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Aims: There remains a large emphasis on optimisation of guideline-directed medical therapy (GDMT) during the ‘vulnerable phase’ of acute heart failure (HF). Multidisciplinary team heart failure (MDT-HF) clinics have been shown to be beneficial in increasing key GDMT prescriptions. The aim of this study was to report on the authors’ experience running the first Malaysian early, post-discharge MDT-HF clinic. Methods: A retrospective review of the MDT-HF clinic was conducted in Institut Jantung Negara, Malaysia, over a 3-year period (2019–22). Results: A total of 186 patients and 488 clinic encounters were identified. Patients were mainly of New York Heart Association functional class II (45.2%) and had a mean left ventricular ejection fraction of 26.1%. Blood investigations on average were stable, aside from estimated glomerular filtration rate (≤60 ml/min/1.73 m2 in 53.2% of patients) and NT-pro-brain natriuretic peptide (mean of 5,201 pg/ml). Common comorbidities included diabetes (60.0%), hypertension (60.0%), dyslipidaemia (46.2%) and chronic kidney disease (38.2%). A high proportion of new prescriptions and uptitration of medication were for key GDMTs, while the majority of downtitrations were for diuretics. A substantial number of patients were on three or four GDMTs (37.6% and 49.5%, respectively). Counselling provided during the MDT-HF clinic was also analysed, which included education on self-care and medication management, and lifestyle counselling. Conclusion: MDT-based services offer evidence-based, holistic care to HF patients. Hopefully, this description of the establishment of the first MDT-HF clinic should encourage the development of similar services across the region.

Background: There is sparsity in regional data surrounding heart failure with preserved ejection fraction (HFpEF)-related acute decompensated heart failure (ADHF) admissions in southeast Asia. This study aims to describe the characteristics, clinical parameters and outcomes related to HFpEF-linked ADHF admissions. Methods: A retrospective, observational study was conducted in a major cardiac tertiary centre in Malaysia over a 10-year period (2009–2018). A total of 4,198 patients were identified, of which 632 had HFpEF. Results: HFpEF patients were significantly older (mean 67.6 years) and female (52.2%). A high proportion of HFpEF patients had hypertension (73.4%), diabetes (58.1%), coronary artery disease (57.9%) and ischaemic cardiomyopathy (50.8%), although this remains significantly lower versus non-HFpEF patients. Atrial fibrillation (AF) was more common among HFpEF patients (34.7%). HFpEF patients in the study population appeared relatively stable, compared to non-HFpEF patients, supported by better blood results (suggestive of less congestion) on admission, shorter duration of inpatient stay, lower use of emergency cardiac procedures, lower in-hospital mortality rates and lower rates of HF readmission and all-cause mortality. However, when compared to other registries, specifically the ASIAN-HF cohort, HF readmission and all-cause mortality within the first year were higher in the present study cohort (37.9%, versus 12.1–23.6%). Conclusion: The present study highlights key characteristics of HFpEF patients in Malaysia and challenges the notion of the five major phenotypes of HF proposed by previous studies. Therefore, granularity in data collection and analysis is key, especially in a heterogenous condition like HFpEF, and efforts should be improved to obtain more information on local HFpEF patients.

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease.

Patient Initials or Identifier Number ABM ### Relevant Clinical History and Physical Exam A 56 years old, diabetic, hypertensive, active smoker, presented with chest pain for 4 days. He had a history of percutaneous coronary intervention to Left anterior descending (LAD) and right coronary