Atrial Fibrillation/complications* ; Humans ; Singapore ; Stroke/prevention & control* ; Thailand

Aspirin ; therapeutic use ; Bisoprolol ; therapeutic use ; Cardiomyopathies ; chemically induced ; etiology ; Cardiotonic Agents ; adverse effects ; Chest Pain ; diagnostic imaging ; Dobutamine ; adverse effects ; Echocardiography, Stress ; adverse effects ; Enalapril ; therapeutic use ; Humans ; Male ; Middle Aged ; Simvastatin ; therapeutic use

Echocardiography, Transesophageal ; Electrodes, Implanted ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Intraoperative Complications ; diagnostic imaging ; Male ; Middle Aged ; Pacemaker, Artificial

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia in singapore. We describe a cohort of multi-ethnic Asian patients with AF, with the aim to evaluate anticoagulation use and to identify factors predictive of stroke, bleeding and all-cause mortality. Materials and Methods: this was a single centre, retrospective cohort study. All patients with an admission diagnosis of AF between 1 January 2000 and 31 December 2010 were identified. Of these patients, those who had follow-up data up to 31 December 2012 were included in the study. results: there were 1095 eligible patients. the mean age was 67±14 years, mean cHADs2 score was 2±1 and mean HAs-bLED score 2±1. Of the 1095 patients, 657 (62.0%) had a cHADs2 score ≥ 2 but only 215 (32.7%) were eventually prescribed warfarin. Patients not on warfarin were older (p<0.0001) and were more likely females (p<0.0001). Among patients not on warfarin, 52% had HAs-bLED score ≤3. Multivariate analysis revealed that warfarin use and high HAs-bLED score were associated with increased bleeding risk. Age, Indian ethnicity and cHADs2 score were predictive of ischemic stroke. All-cause mortality was significantly related to age, presence of heart failure and HAs-bLED score. conclusions: Anticoagulation management of AF patients remains inadequate. Objective assessment of bleeding risks should be performed before withholding anticoagulation.

Adult ; Aortic Valve ; diagnostic imaging ; Coronary Angiography ; instrumentation ; methods ; Fibroma ; diagnostic imaging ; Heart Neoplasms ; diagnostic imaging ; Heart Valve Diseases ; diagnostic imaging ; Humans ; Incidental Findings ; Male ; Tomography, X-Ray Computed ; instrumentation ; methods ; Ultrasonography

Clinical trials have established the benefits of implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in the treatment of heart failure patients. As adjuncts to guideline-directed medical therapy, ICDs confer mortality benefits from sudden cardiac arrest, while CRT reduces mortality, hospitalisation rates and improves functional capacity. This review discusses the use of ICDs and CRT devices in heart failure management, outlining the evidence supporting their use, indications and contraindications.
Asian Continental Ancestry Group ; Cardiac Resynchronization Therapy ; Cardiology ; Clinical Trials as Topic ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Heart Failure ; diagnostic imaging ; epidemiology ; therapy ; Humans ; Practice Guidelines as Topic ; Singapore ; Ventricular Dysfunction, Left ; therapy

With the increased use of cardiac implantable electronic devices (CIEDs), it is increasingly important to recognise the unique challenges involved in the management of patients with CIEDs who are undergoing surgery. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. This review discusses and presents a practical approach to perioperative CIED management in the Singapore context.
Algorithms ; Bradycardia ; surgery ; Cardiac Surgical Procedures ; Cardiology ; methods ; Decision Making ; Defibrillators, Implantable ; Hemodynamics ; Humans ; Intraoperative Period ; Pacemaker, Artificial ; Preoperative Period ; Radiography, Thoracic ; methods ; Singapore

Cardiac Catheterization ; adverse effects ; Device Removal ; Humans ; Male ; Middle Aged

INTRODUCTIONIn Singapore, the age-standardised event rates of myocardial infarction (MI) are 2- and 3-fold higher for Malays and Indians respectively compared to the Chinese. The objectives of this study were to determine the prevalence and quantity of coronary artery calcification (CAC) and non-calcified plaques across these 3 ethnic groups.

MATERIALS AND METHODSThis was a retrospective descriptive study. We identified 1041 patients (810 Chinese, 139 Malays, 92 Indians) without previous history of cardiovascular disease who underwent cardiac computed tomography for atypical chest pain evaluation. A cardiologist, who was blinded to the patients' clinical demographics, reviewed all scans. We retrospectively analysed all their case records.

RESULTSOverall, Malays were most likely to be active smokers (P = 0.02), Indians had the highest prevalence of diabetes mellitus (P = 0.01) and Chinese had the highest mean age (P <0.0001). The overall prevalence of patients with non-calcified plaques as the only manifestation of sub-clinical coronary artery disease was 2.1%. There was no significant difference in the prevalence of CAC, mean CAC score or prevalence of non-calcified plaques among the 3 ethnic groups. Active smoking, age and hypertension were independent predictors of CAC. Non-calcified plaques were positively associated with male gender, age, dyslipidaemia and diabetes mellitus.

CONCLUSIONThe higher MI rates in Malays and Indians in Singapore cannot be explained by any difference in CAC or non-calcified plaque. More research with prospective follow-up of larger patient populations is necessary to establish if ethnic-specific calibration of CAC measures is needed to adjust for differences among ethnic groups.

Adult ; Age Distribution ; Aged ; Analysis of Variance ; Asian Continental Ancestry Group ; statistics & numerical data ; Case-Control Studies ; China ; ethnology ; Coronary Artery Disease ; diagnostic imaging ; ethnology ; Coronary Vessels ; diagnostic imaging ; Diabetes Mellitus ; ethnology ; Dyslipidemias ; ethnology ; European Continental Ancestry Group ; statistics & numerical data ; Female ; Humans ; Hypertension ; ethnology ; India ; ethnology ; Malaysia ; ethnology ; Male ; Middle Aged ; Plaque, Atherosclerotic ; diagnostic imaging ; ethnology ; Prevalence ; Retrospective Studies ; Sex Distribution ; Singapore ; epidemiology ; ethnology ; Smoking ; ethnology ; Tomography, X-Ray Computed ; Vascular Calcification ; diagnostic imaging ; ethnology

Humans ; Bundle-Branch Block/diagnosis*