This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
i
Disclaimer:
The content of this report is based on information mainly gathered from published secondary sources. Although best efforts have been made to ensure that the information and data contained here is reliable, no representations are made as to its completeness, timeliness or quality. Majority of data originated from the Ministry of Health institutions hence generalizability is limited to the population of which they represent. Anyone may reproduce, publish or otherwise use the content of this report as the concepts and information herein are already in the public domain. However, acknowledgement to Malaysian Healthcare Performance Unit, Ministry of Health Malaysia would be appreciated.
Suggested citation is: Malaysia Acute Coronary Care Performance Report 2016 (2017) Malaysian Healthcare Performance Unit, Ministry of Health Malaysia, Kuala Lumpur.
Acknowledgement of Publication:
We would like to thank the Director General of Health Malaysia, for his permission to publish this article.
Published by:
Malaysian Healthcare Performance Unit National Institute of Health, c/o Deputy Director General (Research and Technical Support) Office Ministry of Health Malaysia Block E7, Federal Government Administrative Centre 62590 Putrajaya, Malaysia. Tel : (603) 8000 8000 Fax : (603) 8888 6187 Email : [email protected], [email protected]
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
ii
FOREWORD 1
Needless to say that Cardiovascular disease is one of our top priority in term of burden of disease as well as the impact it can have on both quality of life as well as economic impact on the family and the nation. Hence it is imperative for us as custodians of health for the nation to start performance assessment of our health services in this area.
This proof of concept is preliminary evidence that good team effort of clinicians, public health specialists, data holders and MHP can result in something meaningful for future improvement.
Although as a starter this report is limited to Acute Coronary care performance, I anticipate that eventually it will evolve to be more holistic in nature spanning the entire subsystem for Cardiovascular Disease Care, including both natural as well as clinical pathway where possible. This means that it should cover performance from health promotion, preventive, curative right up to rehabilitative care. The idea is not only must we go beyond average level of provision of care and the ensuing outcomes, but also to narrow the unfavourable variations and improve equity.
My advice is for all stakeholders to start using this and future reports for their policy and decision making with the common aim in mind for better care and better outcome for our rakyat!!
YBhg Datuk Dr Noor Hisham Abdullah Director General of Health Ministry of Health, Malaysia
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
iii
FOREWORD 2
MHP is the DG’s aspiration – as a mean to have a governance tool for monitoring and evaluating performance of the health system or subsystems.
2016 was MHP third year and this report is their second attempt at assessing a selected subsystem (disease-specific) performance assessment, their first being the cardiovascular care performance report.
The attempt to introduce performance assessment using scorecards is rather new in the nation’s health arena – people need to adapt to it and soon when they find it useful the work will become less challenging.
I must acknowledge that MHP have been successful in engaging the various stakeholders and data holders in converting readily available data into actionable information.
However there will always be room for future improvement, building on lessons learnt from this first report. I urge all the pertinent players to make use of the report.
Again I would like to remind that this report belongs to us; it is our assessment of our system, and thus we welcome any constructive feedbacks or comments.
Lastly I would like to thank all those who have contributed in many ways to make our DG’s aspiration a reality.
YBhg Datuk Dr Shahnaz Murad Deputy Director General of Health (Research and Technical Support) Ministry of Health, Malaysia
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
iv
ACKNOWLEDGEMENTS
We wish to thank YBhg. Datuk Dr Noor Hisham bin Abdullah, Director General of Health and Datuk Dr Shahnaz binti Murad, the Deputy Director General of Health (Research & Technical Support) for their guidance. We also sincerely thank the Director of National Clinical Research Centre, Dr Goh Pik Pin for her strong support. Acknowledgement of contribution goes to all state health directors and other stakeholders listed below:-
Y.Bhg. Datuk Dr Lokman Hakim b. Sulaiman Timbalan Ketua Pengarah Kesihatan (Kesihatan Awam) Kementerian Kesihatan Malaysia
Y.Bhg. Dato' Dr Hj Azman bin Abu Bakar Pengarah Bahagian Perkembangan Perubatan Kementerian Kesihatan Malaysia
Dr Md. Khadzir bin Sheikh Hj. Ahmad Timbalan Pengarah Pusat Informatik Kesihatan (PIK) Kementerian Kesihatan Malaysia
External reviewer
Professor Niek Klazinga
Health Care Quality Indicator Project Directorate for Employment, Label, and Social Affair (OECD)
Contributors
Dr. Jamilah Hashim Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Sarawak
Datuk Dr. Christina Rundi Pengarah Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Sabah
Dr. Sakinah Alwi Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Perlis
Dato’ Dr. Norhizan Ismail Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Kedah
Dato’ Dr. Hj. Ahmad Razin Dato’ Hj. Ahmad Mahir Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Kelantan
Dr. Saifur Rahman Muhammad Wakil Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Terengganu
Dr Julian Tey Hock Chuan Wakil Pengarah Kesihatan Negeri Jabatan Kesihatan Negeri Melaka
Dr. Nur Zulaiha Wakil Pengarah Kesihatan Negeri Jabatan Kesihatan Pulau Pinang
Dato' Dr Omar bin Ismail Pakar Perunding Kanan Kardiologi & Ketua Jabatan Kardiologi, Hospital Pulau Pinang
Dato' Dr. Mohd Hamzah bin Kamarulzaman Pakar Perunding Kanan Kardiotorasik Hospital Serdang
Dr. Abdul Kahar Bin Abdul Ghapar Pakar Perunding Kanan Kardiologi & Ketua Jabatan Kardiologi, Hospital Serdang
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
v
Dr G. R. Letchuman Ramanathan Pakar Perunding Kanan Perubatan & Ketua Jabatan Perubatan, Hospital Raja Permaisuri Bainun, Ipoh
Dr. Rozlan B Ishak Timbalan Pengarah, Cawangan Penyakit Tidak Berjangkit Bahagian Kawalan Penyakit
Dr. Fatanah Binti Ismail Ketua Penolong Pengarah Kanan, Cawangan Kesihatan Primer Bahagian Pembangunan Kesihatan Keluarga
Dr Paa Mohamed Nazir Bin Abdul Rahman Pakar Perubatan Kesihatan Awam, Cawangan Kualiti Penjagaan Perubatan Bahagian Perkembangan Perubatan
Dr. Muhammad Fadhli Bin MohdYusoff Pakar Perubatan Kesihatan Awam, Pusat Penyelidikan Penyakit Tidak Berjangkit, Institut Kesihatan Umum
Dr. Rotina Binti Abu Bakar Ketua Penolong Pengarah Kanan, Bahagian Kawalan Penyakit
Datin Dr. Siti Haniza Mahmud Pegawai Penyelidik, Institut Penyelidikan Sistem Kesihatan
Dr Nur Athirah Imran Penolong Pengarah Kanan Pusat Informatik Kesihatan
Dr Foo Chee Yong Pegawai Perubatan, Healthcare Statistics Unit, Pusat Penyelidikan Klinikal Kebangsaan
Dr Chin May Chien Pegawai Perubatan, Healthcare Statistics Unit, Pusat Penyelidikan Klinikal Kebangsaan
Matron Pn Jalalah Mohamad Penolong Pengarah Bahagian Kejururawatan
Puan Viola Michael Pegawai Dietetik, Unit NCD/CVS Diabetes, Bahagian Kawalan Penyakit
Ms. Gunavathy Selvaraj NCVD Registry National Heart Association Malaysia
Malaysian Healthcare Performance Unit
Team lead:
Dr. Jamaiyah Haniff
Project lead:
Dr Mohd Kamarulariffin Kamarudin
Members:
Dr Nor Aini Abdullah Dr Theyveeka Selvy Rajoo Dr Ariza Zakaria Cik Nuramalina Abdullah
vi
Contents
List of tables ...................................................................................................................................................................... vii
List of figures .................................................................................................................................................................... vii
List of abbreviations .................................................................................................................................................... viii
EXECUTIVE SUMMARY ................................................................................................................................................. ix
ACUTE CORONARY CARE PERFORMANCE SCORECARD ..................................................................................x
Chapter 1 Introduction ................................................................................................................................................... 1
Background .................................................................................................................................................................... 2
Report Objectives ........................................................................................................................................................ 2
Methodology & Analysis ........................................................................................................................................... 3
Chapter 2 Malaysian Coronary Heart Disease Profiling ................................................................................... 8
Disease Demographics ............................................................................................................................................... 9
Coronary Heart Disease Risk Factors Prevalence ....................................................................................... 11
Chapter 3 Cardiac Care Performance Indicators .............................................................................................. 14
Where we stand ......................................................................................................................................................... 15
Human Resources & Facility ................................................................................................................................ 16
Process of Care ........................................................................................................................................................... 19
Health Outcome ......................................................................................................................................................... 22
Admission Rate ..................................................................................................................................................... 22
30-day Case Fatality after Acute Myocardial Infarction ...................................................................... 24
Conclusion ................................................................................................................................................................... 27
Recommendations .................................................................................................................................................... 28
Bibliography .................................................................................................................................................................... 29
GLOSSARY ......................................................................................................................................................................... 30
APPENDIX ......................................................................................................................................................................... 32
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
vii
LIST OF TABLES
Table 1: Data availability, coverage, and levels of disaggregation of selected performance indicators ............................................................................................................................................................................. 5 Table 2: Cardiovascular disease (CVD) risk factor prevalence, 2015. .................................................... 12 Table 3: State variation of CVD risk factor prevalence, 2015. .................................................................... 12 Table 4: Number & density of cardiologist, cardiothoracic surgeon and cardiac catheterization laboratory, 2013. ........................................................................................................................................................... 16 Table 5: State variation of number & density (per 1 000 000 population) of cardiologist, cardiothoracic surgeon and cardiac catheterization laboratory, 2013. .................................................. 18 Table 6: Percentage of STEMI patients who received timely fibrinolysis therapy and the median time-to-intervention, 2013. ....................................................................................................................................... 20 Table 7: Hospital admission rate (per 100 000 population) for acute coronary syndrome (ACS), 2013. ................................................................................................................................................................................... 23 Table 8: State variation of hospital admission rate for ACS (per 100 000 population), 2013. ...... 23 Table 9: 30-day case fatality rate for ACS patients, 2013 ............................................................................ 26
LIST OF FIGURES
Figure 1: Breakdown of cases by age groups, 2013 .......................................................................................... 9 Figure 2: Breakdown of cases by ethnicity, 2013 .............................................................................................. 9 Figure 3: Age-specific prevalence of ACS, 2010-2013 .................................................................................. 10 Figure 4: National hypertension prevalence progression 18+, 2006-2015 ......................................... 11 Figure 5: National hypercholesterolemia prevalence progression 18+, 2006-2015 ....................... 11 Figure 6: National diabetes prevalence progression 18+, 2006-2015 ................................................... 11 Figure 7: National daily smoker prevalence progression by gender 15+, 2006-2015 .................... 11 Figure 8: Malaysian rankings of selected performance indicators .......................................................... 15 Figure 9: Proportion of cardiologist (public vs private) and the total cardiologist density by state, 2013 ........................................................................................................................................................................ 17 Figure 10: Proportion of cardiothoracic surgeon (public vs private) and the total cardiothoracic surgeon by state, 2013 ................................................................................................................................................ 17 Figure 11: Median DTN time 2006-2013 ............................................................................................................ 19 Figure 12: Median DTB time 2006-2013 ............................................................................................................ 19 Figure 13: Rate of fibrinolysis, 2006-2013 ........................................................................................................ 20 Figure 14: Rate of primary PCI, 2006-2013 ...................................................................................................... 20 Figure 15: State variation of door-to-needle time achievement ............................................................... 21 Figure 16: Hospital admission rate for STEMI ................................................................................................. 22 Figure 17: Hospital admission rate for NSTEMI .............................................................................................. 22 Figure 18: Hospital admission rate for unstable angina .............................................................................. 22 Figure 19: 30-day case fatality rate after STEMI, 2006-2013 .................................................................... 24 Figure 20: 30-day case fatality rate after AMI, 2006-2013 ......................................................................... 24 Figure 21: State variation of in-hospital NSTEMI/UA case fatality rate, 2013 vs 2014 .................. 25 Figure 22: State variation of in-hospital STEMI case fatality rate, 2013 vs 2014 .............................. 25
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
viii
LIST OF ABBREVIATIONS
AAR Average Annual Rate of Change
ACS Acute Coronary Syndrome
AMI Acute Myocardial Infarction
BMI Body Mass Index
BP Blood Pressure
CHD Coronary Heart Disease
CHF Congestive Heart Failure
CPG Clinical Practice Guideline
CKPP Clinical Performance Surveillance Unit
CVD Cardiovascular Disease
DTB Door-to-balloon Time
DM Diabetes Mellitus
DTN Door-to-needle Time
ECG Electrocardiogram
ED Emergency Department
GP General Practitioner
KOSPEN Komuniti Perkasa Negara
LDL Low Density Lipoprotein
NCD Non-communicable Disease
NCVD National Cardiovascular Database
NDR National Diabetes Registry
NHEWS National Health Care Establishment and Workforce Statistics
NHMS National Health and Morbidity Survey
NSTEMI Non-ST-elevation Myocardial Infarction
OECD Organization for Economic Cooperation and Development
PCI Percutaneous Coronary Intervention
SMRP Sistem Maklumat Rawatan Perubatan
STEMI ST-elevation Myocardial Infarction
UA Unstable Angina
WHO World Health Organization
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
ix
EXECUTIVE SUMMARY
Malaysian cardiovascular scenarios
National health and Morbidity Survey (NHMS) shows significant increase in the prevalence of
diabetes and hypercholesterolemia over the last 10 years period, with high proportion are made up
of undiagnosed cases. This phenomenon will likely contribute to the increasing burden of NCDs in
Malaysia.
