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1. Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia

Author

Tiew-Hwa K. Teng, Wan Ting Tay, Arthur Mark Richards, Timothy Shi Ming Chew, Inder Anand, Wouter Ouwerkerk, Chanchal Chandramouli, Weiting Huang, Claire A. Lawson, Umesh T. Kadam, Jonathan Yap, Shirlynn Lim, Chung-Lieh Hung, Michael Ross MacDonald, Seet Yoong Loh, Wataru Shimizu, Jasper Tromp, Carolyn Su Ping Lam, Lieng Hsi Ling, Houng Bang Liew, Calambur Narasimhan, Tachapong Ngarmukos, Sang Weon Park, Eugenio Reyes, Bambang B. Siswanto, Shu Zhang, Xiaohan Fan, Keping Chen, Liqun Wu, Yucai Xie, Qi Jin, Tianyou Ling, Xinli Li, Fang Zhou, Yanli Zhou, Dongjie Xu, Haifeng Zhang, Yangang Su, Xueying Chen, Shengmei Qin, Jingfeng Wang, Xue Gong, Zhaodi Wu, Cheuk Man Yu, B K S Sastry, Arun Gopi, K Raghu, C Sridevi, Daljeet Kaur, Ajay Naik, Keyur Parikh, Anish Chandarana, Urmil Shah, Milan Chag, Hemang Baxi, Satya Gupta, Jyoti Bhatia, Vaishali Khakhkhar, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Gurpreet Singh Wander, Rohit Tandon, Vijay Chopra, Manoj Kumar, Hatinder Jeet Singh Sethi, Rashmi Verma, Sanjay Mittal, Jitendra Sawhney, Manish Kr. Sharma, Mohanan Padinhare Purayil, Bambang Budi Siswanto, RS Dr Hasan Sadikin, Pintoko Tedjokusumo, Erwan Martanto, Muhammad Munawar, Jimmy Agung Pambudi, RS Siloam Karawaci, Antonia Lukito, Ingrid Pardede, Alvin Thengker, Vito Damay, Siska Suridanda Danny, Rarsari Surarso, Takashi Noda, Ikutaro Nakajima, Mitsuru Wada, Kohei Ishibashi, Takashi Kurita, Ryoubun Yasuoka, Kuniya Asai, Kohji Murai, Yoshiaki Kubota, Yuki Izumi, Takanori Ikeda, Shinji Hisatake, Takayuki Kabuki, Shunsuke Kiuchi, Nobuhisa Hagiwara, Atsushi Suzuki, Dr Tsuyoshi Suzuki, Sang-Weon Park, Suk Keun Hong, SookJin Lee, Lim Dal Soo, Dong-Hyeok Kim, Jaemin Shim, Seong-Mi Park, Seung-Young Roh, Young Hoon Kim, Mina Kim, Jong-Il Choi, Jin Oh Na, Seung Woon Rha, Hong Seog Seo, Dong Joo Oh, Chang Gyu Park, Eung Ju Kim, Sunki Lee, Boyoung Joung, Jae-Sun Uhm, Moon Hyoung Lee, In-Jeong