A multinational study involving over 5,000 heart failure patients to determine characteristics and outcomes in Asian patients has shed new light on the prevalence of the three major risk factors for heart failure – coronary artery disease, hypertension and diabetes.

The study initiated by the National University Heart Centre, Singapore (NUHCS), in partnership with the National Heart Centre Singapore (NHCS) and other centres recruited 5,276 heart failure patients from 50 centres distributed over 11 Asian regions. Of the 1,066 patients from Singapore participating in the study, 62 per cent had coronary artery disease, 70 per cent had hypertension and 58 per cent had diabetes. In addition, the average body mass index (BMI) of Singaporean patients was 25.9; a BMI higher than 23 increases one’s risk of getting heart disease and diabetes, among the other health issues.

“The silver lining is that most cardiovascular risk factors are modifiable; in other words there is a lot that we can do to reduce or prevent the risk of hypertension, diabetes and coronary artery disease,” said Associate Professor Carolyn Lam, principal investigator of the study and Senior Consultant, Department of Cardiology, NHCS. “By extension, this means that most of us will be able to lower our risk of developing heart failure if we keep to a healthy lifestyle through a sensible diet and regular exercise. Singapore’s recently announced war on diabetes is a prime example of efforts underway to improve outcomes among our patients.”

Professor Mark Richards, Chair of the Executive Committee of ASIAN-HF, said, “This study has given us the first prospective multinational data from Asia which shows that, aside from a consistently early age of onset compared with the West, there is no single Asian phenotype, and that Asian heart failure patients are very different from each other based on the region they are living in and their ethnicity.” Prof Richards is also the Director of the Cardiovascular Research Institute of Singapore (CVRI) at the National University Health System and Director of Research at NUHCS.

Associate Professor Lam added, “Based on this study, one possible explanation for the high cardiovascular risk profile we see in Asian patients with heart failure may be the rapid development of some regions in the last few decades.” She is also a Clinician Scientist with the SingHealth DukeNUS Cardiovascular Sciences Academic Clinical Programme, and an Associate Professor with the Programme in Cardiovascular & Metabolic Disorders at Duke-NUS Medical School.

Discovering new knowledge on Asian heart failure

Asia has the lion’s share of patients with heart failure in the world, and the condition accounts for around 6,000 hospitalisations annually in Singapore1 alone. Despite the staggering numbers and deep insights on the condition gleaned from decades of research in Europe and the US, contemporary data on heart failure in Asia remains scarce.

To bridge this large knowledge gap in this part of the world, the ASIAN-HF registry was started in 2012 to gather real world data on the demographics and risk factors of heart failure patients from 11 Asian regions: China, India, Japan, South Korea, Indonesia, Malaysia, Singapore, the Philippines, Thailand, Taiwan and Hong Kong. The late-breaking findings of this study were presented by Associate Professor Lam at the European Society of Cardiology Heart Failure Congress held in Florence, Italy on 23 May 2016.

This study aims to deepen our understanding of heart failure in Asians by comparing the three key risk factors of heart failure across geographic regions, regional income levels and ethnicity, and the results will inform and encourage research to improve patient outcomes.

Diversity among Asian patients

The Asian patients involved in the study were relatively young with an average age of 60 years old, yet 64 per cent of them had two or more risk factors for heart failure.

Deeper analysis revealed ethnic differences between heart failure patients. For instance, Chinese patients across Asia were more than twice as likely to develop coronary artery disease as the Japanese or South Koreans, and Malay patients had the highest risk of diabetes among all the Asian ethnic groups studied.

The findings also indicated that regional income differences can influence one’s risk of getting heart failure. Indian patients from higher income regions, for example, had five times the risk of developing diabetes than their counterparts from lower income regions.

The research team plans to follow up on the heart failure patients from the study for the next two to three years to observe their prognoses and outcomes.

The ASIAN-HF study is supported by grants from the Boston Scientific Investigator Sponsored Research Program, National Research Foundation Singapore under its Translational and Clinical Research (TCR) Flagship Programme administered by the Singapore Ministry of Health’s National Medical Research Council, the Asian Network for Translational Research and Cardiovascular Trials (ATTRaCT) programme funded by the Agency for Science, Technology and Research, and Bayer.



1 Based on the hospital bill sizes for heart failure and heart failure with complications published on the Ministry of Health’s website, www.moh.gov.sg.