Cigarette smoking among the male population is a concern. The prevalence of Malaysian male
smokers is almost 2-fold of the prevalence reported in most OECD countries. The high prevalence of
smoking seems to correlate with high mortality secondary to cardiovascular disease.
In addition, for every 100 cases of AMI admitted to our hospitals, close to 10% succumbed to death
within 30-days, a rate that is higher than an average OECD country.
Resources and facilities
We observed a positive growth in human resources related to cardiology and cardiothoracic services
from 2009 to 2013. The number of cardiologist and cardiothoracic surgeon are increasing at a rate of
9% and 5.4% respectively.
However, there is evidence of uneven distribution of cardiologists and cardiothoracic surgeons
reported between sectors and states with majority based in private sector.
More cardiac catheterization laboratories are available in private sector compared to public sector.
Some states like Melaka, Negeri Sembilan and Perlis have no such facility in public hospitals at all.
Process of care
More than half of eligible patients did not receive timely PCI.
Recent data shows about 94% of cases achieved fibrinolysis therapy initiation within 30 minutes of
arrival to Emergency Department.
Outcome
Overall increase in acute coronary syndrome hospital admission reflects the growing burden of
disease attributable to cardiovascular diseases.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
x
ACUTE CORONARY CARE PERFORMANCE SCORECARD
Year Achievement AAR (%)
AAR
period Standard
Input
4.3. Cardiologist per 1 000 000 populationPP
2013 8 - - -
4.4. Cardio-thoracic surgeon per 1 000 000 populationPP
2013 3 - - -
4.5. Cardiologist public : private ratio 2013 1 : 4 - - -
4.6. Cardiothoracic surgeon public : private ratio
2013 1 : 2 - - -
4.7. Ratio of public : private with cardiac catheterization laboratory
2014 1 : 4 - - -
Process of care
6.1. % of fibrinolysis with door-to-needle time < 30 minutesP
2014 94% ↓0.3 2013-2014 >85%1
6.2. Median door-to-needle-time (minute)PP
2013 49 - - <302
6.3. Median door-to-balloon time (minute)PP
2013 104 - - <902
6.4. % of STEMI not given fibrinolytic therapy due to missed thrombolysis timePP
2013 11% ↓2.4 2006-2013 -
6.5. Rate of fibrinolytic therapyPP 2013 74% ↑0.8 2006-2013 -
6.6. Rate of primary PCIPP 2013 10% ↑3.5 2006-2010 -
Outcome (Admission)
7.1. Admission rate for UA (per 100 000)PP
2013 112 ↓4.8 2010-2013 -
7.2. Admission rate for STEMI (per 100 000)PP
2013 20 ↑12 2010-2013 -
7.3. Admission rate for NSTEMI (per 100 000)PP
2013 20 ↑36 2010-2013 -
P Public sector only
PP Public and private sector
1 Cawangan Kualiti Penjagaan Perubatan 2 Clinical Practice Guidelines, Management of Acute ST Segment Elevation Myocardial Infarction 2014
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
xi
Year Achievement AAR
(%) AAR period Standard
Outcome (Mortality)
9.1. 30-day case fatality after STEMIPP 2013 11.4% ↓8.5 2006-2013 -
9.2. 30-day case fatality after AMI
(STEMI & NSTEMI)PP 2013 10.9% ↓11 2006-2013
9.3. In-hospital STEMI case fatality
ratePP 2013 5.9% ↓8.7 2008-2013 ≤15%
1
9.4. In-hospital UA/NSTEMI case fatality
ratePP 2013 3.3% ↓16 2008-2013 ≤10%
1
Impact
2.1. Prevalence of hypertension 2015 30.3% ↓0.7 2006-2015 -
2.2. Prevalence of hypercholesterolemia 2015 47.7% ↑9.7 2006-2015 -
2.3. Prevalence of diabetes 2015 17.5% ↑4.7 2006-2015 -
2.4. Prevalence of obesity 2015 30.6% ↑9.1 2006-2015 -
2.5. Prevalence of daily tobacco smoker,
male 2015 38.8% ↑3.9 2011-2015 -
2.6. Prevalence of daily tobacco smoker,
female 2015 1.1% →0.0 2011-2015 -
P Public sector only
PP Public and private sector
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
1
CHAPTER 1 INTRODUCTION
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
2
BACKGROUND
National Health and Morbidity (NHMS) survey, a series of community-based survey on the pattern of
common health problems, health service utilisation and health expenditure in Malaysia reports a
steady uprising of cardiovascular risk factor prevalence from 1986 to 2015. The latest findings
support the current concerns of increasing disease burden with one in three Malaysians diagnosed
with hypertension; about one in five diagnosed with hypercholesterolemia; and one fifth found to be
suffering from diabetes (Institute for Public Health, 2015) . The high risk factor prevalence is
expected to contribute significantly to the incidence of cardiovascular diseases namely the acute
coronary syndrome (ACS) and stroke.
Health promotion and disease prevention remain the most efficient strategies to reduce burden of
disease. They provide opportunities to curb diseases at earlier stages when they are often more
responsive to treatment. However, the implementation of any preventive programmes or
interventions must be monitored and evaluated on a regular basis to understand the underlying
processes that may have resulted in unintended outcomes.
Many different divisions within the Ministry of Health have been collecting data in various aspect of
health care as part of administrative, academic, clinical and quality improvement work. Malaysian
Healthcare Performance unit (MHPU) was established to transform those various databases into
actionable information as well as to benchmark health performance against best practices locally or
internationally. We aim to identify variation in practices and health outcomes within the health
system in order to promote health care innovation and improvement of the care delivery.
This report is intended to serve as a foundation of a more comprehensive reporting work pertaining
to cardiac care performance in Malaysia. Cardiac care encompasses multitude of cardiovascular
services inclusive of cardiac and thoracic surgical services across all age categories (Ministry of
Health, Cardiothoracic Surgery Services Operational Policy, 2011). This current report focuses only
on performance assessment of acute coronary care before the year 2015 following a framework that
incorporates various health care system and quality domains used by the World Health Organization
WHO (World Health Organization, 2003).
The report consists of three chapters. The first chapter is an introduction to performance
assessment work, the report methodology and analysis. The second chapter describes the
demographic profiling of the population with acute coronary syndrome (ACS) diagnosis. The third
chapter reports statistics concerning the service inputs and resources, the critical aspect of process
of care in adults with acute coronary syndrome and the outcomes.
REPORT OBJECTIVES
1. To describe the magnitude of acute coronary syndrome burden in Malaysia.
2. To describe the performance of acute coronary care based on latest available data.
3. To show the performance trending information
4. To describe variation in performance by state
5. To benchmark performance against OECD countries or other selected comparator countries.
6. To propose strategy to improve Cardiovascular Health care nationwide, aiming to achieve
international standards
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
3
METHODOLOGY & ANALYSIS
We employed disease-based approach to reflect performance across programme and services. The
choice of acute coronary care as the topic is in keeping with the findings of Malaysian Burden of
Disease and Injury study (Ahmad Faudzi Yusoff, Gurpreet Kaur, Mohd Azahadi Omar, & Amal Nasir
Mustafa, 2004) that revealed ischemic heart disease and cerebrovascular disease as the top
contributors to mortality and disability-adjusted life year (DALY) in Malaysia.
Literature search was done on the topic related to quality improvement and healthcare performance
assessment for coronary heart disease using online search engines. The searching was purposive
with priority given to review articles and local studies that mention performance in cardiac care or
its equivalence. A table comprising a list of indicators was constructed and filled along as new
indicators were found and described in the literature during the literature search period. The
indicators were grouped into the domains of input, process, outcome and impact that reflect
Donabedian’s conceptual model of assessing quality in health system (Avedis Donabedian, John R. C.
Wheeler, & Leon Wys, 1982). Each indicator was first deliberated by MHPU team members on the
suitability (relevance in local context) and potential data sources.
Majority of the indicators and their definition were taken verbatim from their respective source
documents. These are the commonly used indicators to describe health system performance
internationally. However, some of the indicators were replaced with an equivalent proxy to
accommodate local data definition and data availability. Corresponding data were synthesised from
published documents and reports; they were then reconstructed into a data frame in an electronic
spread sheet. Majority were published data of aggregate number or rate at either state or national
level. Detailed information on the datasets used and their sources, coverage, and levels of
disaggregation are given in Table 1.
Data cleaning process involved manual tracking of wrongly entered value by at least one other
person using the original source documents as reference. A statistician service was utilised for data
proof-reading and reviewing of mathematical formula and rate calculation. If any discrepancies,
correction will be done on the master spread sheet by the same person who constructed the data
frame.
Analysis largely involved visual analytics; plotting data using column or line graph- looking at the
trend over time or constructing three dimensional scatter plots- assessing the visual correlation. No
adjustment or standardization of rate was attempted.
In this report, performance is described in four ways:
1. Whether or not Malaysia has reached a specific achievement target.
- Health related activities and outcomes are measurable; a target is ideally set to assess
the progress of any implemented strategy in health promotion or intervention.
2. Whether there have been desirable changes in latest achievement compared to the
achievement in previous years.
- Desirable changes are expected trend in achievement based on historical data. An
increasing trend is desirable for positive outcomes while decreasing trend is desirable
for unwanted outcomes.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
4
3. The average annual rate of change (AAR) of the achievements over a time period ;
- AAR is calculated by taking the geometric mean of the annual percentage difference
between the baseline achievement (beginning value) and the current achievement
(ending value) with the assumption that the achievements have been compounding
discretely over the specified period. The mathematical formula is given by:
AAR = (
)(
)
4. Malaysia achievement in comparison with selected OECD countries and other comparator
countries.