Cho, Hui-Nam Park, Hyung-Wook Park, Jeong-Gwan Cho, Namsik Yoon, KiHong Lee, Kye Hun Kim, Seong Hwan Kim, Sahrin Saharudin, Boon Cong Beh, Yu Wei Lee, Chia How Yen, Mohd Khairi Othman, Amie-Anne Augustine, Mohd Hariz Mohd Asnawi, Roberto Angelo Mojolou, You Zhuan Tan, Aida Nurbaini Arbain, Chii Koh Wong, Razali Omar, Azmee Mohd Ghazi, Surinder Kaur Khelae, David S.P. Chew, Lok Bin Yap, Azlan Hussin, Zulkeflee Muhammad, Mohd. Ghazi Azmee, Imran Zainal Abidin, Ahmad Syadi Bin Mahmood Zhudi, Nor Ashikin Md Sari, Ganiga Srinivasaiah Sridhar, Ahmad Syadi Mahmood Zuhdi, Muhammad Dzafir Ismail, Tiong Kiam Ong, Yee Ling Cham, Ning Zan Khiew, Asri Bin Said, Alan Yean Yip Fong, Nor Hanim Mohd Amin, Keong Chua Seng, Sian Kong Tan, Kuan Leong Yew, Jones Santos, Allan Lim, Raul Lapitan, Ryan Andal, Eleanor Lopez, Kheng Leng David Sim, Boon Yew Tan, Choon Pin Lim, Louis L.Y. Teo, Laura L.H. Chan, Ping Chai, Ching Chiew Raymond Wong, Kian Keong Poh, Poh Shuan Daniel Yeo, Evelyn M. Lee, Min Er Ching, Deanna Z.L. Khoo, Min Sen Yew, Wenjie Huang, Kui Toh Gerard Leong, Jia Hao Jason See, Yaozong Benji Lim, Svenszeat Tan, Colin Yeo, Siang Chew Chai, Fazlur Rehman Jaufeerally, Haresh Tulsidas, Than Aung, Hean Yee Ong, Lee Fong Ling, Dinna Kar Nee Soon, Hung-I Yeh, Jen-Yuan Kuo, Chih-Hsuan Yen, Juey-Jen Hwang, Kuo-Liong Chien, Ta-Chen Su, Lian-Yu Lin, Jyh-Ming Juang, Yen-Hung Lin, Fu-Tien Chiang, Jiunn-Lee Lin, Yi-Lwun Ho, Chii-Ming Lee, Po-Chih Lin, Chi-Sheng Hung, Sheng-Nan Chang, Jou-Wei Lin, Chih-Neng Hsu, Wen-Chung Yu, Tze-Fan Chao, Shih-Hsien Sung, Kang-Ling Wang, Hsin-Bang Leu, Yenn-Jiang Lin, Shih-Lin Chang, Po-Hsun Huang, Li-Wei Lo, Cheng-Hsueh Wu, Hsin-Yueh Liang, Shih-Sheng Chang, Lien-Cheng Hsiao, Yu-Chen Wang, Chiung-Ray Lu, Hung-Pin Wu, Yen-Nien Lin, Ke-Wei Chen, Ping-Han Lo, Chung-Ho Hsu, Li-Chuan Hsieh, Mann Chandavimol, Teerapat Yingchoncharoen, Prasart Laothavorn, Waraporn Tiyanon, Wanwarang Wongcharoen, Arintaya Phrommintikul, Cardiovascular Centre (CVC), and Epidemiology and Data Science

