflect the global shift in cardiovascular disease burden to developing countries
      in Asia. In fact, the World Health Organization has projected that the largest increases in
      cardiovascular disease worldwide are occurring in Asia, due to rapidly increasing rates of
      smoking, obesity, dyslipidemia and diabetes among Asians. Thus the burden of HF is expected
      to reach epidemic proportions in Asia. Yet in sharp contrast to the wealth of data regarding
      HF in Western nations, epidemiologic data are scarce in Asian patients with HF.

      The study will involve 46 top medical centers across 11 Asian regions (Korea, Thailand,
      Indonesia, Philippines, India, Japan, Malaysia, Hong Kong, China, Taiwan and Singapore). Site
      selection targeted a mix of centers covering a broad spectrum of medical, cardiology and HF
      specialty units regularly admitting patients with acute HF and following outpatients with
      chronic HF, constituting a novel network of Asian centers of cardiovascular expertise.

      Data collection will include demographic variables, clinical symptoms, functional status,
      date of HF diagnosis and prior cardiovascular investigations, clinical risk factors,
      lifestyle factors, socioeconomic status, and survey of cultural beliefs, health practices and
      attitudes towards device therapy. Center-level characteristics (caseload, referral pattern,
      specialization, infrastructure) will also be obtained. Patients will undergo standard 12-lead
      electrocardiography and transthoracic echocardiography at baseline, and followed over 3 years
      for outcomes of death or hospitalization. Each outcome event and its cause will be
      adjudicated by a central committee using pre-specified criteria.
    

Intervention name(s): Saliva Genetic testing
Intervention type(s): Genetic
Intervention description(s): To compare the genetic variants between the two phenotypes of reduced versus preserved ejection fraction (HFrEF versus HFpEF)
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        This is a prospective, observational, multinational, multicenter Asian registry of patients
        with Stage C HF, including both HFrEF (ejection fraction <40%) and HFpEF (ejection fraction
        ≥50%).

        This study population (Stage C HF) was selected in recognition of current recommendations
        emphasizing that HF is a progressive, staged disease.The HFrEF population was defined based
        on a recent meta-analysis showing that risk of death in HF increases particularly as
        ejection fraction falls below 40%. The HFpEF population was defined according to current
        guidelines. Patients with an ejection fraction in the range of 40% to 50% represent an
        intermediate group which was not included since we aimed to study distinct clinical
        phenotypes.
      
Keywords: Heart Failure; HF