- OECD has an online updated database that conglomerate common statistics from
various member countries in time series. OECD as a benchmark is our attempt to close
the gap so as to achieve the standard enjoyed by developed nations. OECD online
database can be accessed through stats.oecd.org
All indicators along with the data were discussed with and presented to the respective stakeholders
for reconciliation. Improvement and additional work were tailored according to the stakeholders’
suggestions and needs.
Findings are reported using the following symbols and colour codes: ↑ Increased since previous year Desirable change ↓ Decreased since previous year Indicator of concern → Remained the same since previous year Status quo - Missing or unavailable information
A note about making comparisons (limitation):
All indicators are presented in crude measure without adjustment to baseline characteristics or risks. Therefore, comparability of rates between different periods of data collection or regions is limited.
The report findings are based on secondary aggregated data. Degree of ascertainment, duplications, and missing data could not be fully verified.
Majority of data represents only the public institutions and Ministry of Health sector although the interpretations in this report are meant to describe the Malaysian scenarios as whole. Potentially, there are data from other sectors that have yet to be explored by the time this report is published
Due to the nature of this report that used aggregated data from multiple sources, direct causality or longitudinal relationship cannot be assessed and the findings cannot be inferred without estimate adjustment or predictive modelling.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
5
Table 1: Data availability, coverage, and levels of disaggregation of selected performance indicators
Indicator Time period Coverage Data source Domain
1. Number of Cardiologist 2009-2013 By state
By sector
NHEWS
(Published)
NCVD (Published)
Input
2. Number of Cardiothoracic surgeon 2009-2013 By state
By sector
NHEWS
(Published) Input
3. Cardiologist density per 100 000 population
2009-2013 By state NHEWS
(Published) Input
4. Cardio-thoracic surgeon density per 100 000 population
2009-2013 By state NHEWS
(Published) Input
5. Number of hospital with cardiac catheterization laboratory (ICL)
2012, 2014 By state
By sector
NHEWS
(Published)
NCVD
(Published)
Input
6. % of STEMI undergone fibrinolysis with door-to-needle time < 30 minutes
2013-2014 By state
MOH only
CKPP (Unpublished-data updated until January
2015)
Process of care
7. Median door-to-needle-time (minute) 2006-2013
National aggregate
MOH/MOE only
NCVD
(Published)
Process of
care
8. Median door-to-balloon time (minute) 2006-2013
National aggregate
MOH/MOE only
NCVD
(Published) Process of
care
9. % of STEMI not given fibrinolytic therapy due to missed thrombolysis time
2006-2013
National aggregate
MOH/MOE only
NCVD
(Published) Process of
care
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
6
Table 1: Data availability, coverage, and levels of disaggregation of selected performance indicators (continued)
Indicator Time period Coverage Data source Category
10. Rate of fibrinolytic therapy 2006-2013
National aggregate
MOH/MOE only
NCVD
(Published) Process of
care
11. Rate of primary PCI 2006-2010
National aggregate
MOH/MOE
NCVD
(Published) Process of
care
12.
Admission rate
for unstable angina
for STEMI
for NSTEMI
2010-2014 By state
By sector
SMRP (Unpublished-data updated
until July 2015)
Outcome
13. 30-day fatality rate after STEMI 2006-2013
National aggregate
MOH/MOE only
NCVD
(Published) Outcome
14. 30-day fatality rate after AMI 2008-2013 By state
By sector
SMRP (Unpublished-data updated
until July 2015)
Outcome
15. In-hospital STEMI case fatality rate 2013-2014 By state
By sector
SMRP (Unpublished-data updated
until July 2015)
Outcome
16. In-hospital UA/NSTEMI case fatality rate 2013-2014 By state
By sector
SMRP (Unpublished-data updated
until July 2015)
Outcome
17.
Prevalence among general population
Hypertension
Hypercholesterolemia
Diabetes
Obesity
Daily tobacco male smoker
Daily tobacco female smoker
2006-2015 By state NHMS
(Published) Impact
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
7
Table 1: Data availability, coverage, and levels of disaggregation of selected performance indicators (continued)
Indicator Time period Coverage Data source Category
18. Estimated mortality from cardiovascular disease
2012 National
aggregate OECD
(Published) Impact
19. In-hospital 30-day case-fatality after AMI 2011 National
aggregate OECD
(Published) Impact
NHEWS: National Healthcare Establishments & Workforce Statistics (Hospital) 2008-2009
National Healthcare Establishments & Workforce Statistics (Hospital) 2011
National Healthcare Establishments & Workforce Statistics (Hospital) 2012-2013
NCVD: Annual Report of the NCVD-ACS Registry Malaysia 2006
Annual Report of the NCVD-ACS Registry Malaysia 2007 & 2008
Annual Report of the NCVD-ACS Registry Malaysia 2009 & 2010
Annual Report of the NCVD-ACS Registry Malaysia 20011 & 2013
NHMS: The Third National Health and Morbidity Survey (NHMS III) 2006, Vol 2
National Health and Morbidity Survey 2011 (NHMS 2011). Vol. II: Non-Communicable Diseases
National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health
Problems
NHMS 2015: Report on Smoking Status Among Malaysian Adults
OECD: Health at a Glance 2013 - © OECD 2013
Health at a Glance: Asia/Pacific 2014 - © OECD 2014
stats.oecd.org
CKPP: Cawangan Kualiti Penjagaan Perubatan, Bahagian Perkembangan Perubatan
SMRP: Sistem Maklumat Rawatan Perubatan
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
8
CHAPTER 2 MALAYSIAN CORONARY HEART DISEASE PROFILING
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
9
DISEASE DEMOGRAPHICS
The population demographic breakdown for coronary heart disease (CHD) in Malaysia is given by Figure 1 and Figure 2 for age group and ethnicity respectively. Until 2013, 31,677 patients had been diagnosed with ACS based on the NCVD ACS registry reports. The mean age for period 2006-2010 was 59. The mean age reduced to 58.5 subsequently for 2011-2013. Overall, more than half of those who had had CHD were younger than 60 years of age.
Aggregate level analysis of 2013 data finds, of the total registered patients, 79% were men and 21% were women (W.A Wan Ahmad & K.H Sim., 2015). In term of ethnicity, 52% were Malay, 22% were Chinese, 19% were Indian and 2.6% were non-Malaysians.
The racial distribution is reflective of general Malaysian ethnic composition made up mostly by the Malay ethnic group (Jabatan Perangkaan Malaysia, 2015). However, until 2013, only 19 out of total 351 hospitals (141 public vs 210 private) involved in NCVD registry. Therefore, due to case ascertainment bias, population inference of any statistical estimates in the report may be limited.
FIGURE 1: BREAKDOWN OF CASES BY AGE GROUPS, 2013
FIGURE 2: BREAKDOWN OF CASES BY ETHNICITY, 2013
Data source: National Cardiovascular Disease Database (NCVD) Registry
20 - 30 1% 30 - 40
6%
40 - 50 17%
50 - 60 33%
60 - 70 25%
70 - 80 15%
≥ 80 3%
Malay 52%
Chinese 22%
Indian 19%
Bumiputera Sabah & Sarawak
4%
Others 2% Non-
Malaysian 3%
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
10
FIGURE 3: AGE-SPECIFIC PREVALENCE OF ACS, 2010-2013
20-29 0.5 0.8 0.7 0.9 22%
30-39 4.5 4.7 6.0 7.7 20%
40-49 18 22 24 29 18%
50-59 45 49 53 74 19%
60-69 60 70 80 98 18%
70-79 84 98 99 127 15%
≥80 60 58 68 76 8.1%
Data source: National Cardiovascular Disease Database (NCVD) Registry
What does this mean for Malaysia? 1. Prevalence of acute coronary syndrome (ACS) has increased in all age groups over the three
years period. 2. Rate of increase for age group 20-29 is the highest at 22% while the rate of increase for age
group ≥ 80 is the lowest at 8.1%. Incidence of ACS within the younger age groups is increasing
0.9 7.7
29
98
127
76
2010 2011 2012 2013
per
10
0 0
00
20-29
30-39
40-49
50-59
60-69
70-79
≥80
AAR
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
11
CORONARY HEART DISEASE RISK FACTORS PREVALENCE
“Kempen Cara Hidup Sihat” is a series of health promotion campaign that was launched since 1991 by the Ministry of Health (MOH) to help create public awareness, improve knowledge and promote health as a lifestyle goal (http://www.infosihat.gov.my). In 2013, “Kempen Nak Sihat” was launched as another initiative to encourage the public especially the youth to assimilate healthy lifestyle through active engagement in physical activity. The MOH also initiated “Komuniti Sihat Perkasa Negara” (KOSPEN) an inter-institutional collaborative program meant to boost the existing health promoting mechanism by engaging and empowering the community. Despite the on-going efforts, the prevalence of NCD and NCD risk factors continue to rise.
A situational analysis reveals that the implementation of NCD programs and activities most of the time were confined only within the health ministry territories (Ministry of Health Malaysia, 2010). In 2010 National strategic plan for NCD was implemented to encourage inter-sectorial collaboration and address a lack of policy in creating health promoting environment in Malaysia.
National Health Morbidity Survey (NHMS) demonstrates the NCD risk factors progression in Malaysia over a period of two decades (2006-2015). The prevalence of diabetes and hypercholesterolemia among the respondents aged 18 and above was showed to have increased over time.
FIGURE 4: NATIONAL HYPERTENSION PREVALENCE PROGRESSION 18+, 2006-2015
FIGURE 5: NATIONAL HYPERCHOLESTEROLEMIA PREVALENCE PROGRESSION 18+, 2006-2015
Data source: National Health and Morbidity Survey
FIGURE 6: NATIONAL DIABETES PREVALENCE PROGRESSION 18+, 2006-2015
Data source: National Health and Morbidity Survey
FIGURE 7: NATIONAL DAILY SMOKER PREVALENCE PROGRESSION BY GENDER 15+, 2006-2015
32 33 30
61% 57%
2006 2011 2015
%
Overall Undiagnosed Known
21
35
48
76% 81%
2006 2011 2015
%
Overall
Undiagnosed
Known
11.6
15.2 17.5
53% 53%
2006 2011 2015
%
Overall Undiagnosed Known
33.3 38.8
1.1 1.1
2011 2015
%
Male
Female
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
12
Table 2: Cardiovascular disease (CVD) risk factor prevalence, 2015.
Period Value (%) Target AAR (%) Benchmark
2.1. Prevalence of hypertension 2015 30.3 - ↓0.7 The US
3
29.1
2.2. Prevalence of hypercholesterolemia 2015 47.7 - ↑9.7 Australia
4
32.8
2.3. Prevalence of diabetes 2015 17.5 - ↑4.7 OECD-34
5
7.0
2.4. Prevalence of obesity 2015 30.6 - ↑9.1 OECD-27
5
17.2
2.5. Prevalence of daily tobacco smoker,
male 2015 38.8 - ↑3.9
OECD-325
22.8
2.6. Prevalence of daily tobacco smoker,
female 2015 1.1 - →0.0
OECD-325
14.6
* AAR is calculated for period 2011-2015 for 2.4 & 2.5 2006-2015 for 2.1, 2.2, 2.3, 2.6 Data source: National Health and Morbidity Survey
Table 3: State variation of CVD risk factor prevalence, 2015.