Subjects
Male, Asia, heart failure, socioeconomic factors, Social class, Sudden cardiac death, Economic inequality, Quality of life, medicine, Humans, In patient, Prospective Studies, Socioeconomic status, Ejection fraction, business.industry, INCOME INEQUALITY, Stroke Volume, Middle Aged, medicine.disease, health status disparities, quality of life, CARDIOVASCULAR-DISEASE, Heart failure, PURE, Female, HEALTH, social class, Cardiology and Cardiovascular Medicine, business, SUDDEN CARDIAC DEATH, Demography
Abstract

Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (P interaction Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.

Published
2021
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2. Empagliflozin in heart failure with a preserved ejection fraction

Author

Bela Merkely, Nikolaus Marx, Subodh Verma, Michele Senni, Eduardo Chuquiure-Valenzuela, James L. Januzzi, Vijay K. Chopra, Dong-Ju Choi, Stefan D. Anker, Stefano Taddei, Ileana L. Piña, Juan Esteban Gomez-Mesa, Jose R Gonzalez-Juanatey, Dragos Vinereanu, Sergio V. Perrone, Faiez Zannad, Jian Zhang, Carolyn Su Ping Lam, Stuart J. Pocock, Stefan Janssens, Iain Squire, Waheed Jamal, Hans-Peter Brunner-La Rocca, Peter E. Carson, Javed Butler, David K.L. Sim, EMPEROR-Preserved Trial Investigators, Stephen J. Nicholls, Hiroyuki Tsutsui, Janet Schnee, Martina Brueckmann, João Pedro Ferreira, Piotr Ponikowski, Naveed Sattar, Gerasimos Filippatos, Sven Schnaidt, Edimar Bocchi, Michael Böhm, Jindrich Spinar, Cordula Zeller, Nadia Giannetti, Milton Packer, Anker, S, Butler, J, Filippatos, G, Ferreira, J, Bocchi, E, Böhm, M, Brunner-La Rocca, H, Choi, D, Chopra, V, Chuquiure-Valenzuela, E, Giannetti, N, Gomez-Mesa, J, Janssens, S, Januzzi, J, Gonzalez-Juanatey, J, Merkely, B, Nicholls, S, Perrone, S, Piña, I, Ponikowski, P, Senni, M, Sim, D, Spinar, J, Squire, I, Taddei, S, Tsutsui, H, Verma, S, Vinereanu, D, Zhang, J, Carson, P, Lam, C, Marx, N, Zeller, C, Sattar, N, Jamal, W, Schnaidt, S, Schnee, J, Brueckmann, M, Pocock, S, Zannad, F, Packer, M, EMPEROR-Preserved Trial, I, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H02 Cardiomyopathy

Subjects
Adult, Male, medicine.medical_specialty, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Empagliflozin, Preserved Ejection Fraction, Placebo, chemistry.chemical_compound, All institutes and research themes of the Radboud University Medical Center, Double-Blind Method, Glucosides, Diabetes mellitus, Internal medicine, medicine, Humans, Benzhydryl Compounds, Sodium-Glucose Transporter 2 Inhibitors, Heart Failure, Ejection fraction, business.industry, Hazard ratio, Stroke Volume, General Medicine, Stroke volume, medicine.disease, SPIRONOLACTONE, Hospitalization, chemistry, Cardiovascular Diseases, Heart failure, Chronic Disease, Cardiology, Spironolactone, Female, business
Abstract

Item does not contain fulltext BACKGROUND: Sodium-glucose cotransporter 2 inhibitors reduce the risk of hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, but their effects in patients with heart failure and a preserved ejection fraction are uncertain. METHODS: In this double-blind trial, we randomly assigned 5988 patients with class II-IV heart failure and an ejection fraction of more than 40% to receive empagliflozin (10 mg once daily) or placebo, in addition to usual therapy. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. RESULTS: Over a median of 26.2 months, a primary outcome event occurred in 415 of 2997 patients (13.8%) in the empagliflozin group and in 511 of 2991 patients (17.1%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.69 to 0.90; P

