CHAPTER 1 PROVISION OF ACUTE CORONARY CARE SERVICES IN MALAYSIA

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1 CHAPTER 1 PROVISION OF ACUTE CORONARY CARE SERVICES IN MALAYSIA Sim Kui Hian Wan Azman Wan Ahmad Robaayah Zambahari Chin Sze Piaw Jamaiyah Haniff Lim Teck Onn

2 In 26, there were a total of admissions to the 73 coronary care units (CCU) in Malaysia, of which admissions were due to Acute Coronary Syndrome () (Table 1). The incidence of admission was therefore 47.1 per, population in 26. Assuming half of all coronary heart disease (CHD) first presented with and only half were admitted to CCU with a third who died before being admitted into hospital, a rough estimate of the incidence of CHD in Malaysia is 141 per, population. The 37 CCUs in MOH hospitals took care of the majority (6%) of admissions, the 3 university hospitals CCUs cared for another 1% while the private sector accounted for 27% of admissions. As expected, the economically developed states like Penang, Perak, Selangor/Wilayah Persekutuan have disproportionately large numbers of admissions, while the less developed states (Kedah/Perlis, Terengganu, Sabah and Sarawak) were under-resourced, the surprising exception being Kelantan. Thus, the pattern parallels the availability of acute coronary care services in these states. The 73 CCUs in the country provided 414 CCU beds. Table 1.2 shows the utilization of these resources. The MOH sector is clearly under-resourced relative to the demands it faces, resulting in over 4 being denied admission into its CCU in 26. It has a 3% shortfall in CCU beds, and even if non-acute cardiac admissions are excluded, it is still short of 1% of its required bed strength. Table 1.3 shows the cardiac care patients received after being admitted into CCU. A remarkable 59% of patients in IJN had thrombolytic. Patients in private hospitals, including IJN, are more likely to receive invasive coronary interventions (emergency angiogram, PCI and coronary artery bypass graft [CABG]). Figure 1.1 and 1.2 shows that the likelihood of patients receiving emergency angiogram, PCI and CABG are driven by availability of cardiologist and on-site invasive cardiac catheterization laboratory (cath lab) facility. 4 Report of the Acute Coronary Syndrome () Registry 26

3 Similarly, the likelihood of receiving emergency coronary artery bypass graft (CABG) correlates with availability of cardiac surgical services (Figure 1.3). What is the optimum level for the provision of these services however remains to be determined, and whether availability of such emergency services translated into better health outcomes are addressed in another chapter in this report. Summary Points: The incidence of admission to CCU was 47 per, populations in 26. MOH Hospitals received 6% of while Private Hospitals account for only 27%. However the MOH sector is clearly under-resourced in terms of CCU beds, on-site Cardiologists, Catheterization Laboratory and Cardiac Surgical Facilities. The likelihood of patients receiving intervention (PCI or CABG) is driven by the availability of these resources. Report of the Acute Coronary Syndrome () Registry 26 5

4 Table 1.1 Acute Coronary/ Cardiac Care Services and Admissions in Malaysia 26 Populati on no in, CCU Total beds CCU beds CCU nurses Cardiolo gist Cath lab Cardiac surgical service No No No No No PMP* No PMP* No PMP* CCU admision All acute admision admision No No PMP* No PMP* (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Malaysia By sector Private MOH IJN University States P.Pinang Melaka Johor Perak Selangor & Kuala Lumpur , Negeri Sembilan Kedah & Perlis Terengganu Pahang Kelantan Sarawak Sabah *PMP = Per Million Population Note: Percentage is to the nearest decimal point 6 Report of the Acute Coronary Syndrome () Registry 26

5 Table 1.2 Utilization of Acute Coronary/Cardiac Services in Malaysia 26 Pop in, Current bed Bed occup. rate Use for all acute Use for Use for non cardiac denied % % % % % No denied % of all Required bed strengths (RBS) No (% shortfall) RBS if non cardiac excluded Malaysia No (% shortfall) Sector Private MOH IJN University States P.Pinang Melaka Johor Perak Selangor & Kuala Lumpur Negeri Sembilan Kedah & Perlis Terengganu Pahang Kelantan Sarawak Sabah Note: Percentage is to the nearest decimal point. Report of the Acute Coronary Syndrome () Registry 26 7

6 Table 1.3 Cardiac Care provided for in Malaysia 26 Population admits PMP* Trombolytic PMP* Angiogram PMP* PCI PMP* CABG PMP* no in, No % No % No % No % No % Malaysia Sector Private MOH IJN University States Pulau Pinang Melaka Johor Perak Selangor & Kuala Lumpur Negeri Sembilan Kelantan Kedah & Perlis Terengganu Pahang Sarawak Sabah *PMP = Per Million Population Note: Percentage is to the nearest decimal point. 8 Report of the Acute Coronary Syndrome () Registry 26

7 Figure 1.1 Relationship between availability of cardiologist and provision of emergency Coronary angiogram and Percutaneous Coronary Intervention (PCI) for patients admitted with in 26 4 Distribution of Cardiologist per million population (pmp) by state 25 Coronary Angiogram pmp PCI pmp Cardiologist pmp Coronary Angiogram pmp PCI pmp Report of the Acute Coronary Syndrome () Registry 26 9

8 Figure 1.2 Relationship between availability of Cath Lab and provision of emergency Coronary angiogram and Percutaneous Coronary Intervention (PCI) for patients admitted with in 26 4 Distribution of Cath lab per million population (pmp) by state 25 2 Coronary Angiogram pmp PCI pmp Cath lab pmp Coronary Angiogram pmp PCI pmp Figure 1.3 Relationship between availability of cardiac surgical services and provision of emergency CABG for patients admitted with in 26 Distribution of Cardiac surgical service per million population (pmp) by state 8 CABG pmp Cardiac surgical service pmp 1 Report of the Acute Coronary Syndrome () Registry 26

National Cardiovascular Disease Database (NCVD) Inaugural. Report of the Acute Coronary Syndrome (ACS) Registry

National Cardiovascular Disease Database (NCVD) Inaugural Report of the Acute Coronary Syndrome (ACS) Registry 26 Editors: Wan Azman Wan Ahmad Sim Kui-Hian Published by: National Cardiovascular Disease