Prevalence of
hypertension
Prevalence of
hypercholesterolemia
Prevalence of
diabetes
Prevalence of current
tobacco smoker
Kedah 37.5 ↓ 0.5% 53.5 ↑ 5.4% 25.4 ↑ 7.2% 26.5 ↑ 0.4%
Sarawak 37.3 ↓ 2.0% 48.6 ↑ 9.7% 14.8 ↑ 4.5% 25.4 ↑ 3.1%
Perak 36.4 ↓ 4.0% 48.3 ↑ 1.8% 19.4 ↑ 4.9% 21 ↑ 0.1%
Perlis 35.4 ↓ 3.7% 47.0 ↑ 1.0% 20.6 ↑ 4.8% 22.2 ↓ 4.3%
Kelantan 33.8 ↑ 4.9% 51.7 ↑ 11% 18.5 ↑ 5.2% 24.6 ↓ 1.2%
WP Kuala Lumpur 33.8 ↑ 5.7% 52.9 ↑ 16% 17.4 ↑ 3.7% 19.1 ↑ 2.2%
Negeri Sembilan 32.5 ↓ 1.2% 49.5 ↑ 5.7% 19.3 ↑ 2.6% 20.9 ↓ 1.2%
Penang 29.8 ↑ 1.2% 52.2 ↑ 12% 18.1 ↑ 2.2% 19.2 ↑ 0.4%
Pahang 28.5 ↓ 1.2% 56.2 ↑ 15% 14.8 ↑ 2.3% 25.5 ↓ 0.8%
Johor 27.4 ↓ 6.9% 45.8 ↑ 5.0% 19.8 ↑ 6.6% 22.2 ↑ 0.8%
Terengganu 26.9 ↑ 0.1% 52.1 ↑ 11% 18.6 ↑ 5.9% 22.2 ↓ 1.9%
Sabah & WP Labuan 26.8 ↓ 2.0% 40.9 ↑ 7.1% 14.2 ↑ 13% 28.4 ↑ 5.4%
Melaka 25.8 ↓ 5.8% 46.6 ↑ 6.7% 16.7 ↑ 1.1% 16.9 ↓ 1.9%
Selangor 25.5 ↓ 2.9% 43.5 ↑ 8.1% 15.5 ↑ 2.9% 20.9 ↑ 1.6%
WP Putrajaya 24.1 ↑ 1.7% 46.4 ↑ 8.6% 19.2 ↑ 22% 12.4 ↓ 5.6%
* AAR is calculated for period 2011-2015
Data source: National Health and Morbidity Survey
3 Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012. NCHS data brief, no 133. Hyattsville, MD: National Center for Health Statistics. 2013 4 Australian Bureau of Statistics (4364.0.55.005), Australian Health Survey: Biomedical Results for Chronic Diseases 2011/12 5 http://stats.oecd.org/2015
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
13
What does this mean for Malaysia? 1. Cardiovascular risk factor (diabetes, hypercholesterolemia, smoking, obesity) prevalence is
increasing 2. About 80% of hypercholesterolemia cases were previously undiagnosed. In addition, more
than half of diabetes and hypertension cases were previously undiagnosed. 3. About one third of the population are obese (BMI ≥ 27.5kg/m2) 4. Majority of our daily smokers are male. The prevalence is almost twice as high as OECD. Only
about 1% of females are daily smoker and the prevalence has not changed since 2011.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
14
CHAPTER 3 CARDIAC CARE PERFORMANCE INDICATORS
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
15
WHERE WE STAND
Malaysia continues to work within its capacity to pursue the goal of delivering a world-class health care system. Our national health priorities include enhancing the health care delivery system to increase access to quality care, and reducing the disease burden, both communicable and non-communicable diseases. While we have achieved commendable improvement in life expectancy and maternal and child mortality indicators, we are still behind the performance of countries with higher economic status. Key health challenges that we are facing include the changing disease pattern from communicable to non-communicable diseases and the increasing prevalence of cardiovascular risk factors hence the increasing burden of disease related to cardiovascular complications. WHO Global Health Estimate 2014 reported stroke and ischemic heart disease as the leading causes of death in Western Pacific Region, including Malaysia (World Health Organization, Global Burden of Disease (GBD), 2014). There are indeed variations and differences in term of capacity, processes and outcomes of a health system in different countries depending on its objectives. However, making OECD countries as benchmark will give us insight into the potential improvement that can be undertaken at our local settings given the aspiration of Malaysia becoming a developed nation.
FIGURE 8: MALAYSIAN RANKINGS OF SELECTED PERFORMANCE INDICATORS AMONG PEER COUNTRIES
Percentage
of daily smoker 2013
Estimated mortality from cardiovascular disease
2012*
In-hospital 30-day case-fatality
after AMI 2011**
Indonesia 37.9 Indonesia 336 Singapore 12.5
China 25.5 China 286.1 Japan 12.2 Germany 20.9 India 284.4 Malaysia 9.7† Malaysia 20.5 Malaysia 265.6 Korea Rp. 8.9
United Kingdom 20.0 OECD 160.6 Philippines 8.9 OECD-26 17.4 Germany 158.6 OECD-32 7.9
New Zealand 15.5 United States 158.3 United Kingdom 7.8 United States 13.7 United Kingdom 130.3 Canada 5.7
Singapore 13.2 New Zealand 119 United States 5.5 Australia 12.8 Australia 112.1 Australia 4.8
India 9.6 Singapore 110.1 New Zealand 4.5
*Age-standardised rates per 100 000 population ** Age-sex standardised rates (%) †Unadjusted rate, 2008
Data source: National Health and Morbidity Survey (NHMS) OECD Health Statistics stats.oecd.org
What does this mean for Malaysia?
1. Malaysia performance is below the OECD average for prevalence of daily tobacco smoker. 2. The high cigarette smoking prevalence seems to correlate with high CVD mortality in
Malaysia 3. Estimated cardiovascular mortality in Malaysia is 1.65 times higher than the OECD average. 4. For every 100 cases of AMI admitted to our hospitals, close to 10% succumbed to death
within 30-days.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
16
HUMAN RESOURCES & FACILITY
Generating resources or inputs is one of the functions a health system performs along with stewardship, financing and health service provision. Inputs to the health system are combined to allow the delivery of a series of interventions or health actions with the final objectives mainly to improve the population health status. These inputs particularly human resources, physical resources such as facilities and equipment, and knowledge are factors that would enable health system to perform to its potential. Thus, a well-thought strategy for input generation is very critical. (The World Health Report Health Systems Improving Performance, 2000).
Inputs in term of adequate number of health care facilities and resources are also requisite to ensure universal accessibility to health care. In Malaysia, despite the highly subsidized public health care provision and additional service coverage offered by the private practices, issues like long queues, drug rationing or poor transportation system can be potential contributors to inequity in service delivery (Ministry of Health, 2015).
Table 4: Number & density of cardiologist, cardiothoracic surgeon and cardiac catheterization laboratory, 2013.
Year Achievement Target AAR (%)
Benchmark
Public Private Public Private
4.1. Number of Cardiologist 2013 53 194 - ↑13.4 ↑7.9 US6
25 901
4.2. Number of Cardiothoracic surgeon
2013 49 25 - ↑8.6 ↑7.3 -
4.3. Cardiologist per 1 000 000 population
2013 8 - - US
6
55.7
4.4. Cardio-thoracic surgeon per 1 000 000 population
2013 3 - - -
4.5. Cardiologist public : public ratio
2013 1 : 4 - - -
4.6. Cardiothoracic surgeon public : private ratio
2013 1 : 2 - - -
4.7. Number of hospital with cardiac catheterization laboratory
2014 14 55 - ↑3.8 ↑14.4 -
* AAR is calculated for period 2012-2014 for 4.7 2009-2013 for 4.1-4.6 Public refers to the Ministry of Health, Ministry of Education and Ministry of Defence data Data source: National Health Establishment & Workforce Statistics (NHEWS) Survey National Cardiovascular Disease Database (NCVD) Registry
6 Rodgers GP, Conti JB, Feinstein JA, et al. ACC 2009 Survey Results and Recommendations: Addressing the Cardiology Workforce Crisis: A Report of the ACC Board of Trustees Workforce Task Force. J Am Coll Cardiol. 2009;54(13):1195-1208. doi:10.1016/j.jacc.2009.08.001.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
17
FIGURE 9: PROPORTION OF CARDIOLOGIST (PUBLIC VS PRIVATE) AND THE TOTAL CARDIOLOGIST DENSITY BY STATE, 2013
FIGURE 10: PROPORTION OF CARDIOTHORACIC SURGEON (PUBLIC VS PRIVATE) AND THE TOTAL CARDIOTHORACIC SURGEON BY STATE, 2013
Data source: National Health Establishment & Workforce Statistics (NHEWS) Survey
42
23
13
8 7
5 5 5 4 4 3 3 2 0 0
8
0%
50%
100%
Den
sity
Private Public Average Density per 1 000 000
15
9
5
2 2 2
1 1 1 1
0 0 0 0 0
3
0%
50%
100%
Den
sity
Private Public Average Density per 1 000 000
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
18
Table 5: State variation of number & density (per 1 000 000 population) of cardiologist, cardiothoracic surgeon and cardiac catheterization laboratory, 2013.
Cardiologist density Cardiothoracic surgeon density
Hospital with
catheterization lab†
Public Private Public Private Public Private
Kuala Lumpur 8 65 42 5 21 15 3 9 Selangor 7 41 8 2 11 2 2 14
Pulau Pinang 9 28 23 6 8 9 1 9 Sarawak 8 9 7 4 1 2 1 4
Johor 6 9 4 3 1 1 1 3 Perak 1 11 5 0 2 1 1 3
Melaka 0 11 13 0 4 5 0 3 Kedah 4 6 5 0 0 0 1 5
Sabah & Labuan 2 4 2 1 1 1 1 1 Kelantan 3 2 3 3 0 2 1 1
N. Sembilan 0 5 5 0 0 0 0 2 Pahang 2 2 3 1 0 1 1 1
Terengganu 3 1 4 0 0 0 1 0 Perlis 0 - 0 0 0 0 0 0
Putrajaya 0 0 0 0 0 0 - -
† Data for year 2014 Data source: National Health Establishment & Workforce Statistics (NHEWS) Survey National Cardiovascular Disease Database (NCVD) Registry
What does this mean for Malaysia? 1. The growth of human resources (Cardiologist and Cardiothoracic surgeon) in public sectors is
at a higher rate compared to the private sectors. 2. Private sectors have more cardiac catheterization laboratory than public sectors. 3. There is marked variation/difference in resource of manpower between states, majority
concentrated in West Coast of Malaysian Peninsular mainly in Klang Valley, Penang and Melaka, least in East Coast and East Malaysia
4. In addition, majority of cardiologist are based in private sector. Melaka and Negeri Sembilan especially are states with no public hospital cardiologist. The increasing burden of cardiovascular disease may have a heavier impact on the public sector if such gap remained unfilled.
5. These scenarios highlight the issues concerning accessibility to health care especially in the states with relative lack of facility and skilled professionals.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
19
PROCESS OF CARE
Time is the determining factor of success in management of acute coronary syndrome. Initiation of treatment in an acute setting involves accurate clinical diagnosis of cardiac ischemia or infarction in a timely fashion starting from the point of contact with the healthcare provider. The recommended time for initiation of fibrinolytic therapy for acute ST elevation myocardial infarction (STEMI) is within 30 minutes. The recommended time for initiation of primary PCI for STEMI from the point of medical contact is within 90 minutes (in primary-PCI capable centres) (Clinical Practice Guidelines Management of Acute ST Segment Elevation Myocardial Infarction, 2014).
Cawangan Kualiti Penjagaan Perubatan (CKPP), Medical Development Division, Ministry of Health is collecting hospital data concerning door-to-needle (DTN) time and reported them as aggregate percentage of ST elevation Myocardial Infarction (STEMI) patients receiving thrombolytic therapy within 30 minutes of presentation at the Emergency Department by state. For atypical symptoms or ECG, time-to-treatment is counted from the time of the first diagnostic ECG changes to the thrombolytic therapy given.