Published
2021

3. Large-Scale Whole-Genome Sequencing of Three Diverse Asian Populations in Singapore

Author

Degang Wu, Jinzhuang Dou, Xiaoran Chai, Claire Bellis, Andreas Wilm, Chih Chuan Shih, Wendy Wei Jia Soon, Nicolas Bertin, Clarabelle Bitong Lin, Chiea Chuen Khor, Michael DeGiorgio, Shanshan Cheng, Li Bao, Neerja Karnani, William Ying Khee Hwang, Sonia Davila, Patrick Tan, Asim Shabbir, Angela Moh, Eng-King Tan, Jia Nee Foo, Liuh Ling Goh, Khai Pang Leong, Roger S.Y. Foo, Carolyn Su Ping Lam, Arthur Mark Richards, Ching-Yu Cheng, Tin Aung, Tien Yin Wong, Huck Hui Ng, Jianjun Liu, Chaolong Wang, Matthew Andrew Ackers-Johnson, Edita Aliwarga, Kenneth Hon Kim Ban, Denis Bertrand, John C. Chambers, Dana Leng Hui Chan, Cheryl Xue Li Chan, Miao Li Chee, Miao Ling Chee, Pauline Chen, Yunxin Chen, Elaine Guo Yan Chew, Wen Jie Chew, Lynn Hui Yun Chiam, Jenny Pek Ching Chong, Ivan Chua, Stuart A. Cook, Wei Dai, Rajkumar Dorajoo, Chuan-Sheng Foo, Rick Siow Mong Goh, Axel M. Hillmer, Ishak D. Irwan, Fazlur Jaufeerally, Asif Javed, Justin Jeyakani, John Tat Hung Koh, Jia Yu Koh, Pavitra Krishnaswamy, Jyn Ling Kuan, Neelam Kumari, Ai Shan Lee, Seow Eng Lee, Sheldon Lee, Yen Ling Lee, See Ting Leong, Zheng Li, Peter Yiqing Li, Jun Xian Liew, Oi Wah Liew, Su Chi Lim, Weng Khong Lim, Chia Wei Lim, Tingsen Benson Lim, Choon Kiat Lim, Seet Yoong Loh, Au Wing Lok, Calvin W.L. Chin, Shivani Majithia, Sebastian Maurer-Stroh, Wee Yang Meah, Shi Qi Mok, Niranjan Nargarajan, Pauline Ng, Sarah B. Ng, Zhenyuan Ng, Jessica Yan Xia Ng, Ebonne Ng, Shi Ling Ng, Simon Nusinovici, Chin Thing Ong, Bangfen Pan, Vincent Pedergnana, Stanley Poh, Shyam Prabhakar, Kumar M. Prakash, Ivy Quek, Charumathi Sabanayagam, Wei Qiang See, Yee Yen Sia, Xueling Sim, Wey Cheng Sim, Jimmy So, Dinna K.N. Soon, E. Shyong Tai, Nicholas Y. Tan, Louis C.S. Tan, Hong Chang Tan, Wilson Lek Wen Tan, Moses Tandiono, Amanda Tay, Sahil Thakur, Yih Chung Tham, Zenia Tiang, Grace Li-Xian Toh, Pi Kuang Tsai, Lavanya Veeravalli, Chandra S. Verma, Ling Wang, Min Rui Wang, Wing-Cheong Wong, Zhicheng Xie, Khung Keong Yeo, Liang Zhang, Weiwei Zhai, Yi Zhao, Cardiovascular Centre (CVC), Lee Kong Chian School of Medicine (LKCMedicine), and School of Biological Sciences

Subjects
Male, medicine.medical_specialty, Demographic history, Population, Genome-wide association study, HAPLOTYPE, Biology, VARIANTS, Polymorphism, Single Nucleotide, General Biochemistry, Genetics and Molecular Biology, ANCESTRY ESTIMATION, 03 medical and health sciences, 0302 clinical medicine, Whole-genome Sequencing, Asian People, HISTORY, medicine, Humans, WIDE ASSOCIATION, Medicine [Science], Selection, Genetic, education, ADAPTATION, 030304 developmental biology, Whole genome sequencing, Singapore, 0303 health sciences, Genetic diversity, education.field_of_study, Whole Genome Sequencing, Asian Populations, Genome, Human, Malaysia, Human genetics, GENOTYPE, MODEL, Genetics, Population, Evolutionary biology, Medical genetics, Female, HEALTH, HUMAN-EVOLUTION, 030217 neurology & neurosurgery, Imputation (genetics)
Abstract

