October 2014, 22:15

10 December 2014

Original Article

Original Article

Physicians’ Perception of the Patient Care Pathway for Acute Heart Failure in Asian Countries: Implications for Resource Allocation, Preventive Strategies and Clinical Trial Design

Elvira Zenaida Lansang, David Horsburgh, Yun Ning Lee, Adeline Sng, Ralph Moussalli, Karen Wai, Inder Anand, Shu Zhang, Wataru Shimizu and 9 more

ASEAN Heart Journal

First online: 

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Heart failure (HF) is a growing epidemic in Asia. However, data are scarce regarding the patient care pathway of HF in Asia. We aimed to investigate the HF patient pathways in Asia using a questionnaire-based survey.

Methods and Results

Seventy physicians in 12 Asian countries were surveyed using standardized questionnaires regarding patient source, precipitating factors, clinical presentation, referral pattern, and discharge plans for patients with Acute Heart Failure (AHF). Direct self-referral was reported as the most common source of admission. Majority (70%) of patients presented at the emergency department for worsening of chronic HF, with acute coronary syndrome being the most common precipitating factor, and acute pulmonary edema the most common presentation. Patients spent an average of 10 hours in the Emergency Department and majority were admitted to Cardiology Wards. HF with reduced ejection fraction (HFrEF) were the majority of cases except in Hong Kong and Japan. Most patients were discharged home and only 13-15% were enrolled in outpatient HF programs.



This survey highlights the heterogeneity of AHF patient pathways in Asian countries. These findings underscore the need for prospective studies to validate physicians’ reports, evaluate these differences and guide resource allocation and design of AHF clinical trials.


Cardiovascular - Emergency - Congestive - Referral





1 Quintiles East Asia Singapore (EZL, DH, YNL, AS, RM, KW)

2 VA Medical Center, Minneapolis, MN, USA (ISA)

3 Fuwai Hospital, China (SZ)

4 National Cerebral and Cardiovascular Center and Nippon Medical School, Japan (WS)

5 CARE Hospital, India (CN)

6 Korea University Anam Hospital, Korea (SWP)

7 Prince of Wales Hospital, The Chinese University of Hong Kong (CMY)

8 Ramathibodi Hospital, Mahidol University, Thailand (TN)

9 Institut Jantung Negara, Malaysia (RO)

10 Manila Doctors Hospital, Philippines (EBR)

11 National Cardiovascular Center University Indonesia Jakarta (BBS)

12 Cardiovascular Research Institute, Singapore (CSL, AMR)

Correspondence to: Carolyn S.P. Lam, MBBS, MRCP, MS National University Health System Tower Block Level 9 1E Kent Ridge Road Singapore 119228 Tel: +65-6779-5555 Fax: +65-6872-2998 E-mail: carolyn_lam@nuhs.edu.sg

Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.


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