Malaysian National Cardiovascular Disease Database (NCVD) is another set of database that collects information about cardiovascular disease in Malaysia. NCVD records the individual time lapse of reperfusion therapy initiation from the time of presentation to healthcare facility. Door-to-balloon (DTB) time in NCVD is recorded only for patients diagnosed with STEMI undergoing primary PCI. Findings in NCVD report for DTN and DTB have already excluded transfer-in cases.
FIGURE 11: MEDIAN DTN TIME 2006-2013
FIGURE 12: MEDIAN DTB TIME 2006-2013
National Cardiovascular Disease Database (NCVD) Registry
1349 1435 1440 1440 1440 1390 1380 1440
60 53 50
45 45 40
45 49
2006 2007 2008 2009 2010 2011 2012 2013
Minutes
30
1440 1410 1195 1391 1410 1305 1440 1440
133
112 114 119 108
120 113.5 104
2006 2007 2008 2009 2010 2011 2012 2013
Minutes
90
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
20
FIGURE 13: RATE OF FIBRINOLYSIS, 2006-2013
FIGURE 14: RATE OF PRIMARY PCI, 2006-2013
Data source: National Cardiovascular Disease Database (NCVD) Registry Table 6: Percentage of STEMI patients who received timely fibrinolysis therapy and the median time-to-intervention, 2013.
Period Achievement Target AAR (%) Benchmark
6.1. % of STEMI undergone fibrinolysis with door-to-needle time < 30 minutes
2014 94% >85% ↓0.3 US7
46.8%
6.2. Median door-to-needle-time (minute)
2013 49 <30 - -
6.3. Median door-to-balloon time (minute)
2013 104 <90 - US
7
59
6.4. % of STEMI not given fibrinolytic therapy due to missed thrombolysis time
2013 11% - ↓2.4 -
6.5. Rate of fibrinolytic therapy 2013 74% - ↑0.8 -
6.6. Rate of primary PCI 2013 10% - ↑3.5 -
* AAR is calculated for period 2013-2014 for 6.1 2006-2013 for 6.4-6.6 7
Includes transferred-in cases for fibrinolysis. Data source: CKPP Medical Development Division, Ministry of Health National Cardiovascular Disease Database (NCVD) Registry
7 Masoudi FA, Ponirakis A, Yeh RW, et al. Cardiovascular Care Facts: A Report From the National Cardiovascular Data Registry: 2011. J Am Coll Cardiol. 2013;62(21):1931-1947. doi:10.1016/j.jacc.2013.05.099
70 73 75 75 75 80 72 74
% 8 7 6 5
8 6
11 10 %
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
21
FIGURE 15: STATE VARIATION OF DOOR-TO-NEEDLE TIME ACHIEVEMENT IN PUBLIC HOSPITALS, 2014 VS 2013
Data source: CKPP Medical Development Division, Ministry of Health
What does this mean for Malaysia? 1. More than half of eligible patients did not receive fibrinolysis and primary PCI within the
standard initiation time; 30 minutes and 90 minutes respectively before 2013. 2. The time lapse trend is improving for both thrombolysis and primary PCI since 2006. The
trend observed for DTN is the result of the decision that was made to initiate treatment at the earliest medical contact in the hospital Emergency Department (ED), as compared to initiation of treatment after admission to Cardiac Intensive Care Unit for thrombolysis in the past.
3. More recent data of 2014 shows improvement in DTN whereby 94% of the eligible cases received fibrinolytic therapy within 30 minutes of arrival to Emergency Department.
4. We have no data with regard to these parameters in most private hospitals since the reporting in NCVD ACS registry is still of voluntary basis, mainly involving KKM hospitals, IJN and the university hospitals (mainly UMMC).
79%
94%
85%
0%
100%
Door-to-needle time achievement < 30 minutes
2013
2014
Target
≡
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
22
HEALTH OUTCOME
ADMISSION RATE
Acute coronary syndrome regardless severity requires admission for stabilization and close monitoring. Routine in-patient management involves assessment of mortality risk and potential recurring ischemic event to strategize the next best therapeutic intervention. Patients will be followed up once discharged from the hospital for re-evaluation of existing cardiovascular complications or complications following the acute event. The assessment of complication will include heart failure as a result of underlying coronary artery disease.
Sistem Maklumat Rawatan Perubatan (SMRP) and e-Reporting are the Ministry of Health database of public and private hospital admissions and discharges. Patient discharge diagnoses in the database are coded with ICD-10 system for routine internal reporting purposes. The codes used to generate data for admission rate computation in this report are as follows:
Discharge diagnosis as ST-elevation myocardial infarction (STEMI): I21.0, I21.1, I21.2, I21.3
Discharge diagnosis as non- ST-elevation myocardial infarction (NSTEMI): I21.4
Discharge diagnosis as unstable angina (UA): I20.0
The data were restricted to population aged 15+ for each principal diagnosis code as defined above.
FIGURE 16: HOSPITAL ADMISSION RATE FOR STEMI
FIGURE 17: HOSPITAL ADMISSION RATE FOR NSTEMI
FIGURE 18: HOSPITAL ADMISSION RATE FOR UNSTABLE ANGINA
Data source: Sistem Maklumat Rawatan Perubatan (SMRP)
21
14
20 15
20
2010 2011 2012 2013 2014
per
100
000
Public Private
30
8 12 14
20
2010 2011 2012 2013 2014
per
100
000
Public Private
99 130 144
100 112
2010 2011 2012 2013 2014
per
100
000
Public Private
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
23
Table 7: Hospital admission rate (per 100 000 population) for acute coronary syndrome (ACS), 2013.
Period Value Standard AAR (%) Benchmark
7.1. Admission rate for UA 2013 112 - ↓4.8 -
7.2. Admission rate for STEMI 2013 20 - ↑12 -
7.3. Admission rate for NSTEMI 2013 20 - ↑36 -
* AAR is calculated for period 2010-2013
Data source: Sistem Maklumat Rawatan Perubatan (SMRP)
Table 8: State variation of hospital admission rate for ACS (per 100 000 population), 2013.
Admission rate STEMI Admission rate NSTEMI Admission rate UA
Perlis 17 ↑ 115% 83 - - 583 ↑ 32%
Negeri Sembilan 30 ↑ 67% 64 ↑ 18% 292 ↑ 1.4%
Putrajaya 2 - - 4 - - 164 - -
Pahang 27 ↑ 50% 25 ↑ 102% 148 ↑ 4.1%
Kelantan 34 ↑ 46% 8 ↑ 174% 124 ↑ 1.8%
Johor 13 ↑ 18% 25 ↑ 67% 143 ↓ 2.5%
Perak 42 ↑ 58% 46 ↑ 19% 136 ↓ 13%
Kedah 4 ↓ 54% 2 ↓ 42% 89 ↓ 20%
Pulau Pinang 32 ↑ 21% 9 ↑ 7% 127 ↓ 15%
Melaka 36 ↑ 40% 50 ↑ 10% 159 ↓ 2.4%
Sarawak 16 ↑ 11% 14 ↑ 60% 58 ↑ 15%
Labuan 23 ↓ 1.5 0 - - 77 ↓ 41%
Kuala Lumpur 32 ↑ 26% 20 ↑ 74% 84 ↓ 4.3%
Terengganu 14 ↑ 2.6% 17 - - 213 ↓ 0.8%
Selangor 13 ↓ 14% 16 ↑ 63% 76 ↓ 10%
Sabah 9 ↑ 34% 3 ↑ 61% 36 ↑ 14%
AAR is calculated for period 2010-2013
AAR is calculated for period 2012-2013 for Labuan
AAR is not calculated for Putrajaya due to incomplete data
Data source: Sistem Maklumat Rawatan Perubatan (SMRP)
What does this mean for Malaysia? 1. The increasing admission rate for both STEMI and NSTEMI within 2010-2014 periods reflects
the growing burden of disease attributable to increasing prevalence of cardiovascular risk factors.
2. Admission for UA has decreased in most states. 3. The apparent increase in admission rate for NSTEMI with concurrent decrease for UA in
most states could be due to improvement in clinical diagnosis made in cardiology ward. Suspected ACS cases which were managed in Cardiology ward as opposed to general medical ward received more comprehensive reviews by the cardiologist hence accuracy in diagnosis.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
24
30-DAY CASE FATALITY AFTER ACUTE MYOCARDIAL INFARCTION
Mortality following an AMI or STEMI represents an important outcome (potentially related to quality of care) high rates of which warrant thorough investigation. The 30-day case fatality measures are estimates of deaths from any cause within 30 days of a hospital admission of an AMI or STEMI.
The decision to measure event within 30 days instead of over longer time periods (like 90 days) is made because longer periods may be impacted by factors outside of hospitals’ control such as complicating illnesses, patients’ own behaviour, or care provided to patients after discharge.
In addition, the variation observed in mortality over a period of time may reflect differences in general environments (such as coordination of care, patient safety policies, and staffing) or variation in care processes. It can also be due to differences in baseline individual risk. Therefore, computation of standardized rates is pivotal if we were to compare achievement between different periods or regions. However, the scope of current report is limited to interpretation of crude rates only.
FIGURE 19: 30-DAY CASE FATALITY RATE AFTER STEMI, 2006-2013
FIGURE 20: 30-DAY CASE FATALITY RATE AFTER AMI, 2006-2013
Data source: National Cardiovascular Disease Database (NCVD) Registry
21 19
15 12 12 12 12 11 %
25 21
16 14 15 11 11 11 %
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
25
FIGURE 21: STATE VARIATION OF IN-HOSPITAL NSTEMI/UA CASE FATALITY RATE, 2013 VS 2014
FIGURE 22: STATE VARIATION OF IN-HOSPITAL STEMI CASE FATALITY RATE, 2013 VS 2014
Data source: Sistem Maklumat Rawatan Perubatan (SMRP)
5.2 4.9
3.7
3.3 3.0
2.7 2.6 2.6 2.4 2.2 2.1 2.1 1.7
1.2
0.5
%
Unstable Angina/ NSTEMI fatality rate 2013 Private
2013 Public
2014 Public
65
26 20 19
15 11 11 11 11 10 10 9 7 7
3.3
%
STEMI fatality rate
2013 Private
2013 Public
2014 Public
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
26
Table 9: 30-day case fatality rate for ACS patients, 2013
Period
Value
(%) Standard
AAR
(%) Benchmark
9.1. 30-day case fatality rate after
STEMI 2013 11.4 - ↓13 -
9.2. 30-day case fatality rate after acute
myocardial infarction (AMI) 2013 10.9 - ↓11
OECD-238
8.3
9.3. In-hospital STEMI case fatality rate 2013 5.9 - ↓8.7 -
9.4. In-hospital NSTEMI/UA case fatality
rate 2013 3.3 - ↓16 -
8 Age-standardized rate
* AAR is calculated for period 2006-2013 for 9.1, 9.2 2008-2013 for 9.3, 9.4 AMI refers to STEMI & NSTEMI (ICD-10 I21) Data source: National Cardiovascular Disease Database (NCVD) Registry
What does this mean for Malaysia? 1. 30-days mortality after AMI is reducing since 2006 consistent with the increasing rate of
primary PCI and improvement seen in DTN and DTB. 2. Further improvement in mortality can be expected if issues with resources distribution could
be ameliorated.
8 http://stats.oecd.org/2015
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
27
CONCLUSION
Areas where Malaysia is doing well:
Positive growth of human resource (Cardiologist and Cardiothoracic surgeons) with higher
rate of growth in public sector compared to private.