Underrepresentation of Asian genomes has hindered population and medical genetics research on Asians, leading to population disparities in precision medicine. By whole-genome sequencing of 4,810 Singapore Chinese, Malays, and Indians, we found 98.3 million SNPs and small insertions or deletions, over half of which are novel. Population structure analysis demonstrated great representation of Asian genetic diversity by three ethnicities in Singapore and revealed a Malay-related novel ancestry component. Furthermore, demographic inference suggested that Malays split from Chinese ∼24,800 years ago and experienced significant admixture with East Asians ∼1,700 years ago, coinciding with the Austronesian expansion. Additionally, we identified 20 candidate loci for natural selection, 14 of which harbored robust associations with complex traits and diseases. Finally, we show that our data can substantially improve genotype imputation in diverse Asian and Oceanian populations. These results highlight the value of our data as a resource to empower human genetics discovery across broad geographic regions. Agency for Science, Technology and Research (A*STAR) National Medical Research Council (NMRC) National Research Foundation (NRF) Accepted version We acknowledge H.M. Kang, S. Das, A. Tan, F. Zhang, J. Terhorst, P.-R. Loh, and G. Hellenthal for helpful discussions and support from all participants and clinical research coordinators of the contributing cohorts and studies: the TTSH Healthy Control Workgroup, the SEED cohort, the Asian Sudden Cardiac Death in Heart Failure Study, the Singapore Heart Failure Outcomes and Phenotypes (SHOP) cohort, the Asian neTwork for Translational Research and Cardiovascular Trials (ATTRaCT), the Parkinson’s Disease Study, the Peranakan Genome Study, the Platinum Asian Genomes Project, the Bariatric Surgery Study, the National Heart Centre Singapore Biobank and SingHEART cohorts, and the GUSTO and S-PRESTO study groups. This study was supported by Singapore’s A*STAR (core funding and IAF-PP H17/01/a0/007), BMRC (SPF2014/001, SPF2013/002, SPF2014/003, SPF2014/004, and SPF2014/005), NMRC (CIRG/1371/2013, CIRG/1417/2015, CIRG/1488/ 2018, CSA-SI/0012/2017, CG/017/2013, CG/M006/2017_NHCS, TCR/013- NNI/2014, STaR/0011/2012, STaR2013/001, STaR/014/2013, STaR/0026/ 2015, TCR/006-NUHS/2013, TCR/012-NUHS/2014, TCR/004-NUS/2008, TCR/012-NUHS/2014, and center grants 2010-13 and 2013-2017), NRF (NRFF2016-03), National University of Singapore, SingHealth and DukeNUS, and Alexandra Health small innovative grant SIGII/15203 and funding from Huazhong University of Science and Technology, the Tanoto Foundation, the Lee Foundation, the Boston Scientific Investigator Sponsored Research Program and Bayer, the NSF (DEB-1753489), and the Alfred P. Sloan Foundation. The computation was partially performed on resources of the National Supercomputing Centre, Singapore (https://www.nscc.sg).

Published
2019

4. Correlation of the New York Heart Association Classification and the 6-Minute Walk Distance: A Systematic Review

Author

Jonathan, Yap, Fang Yi, Lim, Fei, Gao, Ling Li, Teo, Carolyn Su Ping, Lam, and Khung Keong, Yeo

Subjects
Adult, Aged, 80 and over, Heart Failure, Male, Exercise Tolerance, Time Factors, Age Factors, Clinical Investigations, Reproducibility of Results, Walking, Middle Aged, Sex Factors, Predictive Value of Tests, Exercise Test, Linear Models, Humans, Female, Aged
Abstract

BACKGROUND: Functional status assessment is the cornerstone of heart failure management and trials. The New York Heart Association (NYHA) classification and 6‐minute walk distance (6MWD) are commonly used tools; however, the correlation between them is not well understood. HYPOTHESIS: We hypothesised that the relationship between the NYHA classification and 6MWD might vary across studies. METHODS: A systematic literature search was performed to identify all studies reporting both NYHA class and 6MWD. Two reviewers independently assessed study eligibility and extracted data. Thirty‐seven studies involving 5678 patients were included. RESULTS: There was significant heterogeneity across studies in 6MWD within all NYHA classes: I (n = 16, Q = 934.2; P

Published
2015

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