Declining percentage of patients who missed thrombolysis due to late presentation
The percentage of STEMI receiving fibrinolysis within standard time 30 minutes in public
hospitals is above 90% on average
Percentage of patient receiving primary PCI is increasing.
Declining 30-day case fatality rate after AMI
Areas for concern:
High and increasing prevalence of ACS risk factors including diabetes, hypercholesterolemia, hypertension, obesity and smoking with a significant proportion of them were undiagnosed.
More young people are inflicted with ACS
Increasing number of admission for AMI
We have yet to achieve our target in number of human resources for cardiologist and
cardiothoracic surgeon.
Uneven distribution of human resources & cardiac facilities between states
Public and private health sector disparity in term of capacity of human resources for
Cardiologist and cardiothoracic surgeon.
Public and private health sector disparity in term of number of cardiac catheterization lab
available
More than half STEMI patients did not receive timely primary PCI
Fatality rate for AMI comparatively higher than OECD countries.
Low ascertainment of ACS cases from limited number of data provider due to the voluntary basis of data entry into NCVD database.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
28
RECOMMENDATIONS
Investing in prevention of disease and disability is known to be the most cost effective
investment in healthcare. The existing health promotion program at community level
programmes can be made extensive with collaboration from sectors outside of ministry of
health. It will be a good move if KOSPEN is made to not only cover residential areas but work
places as well.
Enhancing public health promotion and intervention should focus on the lowering the
prevalence of current smokers, early detection and treatment of hypertension, diabetes and
hypercholesterolemia.
We should leverage fully on information technologies and social media to present and
promote health information in line with today’s expectations, with the aim of providing
evidence-based and authoritative information and provide self-empowerment.
It is also essential to put our priority on cardiovascular diagnostics and amenities in order to
identify the high risk patients for an early intervention. Establishment of new public cardiac
facility and specialty centre as well as intensification of training programmes are mandatory
in view of the ever increasing disease burden. In areas like in Sarawak or Sabah, inter-facility
transfer issues can be the limiting factor that needs focal attention. After all the outcome of
acute cardiovascular diseases are very much related to speed of treatment and availability of
tertiary level specialist medical services with cardiac catheterization laboratory.
To optimise use of available resources and facilities through public-private partnership for a
more sustainable system that further improves the outcome. We must first create a model
of resource sharing that is fair to both parties.
To involve various stakeholders including personnel from Ministry of Education early in planning of health related activities and policies on the mission to prevent, restore and maintain good health for our citizen.
Evaluation of performance must include risk adjustment for fair comparisons. Poor outcome
or unmet objectives of any program implementation should trigger a mechanism for
investigation that will include focus and systematic data collection.
To make mandatory of reporting of cardiac cases to NCVD by creating a KPI for the State
Health Directors. NCVD use should expand to include many more health facilities and
institute both in public and private sectors.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
29
BIBLIOGRAPHY
Ahmad Faudzi Yusoff, Gurpreet Kaur, Mohd Azahadi Omar, & Amal Nasir Mustafa. (2004). Malaysian Burden of Disease and Injury Study. Kuala Lumpur: Institute for Public Health.
Avedis Donabedian, John R. C. Wheeler, & Leon Wys. (1982). Quality, Cost, and Health: An Integrative Model. Medical Care, 975-992.
Clinical Practice Guidelines Management of Acute ST Segment Elevation Myocardial Infarction. (2014). Putrajaya.
http://www.infosihat.gov.my/infosihat/projekkhas/kospen.php. (n.d.). Bahagian Pendidikan Kesihatan Kementerian Kesihatan Malaysia. Retrieved 17 November, 2016, from KOSPEN: http://www.infosihat.gov.my/infosihat/projekkhas/kospen.php
Institute for Public Health. (2015). National Health & Morbidity Survey (Non-Communicable Diseases, Risk Factors & Other Health Problems.
Jabatan Perangkaan Malaysia. (2015). Anggaran Penduduk Semasa Malaysia.
Ministry of Health. (2011). Cardiothoracic Surgery Services Operational Policy.
Ministry of Health. (2015). Country Health Plan.
Ministry of Health Malaysia. (2010). National Strategic Plan For Non-Communicable Disease.
The World Health Report Health Systems Improving Performance. (2000). Switzerland.
W.A Wan Ahmad, & K.H Sim. (2015). Annual Report of the NCVD-ACS REgistry.
World Health Organization. (2003). Health systems performance assessment: debates, methods and empricism. Retrieved from WHO | World HEalth Organization: www.who.int
World Health Organization. (2014). Global Burden of Disease (GBD). Retrieved November, 2016, from http://www.who.int/healthinfo/global_burden_disease/gbd/en/
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
30
GLOSSARY
Acute Coronary Syndrome (ACS)
ACS encompasses clinical features comprising chest pain or overwhelming shortness of breath, is defined by accompanying clinical, ECG and biochemical features. ACS comprises the following: 1. Unstable Angina Pectoris (UAP) 2. Non-ST-elevation Myocardial Infarct (NSTEMI) 3. ST-elevation Myocardial Infarct (STEMI). (NCVD-ACS 2009-2010)
Admission Admission (or inpatient admission) is the formal acceptance by a hospital of a patient who will occupy a hospital bed, crib or bassinet for observation, care, diagnosis or treatment and will have a medical record maintained for him/her. (NHEWS 2012 – 2013)
Cardiovascular disease
Cardiovascular diseases cover a range of illnesses related to the circulatory system, including ischemic heart disease (often referred to as heart attack) and cerebrovascular diseases such as stroke. (Health at a Glance 2015: OECD Indicators)
Current smoker Smoker who daily or occasionally smokes any tobacco product. (NHMS 2015: Report on Smoking Status Among Malaysian Adults)
Daily smoker Person who currently smokes any tobacco product every day. (NHMS 2015: Report on Smoking Status Among Malaysian Adults)
Diabetes A metabolic disorder of multiple etiologies characterized by chronic high blood glucose levels with disturbance of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. (NHMS Vol.2 2006)
Door-to-balloon time The duration between time patients presented to the health care centre to time of first intra-coronary device used and performed in the same centre. (NCVD-ACS 2009-2010)
Door-to-needle time The duration between time patients presented to the health care centre to time intravenous fibrinolytic therapy administered or initiated in the same centre. (NCVD-ACS 2009-2010)
Hospital An institution with primary function to provide inpatient diagnostic and therapeutic services for a variety of medical conditions both surgical and non-surgical. (NHEWS 2012-2013)
Inpatient care In-patient care refers to care for a patient who is formally admitted (or ‘hospitalised’) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution providing in-patient care. (https://stats.oecd.org/glossary/detail.asp?ID=1364)
Ischemic heart disease
Ischemic heart disease (IHD) is caused by the accumulation of fatty deposits lining the inner wall of a coronary artery, restricting blood flow to the heart. (Health at a Glance 2015: OECD Indicators)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
31
Known hypercholesterolemia
Self-reported status by subject in NHMS survey, as having diagnosed with hypercholesterolemia previously by medical personnel.
Known hypertension Self-reported status by subject in NHMS survey, as having diagnosed with hypertension previously by medical personnel.
Obesity Obesity is a complex, multifactorial condition characterized by excess body fat (CPG 2004- BMI ≥ 27.5 kg/m2; WHO 1998- BMI ≥ 30 kg/m2). Generally, men with >25% body fat and women with >35% body fat are considered obese (CPG Management of Obesity, 2004).
Prevalence Statistical concept referring to the number of occurrences of an event of interest that are present in a particular population at a given time.
Smoking cessation Smoking cessation or quitting smoking is a process of discontinuing the practice of inhaling a smoked substance. (NHMS 2015: Report on Smoking Status Among Malaysian Adults)
Tobacco Common name given to the plants of the genus Nicotiana, especially the Nicotiana tabacum from South America, from which the substance called nicotine, is extracted. (NHMS 2015: Report on Smoking Status Among Malaysian Adults)
Tobacco products Two types of tobacco products: 1. Smoked tobacco: manufactured cigarettes, hand-rolled cigarettes, kreteks, other smoked tobacco such as pipe, curut/cigar/cigarillos, water pipes/shisha/hookah, bidis and others. 2. Smokeless tobacco: snuff by keeping in mouth/nose, chewing tobacco, betel quid with tobacco, electronic cigarettes and others. (NHMS 2015: Report on Smoking Status Among Malaysian Adults)
Undiagnosed hypercholesterolemia
Not known to have hypercholesterolemia and has a total blood cholesterol level equals to or more than 5.2 mmol/L. (NHMS Vol.2 2015)
Undiagnosed hypertension
Not known to have hypertension and has an average systolic blood pressure equals to or more than 140mmHg and/or diastolic blood pressure equal to or more than 90mmHg. (NHMS Vol.2 2015)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
32
APPENDIX
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
33
Data table 1: Distribution of patients by age group and ethnicity
Year 2006 2007 2008 2009 2010 2011 2012 2013
No. % No. % No. % No. % No. % No. % No. % No. %
20 - <30 23 1 20 1 19 1 21 1 27 1 44 1 44 1 53 0.8
30 - <40 143 4 161 4 149 5 182 5 185 5 200 5 263 5.7 354 5.8
40 - <50 621 18 681 19 489 17 628 17 603 18 749 18.6 824 18 1033 16.8
50 - <60 1054 31 1118 31 856 30 1079 30 1088 32 1250 30.8 1387 30.2 2011 32.8
60 - <70 881 26 961 26 769 27 933 26 811 24 999 24.6 1207 26.3 1558 25.4
70 - <80 571 17 592 16 469 16 596 17 540 16 658 16.3 687 15 915 15.0
≥ 80 129 4 113 3 100 4 155 4 147 4 147 3.7 177 3.8 203 3.4
Malay 1684 49 1740 48 1426 50 1787 50 1712 50 1991 49.2 2292 50 3176 51.8
Chinese 786 23 853 23 660 23 764 21 697 20 868 21.4 993 21.6 1313 21.5
Indian 799 23 847 23 601 21 866 24 780 23 897 22.3 883 19.2 1124 18.5
Orang asli 0 0 2 0 0 0 1 0 4 0 2 0 1 0 5 0.0
Kadazan 2 0 26 1 9 0 22 1 35 1 33 0.8 37 0.8 65 1.0
Melanau 0 0 0 0 2 0 2 0 3 0 4 0 1 0 5 0.0
Murut
1 0 1 0 1 0 4 0 6 0
Bajau 1 0 28 1 24 1 15 0 36 1 30 0.8 35 0.8 48 0.8
Bidayuh 28 1 12 0 15 1 9 0 6 0 17 0.5 24 0.6 39 0.6
Iban 48 1 41 1 31 1 35 1 19 1 42 1 70 1.6 72 1.2
Sikh 1 0 4 0 4 0 13 0 10 0 0 0 0 0 0 0
Other Malaysian
36 1 46 1 26 1 30 1 46 1 70 1.8 117 2.6 117 2
Foreigner 37 1 43 1 45 2 49 1 52 2 92 2.2 132 2.8 157 2.6
Not available 0 0 4 0 8 0
Data source: Annual Report of NCVD-ACS Registry 2007&2008 (page 9) Annual Report of NCVD-ACS Registry 2009&2010 (page 11) Annual Report of NCVD-ACS Registry 2011-2013(page 7)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
34
Indicator: Number of cardiologist (Table 4 & Table 5)
Data table 2: Number of cardiologist
State 2009 2010 2011 2012 2013 2014
Johor 7 6 8 7 9 8
Kedah 3 6 6 5 6 8
Kelantan 3 2 2 3 2 2
WP Kuala Lumpur 43 52 52 49 65 63
Melaka 11 11 11 8 11 8
Negeri Sembilan 1 3 4 3 5 3
Pahang 2 1 2 2 2 5
Perak 11 10 10 12 11 13
Perlis 0 0 0 0 0 0
Pulau Pinang 19 19 19 26 28 28
Sabah & WP Labuan 4 3 3 4 4 5
Sarawak 12 9 9 9 9 10
Selangor 25 32 33 25 41 30
Terengganu 2 1 1 1 1 1
WP Putrajaya - - - - - -
Malaysia 143 155 160 154 194 184
Johor 3 5 5 2 6 2
Kedah 1 0 1 2 4 0
Kelantan 3 3 3 0 3 1
WP Kuala Lumpur 8 9 8 6 8 9
Melaka 0 0 0 0 0 0
Negeri Sembilan 0 0 0 0 0 0
Pahang 1 3 2 3 2 3
Perak 0 0 1 0 1 1
Perlis 0 0 0 0 0 0
Pulau Pinang 5 8 2 4 9 5
Sabah & WP Labuan 2 3 4 2 2 1
Sarawak 3 7 6 5 8 8
Selangor 6 9 7 7 7 4
Terengganu 0 0 0 1 3 1
WP Putrajaya - - - - - -
Malaysia 32 47 39 32 53 35
Data WP Putrajaya is incorporated into Selangor Data source: NHEWS 2008-2009 (page 86) NHEWS 2012-2013 (page 60-61) Annual Report of NCVD-ACS Registry 2009-2010 (page 5) Annual Report of NCVD-ACS Registry 2011-2013(page 3)
Pu
bli
c P
riva
te
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
35
Indicator: Density of cardiologist (Table 4 & Table 5)
Data table 3: Density of cardiologist
State 2009 2010 2011 2012 2013 2014
Johor 0.03 0.33 0.38 0.03 0.43 0.028
Kedah 0.02 0.31 0.35 0.04 0.49 0.039
Kelantan 0.04 0.32 0.31 0.02 0.3 0.017
WP Kuala Lumpur 0.3 3.64 3.54 0.32 4.21 0.418
Melaka 0.14 1.34 1.32 0.09 1.29 0.094
Negeri Sembilan 0.01 0.29 0.38 0.03 0.47 0.027
Pahang 0.02 0.27 0.26 0.03 0.25 0.051
Perak 0.05 0.43 0.46 0.05 0.49 0.057
Perlis 0 0 0 0 0 0
Pulau Pinang 0.15 1.73 1.32 0.19 2.27 0.2
Sabah & WP Labuan 0.02 0.18 0.21 0.02 0.17 0.016
Sarawak 0.06 0.65 0.6 0.05 0.66 0.068
Selangor 0.06 0.75 0.72 0.06 0.84 0.058
Terengganu 0.02 0.1 0.09 0.02 0.36 0.017
WP Putrajaya - - - - - -
Malaysia 0.06 0.71 0.69 0.06 0.83 0.073
2009, 2012 &2014 population per 10 000 2010, 2011 &2013 population per 100 000 Data WP Putrajaya is incorporated into Selangor
Data source: NHEWS 2008-2009 (page 86) NHEWS 2012-2013 (page 60-61) Annual Report of NCVD-ACS Registry 2009-2010 (page 5) Annual Report of NCVD-ACS Registry 2011-2013(page 3)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
36
Indicator: Number of cardiothoracic surgeon (Table 4 & Table 5)
Data table 4: Number of cardiothoracic surgeon
State 2009 2010 2011 2012 2013
Johor 0 1 1 - 1
Kedah 0 0 0 - 0
Kelantan 0 0 0 - 0
WP Kuala Lumpur 14 19 22 - 21
Melaka 5 4 3 - 4
Negeri Sembilan 0 0 0 - 0
Pahang 0 0 0 - 0
Perak 1 1 1 - 2
Perlis 0 0 0 - 0
Pulau Pinang 6 8 9 - 8
Sabah & WP Labuan 0 0 0 - 1
Sarawak 1 1 1 - 1
Selangor 10 7 8 - 11
Terengganu 0 0 0 - 0
WP Putrajaya - - - - -
Malaysia 37 41 45 - 49
Johor 3 4 4 - 3
Kedah 0 0 0 - 0
Kelantan 2 2 2 - 3
WP Kuala Lumpur 3 5 5 - 5
Melaka 0 0 0 - 0
Negeri Sembilan 0 0 0 - 0
Pahang 0 0 0 - 1
Perak 0 0 0 - 0
Perlis 0 0 0 - 0
Pulau Pinang 3 3 2 - 6
Sabah & WP Labuan 0 1 2 - 1
Sarawak 1 2 2 - 4
Selangor 6 6 7 - 2
Terengganu 0 0 0 - 0
WP Putrajaya - - - - -
Malaysia 18 23 24 - 25
Data WP Putrajaya is incorporated into Selangor Data source: NHEWS 2008-2009 (page 86-87) NHEWS 2012-2013 (page 60-61, 72-73) Annual Report of NCVD-ACS Registry 2009-2010 (page 5)
Pu
bli
c P
riva
te
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
37
Indicator: Density of cardiothoracic surgeon (Table 4 & Table 5)
Data table 5: Density of cardiothoracic surgeon
State 2009 2010 2011 2012 2013
Johor 0.01 0.15 0.15 - 0.12
Kedah 0 0 0 - 0
Kelantan 0.01 0.13 0.12 - 0.18
WP Kuala Lumpur 0.1 1.43 1.59 - 1.5
Melaka 0.07 0.49 0.36 - 0.47
Negeri Sembilan 0 0 0 - 0
Pahang 0 0 0 - 0.06
Perak 0 0.04 0.04 - 0.08
Perlis 0 0 0 - 0
Pulau Pinang 0.06 0.7 0.69 - 0.86
Sabah & WP Labuan 0 0.03 0.06 - 0.06
Sarawak 0.01 0.12 0.12 - 0.19
Selangor 0.03 0.24 0.27 - 0.23
Terengganu 0 0 0 - 0
WP Putrajaya - - - - -
Malaysia 0.02 0.23 0.24 - 0.25
2009 population per 10 000 2010, 2011 &2013 population per 100 000 Data WP Putrajaya is incorporated into Selangor Data source: NHEWS 2008-2009 (page 87) NHEWS 2012-2013 (page 72-73)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
38
Indicator: Number of Hospital with Catheterization Laboratory (Table 4 & Table 5)
Data table 6: Number of Hospital with Catheterization Laboratory in Malaysia by state and sector, 2012& 2014
Private Public
State 2012 2014 2012 2014
Malaysia 42 55 13 14
Perlis 0 0 0 0
Kedah 3 5 1 1
Pulau Pinang 7 9 1 1
Perak 3 3 1 1
Selangor & WP Putrajaya 9 14 2 2
WP Kuala Lumpur 8 9 2 3
Negeri Sembilan 2 2 0 0
Melaka 3 3 0 0
Johor 2 3 1 1
Pahang 1 1 1 1
Kelantan 1 1 1 1
Terengganu 0 0 1 1
Sabah & WP Labuan 0 1 1 1
Sarawak 3 4 1 1
Data source: NCVD 2009 &2010 (page 6) NCVD 2011 -2013 (page 4)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
39
Data table 7: Population by states aged 15 years old and above
State 2010 2011 2012 2013 2014
Malaysia 20766700 21271000 21733400 22430000 22935000
Johor 2448900 2500900 2546500 2575100 22935000
Kedah 1378300 1407900 1442300 1487100 2665100
Kelantan 1049000 1081000 1113700 1143900 1516400
WP Kuala Lumpur 1306000 1325600 1337200 1356100 1180000
Labuan 61700 63100 64100 65100 1368000
Melaka 605500 618700 632900 645800 67200
Negeri Sembilan 751400 771500 784300 801600 661000
Pahang 1051800 1080700 1105800 1131900 811600
Perak 1733200 1768700 1802600 1838000 1157800
Perlis 173600 176100 178100 181100 1863300
Pulau Pinang 1213400 1243100 1267100 1308200 183700
WP Putrajaya 50200 51800 51400 51700 1325500
Sabah 2341000 2426600 2511500 2677100 51300
Sarawak 1768100 1814800 1859100 1936900 2735000
Selangor 4129800 4213900 4295000 4471700 4598200
Terengganu 704400 726700 741500 758800 783700
Sabah & WP Labuan 2402700 2489700 2575600 2742200 2802200
Data source: Department of Statistics Malaysia
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
40
Indicator: Admission rate of unstable angina (Table 7 & Table 8)
Data table 8: Number of admission for unstable angina (Aged 15 years old and above)
State 2010 2011 2012 2013 2014
Johor 3,374 3,542 2,875 3,403 3,189
Kedah 2,149 2,293 1,887 1,049 1,548
Kelantan 1,197 1,388 1,345 1,399 1,100
WP Kuala Lumpur 1,042 1,134 101 625 482
WP Labuan - - 83 50 59
Melaka 870 1,225 588 867 954
Negeri Sembilan 2,046 2,875 2,116 2,230 2,255
Pahang 1,347 1,611 1,188 1,637 1,751
Perak 3,404 3,643 1,849 2,382 2,375
Perlis 445 768 1,061 1,055 1,118
Pulau Pinang 1,869 1,958 472 1,216 1,143
WP Putrajaya - - - 85 133
Sabah 568 781 800 952 823
Sarawak 616 515 404 1,057 903
Selangor 3,829 4,212 2,580 2,779 3,323
Terengganu 1,535 1,789 1,558 1,617 1,563
Institusi 11 17 - - -
Malaysia 24,302 27,751 18,907 22,403 22,719
Johor 402 349 339 279 -
Kedah 229 386 246 268 -
Kelantan 39 51 23 21 -
WP Kuala Lumpur 206 189 297 511 -
WP Labuan 0 0 0 0 -
Melaka 163 194 224 158 -
Negeri Sembilan 56 102 98 108 -
Pahang 35 66 46 42 -
Perak 221 163 119 124 -
Perlis 0 0 0 0 -
Pulau Pinang 678 694 611 446 -
WP Putrajaya - - - - -
Sabah 2 4 3 9 -
Sarawak 65 60 95 62 -
Selangor 498 579 631 611 -
Terengganu 2 0 6 0 -
Institusi - - - - -
Malaysia 2,596 2,837 2,738 2,639 -
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
Pu
bli
c
Pri
vate
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
41
Data table 9: Admission rate for unstable angina (Aged 15 years old and above) per 100 000 populations (Table 7 & Table 8)
State 2010 2011 2012 2013
Johor 154 156 126 143
Kedah 173 190 148 89
Kelantan 118 133 123 124
WP Kuala Lumpur 96 100 30 84
WP Labuan 0 0 129 77
Melaka 171 229 128 159
Negeri Sembilan 280 386 282 292
Pahang 131 155 112 148
Perak 209 215 109 136
Perlis 256 436 596 583
Pulau Pinang 210 213 85 127
WP Putrajaya - - - 164
Sabah 24 32 32 36
Sarawak 39 32 27 58
Selangor 105 114 75 76
Terengganu 218 246 211 213
Malaysia 130 144 100 112
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
42
Indicator: Admission rate of STEMI (Table 7 & Table 8)
Data table 10: Number of admission for STEMI (Aged 15 years old and above)
State 2010 2011 2012 2013 2014
Johor 159 312 284 309 682
Kedah 612 260 257 53 329
Kelantan 116 192 359 390 393
WP Kuala Lumpur 148 132 25 125 213
WP Labuan - - 15 15 12
Melaka 78 108 109 186 139
Negeri Sembilan 44 67 168 235 314
Pahang 79 298 330 307 430
Perak 158 714 303 710 477
Perlis 3 14 6 31 90
Pulau Pinang 67 299 87 256 289
WP Putrajaya - - - 1 20
Sabah 85 151 216 235 285
Sarawak 206 113 101 300 395
Selangor 760 953 301 347 615
Terengganu 91 44 56 106 114
Institusi 0 1 - - -
Malaysia 2,606 3,658 2,617 3,606 4,797
Johor 37 33 25 28 -
Kedah 2 1 4 11 -
Kelantan 0 0 1 0 -
WP Kuala Lumpur 58 60 128 303 -
WP Labuan 0 0 0 0 -
Melaka 1 1 10 44 -
Negeri Sembilan 4 5 1 4 -
Pahang 7 6 5 4 -
Perak 27 26 48 56 -
Perlis 0 0 0 0 -
Pulau Pinang 157 238 235 168 -
WP Putrajaya - - - - -
Sabah 0 0 0 0 -
Sarawak 1 3 4 6 -
Selangor 70 124 198 229 -
Terengganu 0 0 1 0 -
Institusi - - - - -
Malaysia 1,483 2,405 2,866 4,064 -
Data source: Sistem Maklumat Rawatan Perubatan (SMRP)
Pri
vate
P
ub
lic
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
43
Data table 11: Admission rate for STEMI (Aged 15 years old and above) per 100 000 populations (Table 7 & Table 8)
State 2010 2011 2012 2013
Johor 8 14 12 13
Kedah 45 19 18 4
Kelantan 11 18 32 34
Kuala Lumpur 16 14 11 32
Labuan 0 0 23 23
Melaka 13 18 19 36
Negeri Sembilan 6 9 22 30
Pahang 8 28 30 27
Perak 11 42 19 42
Perlis 2 8 3 17
Pulau Pinang 18 43 25 32
Putrajaya - - - 2
Sabah 4 6 9 9
Sarawak 12 6 6 16
Selangor 20 26 12 13
Terengganu 13 6 8 14
Malaysia 14 20 15 20
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
44
Indicator: Admission rate of NSTEMI (Table 7 & Table 8)
Data table 12: Number of admission for NSTEMI (Aged 15 years old and above)
State 2010 2011 2012 2013 2014
Johor 133 312 423 623 1,180
Kedah 119 288 241 25 235
Kelantan 3 11 18 90 116
WP Kuala Lumpur 44 26 3 33 223
WP Labuan - - 1 0 0
Melaka 226 137 245 320 499
Negeri Sembilan 293 358 351 511 710
Pahang 30 121 98 281 413
Perak 386 648 702 800 1,272
Perlis 0 0 4 150 177
Pulau Pinang 41 46 9 53 281
WP Putrajaya - - n.a 2 31
Sabah 19 70 175 91 157
Sarawak 63 51 49 274 352
Selangor 125 335 534 685 894
Terengganu 0 1 13 126 428
Institusi 1 1 - - -
Malaysia 1,483 2,405 2,866 4,064 6,968
Johor 0 4 17 33 -
Kedah 0 0 0 0 -
Kelantan 1 0 0 0 -
WP Kuala Lumpur 7 3 53 245 -
WP Labuan 0 0 0 0 -
Melaka 3 0 14 2 -
Negeri Sembilan 1 0 0 0 -
Pahang 2 0 0 2 -
Perak 79 78 53 40 -
Perlis 0 0 0 0 -
Pulau Pinang 51 90 76 69 -
WP Putrajaya - - - - -
Sabah 0 0 0 0 -
Sarawak 0 0 12 6 -
Selangor 28 4 5 28 -
Terengganu 0 0 0 0 -
Institusi - - - - -
Malaysia 172 179 230 425 -
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
Pu
bli
c P
riva
te
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
45
Data table 13: Admission rate for NSTEMI (Aged 15 years old and above) per 100 000 populations (Table 7 & Table 8)
State 2010 2011 2012 2013
Johor 5 13 17 25
Kedah 9 20 17 2
Kelantan 0 1 2 8
Kuala Lumpur 4 2 4 20
Labuan 0 0 2 0
Melaka 38 22 41 50
Negeri Sembilan 39 46 45 64
Pahang 3 11 9 25
Perak 27 41 42 46
Perlis 0 0 2 83
Pulau Pinang 8 11 7 9
Putrajaya - - - 4
Sabah 1 3 7 3
Sarawak 4 3 3 14
Selangor 4 8 13 16
Terengganu 0 0 2 17
Malaysia 8 12 14 20
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
46
Indicator: UA/NSTEMI case fatality rate (Table 9)
Data table 14: Number of mortality for unstable angina
State 2010 2011 2012 2013 2014
Johor 210 258 148 189 21
Kedah 206 188 128 43 17
Kelantan 124 132 87 28 9
WP Kuala Lumpur 57 61 8 20 0
WP Labuan - - 1 1 0
Melaka 43 9 1 6 2
Negeri Sembilan 144 133 47 13 8
Pahang 72 77 32 33 9
Perak 350 353 80 27 7
Perlis 50 69 60 46 0
Pulau Pinang 241 217 57 79 3
WP Putrajaya - - n.a 2 0
Sabah 48 59 40 33 2
Sarawak 33 28 8 32 3
Selangor 199 172 34 17 8
Terengganu 90 86 52 13 2
Institusi 11 16 - - -
Malaysia 1,878 1,858 783 582 91
Johor 2 3 2 3 -
Kedah 2 0 8 5 -
Kelantan 2 3 0 0 -
WP Kuala Lumpur 2 2 1 3 -
WP Labuan 0 0 0 0 -
Melaka 1 4 0 0 -
Negeri Sembilan 4 2 0 3 -
Pahang 0 1 1 0 -
Perak 0 2 1 1 -
Perlis 0 0 0 0 -
Pulau Pinang 7 6 8 4 -
WP Putrajaya 0 0 0 0 -
Sabah 0 0 0 0 -
Sarawak 1 0 0 0 -
Selangor 5 1 3 0 -
Terengganu 0 0 0 0 -
Institusi - - - - -
Malaysia 26 24 24 19 -
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
Pri
vate
P
ub
lic
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
47
Indicator: UA/NSTEMI case fatality rate (Table 9)
Data table 15: Number of mortality for NSTEMI
State 2010 2011 2012 2013 2014
Johor 13 37 45 74 122
Kedah 15 16 8 1 30
Kelantan 0 0 0 9 23
WP Kuala Lumpur 3 1 1 5 21
WP Labuan - - 0 0 0
Melaka 24 22 24 44 74
Negeri Sembilan 26 36 11 41 71
Pahang 7 17 7 8 37
Perak 35 44 49 103 129
Perlis 0 0 0 7 7
Pulau Pinang 2 2 1 0 14
WP Putrajaya - - n.a 0 8
Sabah 1 7 15 4 22
Sarawak 3 5 5 10 25
Selangor 8 26 31 54 63
Terengganu 0 0 6 17 40
Institusi 1 0 - - -
Malaysia 138 213 203 377 686
Johor 0 0 0 0 -
Kedah 0 0 0 0 -
Kelantan 0 0 0 0 -
WP Kuala Lumpur 0 0 0 1 -
WP Labuan 0 0 0 0 -
Melaka 1 0 1 0 -
Negeri Sembilan 0 0 0 0 -
Pahang 0 0 0 0 -
Perak 3 1 1 1 -
Perlis 0 0 0 0 -
Pulau Pinang 0 3 1 1 -
WP Putrajaya 0 0 0 0 -
Sabah 0 0 0 0 -
Sarawak 0 0 0 0 -
Selangor 1 0 0 0 -
Terengganu 0 0 0 0 -
Institusi - - - - -
Malaysia 5 4 3 3 -
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
Pri
vate
P
ub
lic
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
48
Data table 16: UA/NSTEMI case fatality rate (Table 9)
State 2008 2009 2010 2011 2012 2013
Johor 6.0 6.1 5.8 7.1 5.3 6.1
Kedah 8.8 9.3 8.9 6.9 6.1 3.7
Kelantan 7.4 9.2 10.2 9.3 6.3 2.5
WP Kuala Lumpur 3.0 3.6 4.8 4.7 2.2 2.1
WP Labuan - - - - 1.2 2.0
Melaka 11.3 13.8 5.5 2.2 2.4 3.7
Negeri Sembilan 8.2 8.7 7.3 5.1 2.3 2.0
Pahang 3.4 5.4 5.6 5.3 3.0 2.1
Perak 15.1 11.5 9.5 8.8 4.8 3.9
Perlis 12.5 13.2 11.2 9.0 5.6 4.4
Pulau Pinang 5.9 10.2 9.5 8.2 5.7 4.7
WP Putrajaya - - - - - -
Sabah 6.8 6.8 8.3 7.7 5.6 3.5
Sarawak 4.6 4.6 5.0 5.3 2.3 3.0
Selangor 6.8 7.8 4.8 3.9 1.8 1.7
Terengganu 6.5 4.0 5.9 4.8 3.7 1.7
Malaysia 8.1 8.5 7.2 6.3 4.1 3.3
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
49
Indicator: STEMI case fatality rate (Table 9)
Data table 17: Number of mortality for STEMI
State 2010 2011 2012 2013 2014
Johor 11 38 22 23 78
Kedah 61 19 16 5 48
Kelantan 7 16 26 29 26
WP Kuala Lumpur 14 8 4 12 19
WP Labuan - - 0 1 0
Melaka 7 14 6 18 36
Negeri Sembilan 6 6 14 13 33
Pahang 12 30 18 27 44
Perak 17 59 53 38 91
Perlis 0 0 0 1 3
Pulau Pinang 8 13 4 12 29
WP Putrajaya - - n.a 0 13
Sabah 4 20 10 12 32
Sarawak 21 9 8 24 43
Selangor 67 72 18 21 43
Terengganu 8 5 3 10 23
Institusi 0 0 - - -
Malaysia 243 309 202 246 561
Johor 0 1 2 0 -
Kedah 0 0 0 0 -
Kelantan 0 0 0 0 -
WP Kuala Lumpur 2 2 3 10 -
WP Labuan 0 0 0 0 -
Melaka 0 0 1 0 -
Negeri Sembilan 0 0 0 0 -
Pahang 0 0 0 0 -
Perak 0 1 1 0 -
Perlis 0 0 0 0 -
Pulau Pinang 4 6 6 4 -
WP Putrajaya 0 0 0 0 -
Sabah 0 0 0 0 -
Sarawak 0 0 0 0 -
Selangor 2 4 3 5 -
Terengganu 0 0 0 0 -
Institusi - - - - -
Malaysia 8 14 16 19 -
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
Pri
vate
P
ub
lic
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
50
Data table 18: STEMI case fatality rate
State 2008 2009 2010 2011 2012 2013
Johor 1.8 6.4 5.6 11.3 7.8 6.8
Kedah 10.5 13.8 9.9 7.3 6.1 7.8
Kelantan 4.4 6.4 6.0 8.3 7.2 7.4
WP Kuala Lumpur 9.6 6.4 7.8 5.2 4.6 5.1
WP Labuan - - - - 0.0 6.7
Melaka 22.2 0.0 8.9 12.8 5.9 7.8
Negeri Sembilan 7.5 12.5 12.5 8.3 8.3 5.4
Pahang 10.2 9.5 14.0 9.9 5.4 8.7
Perak 2.5 5.4 9.2 8.1 15.4 5.0
Perlis 12.5 0.0 0.0 0.0 0.0 3.2
Pulau Pinang 10.1 8.1 5.4 3.5 3.1 3.8
WP Putrajaya - - - - - -
Sabah 7.1 4.8 4.7 13.2 4.6 5.1
Sarawak 7.9 6.2 10.1 7.8 7.6 7.8
Selangor 12.7 9.7 8.3 7.1 4.2 4.5
Terengganu 11.0 3.8 8.8 11.4 5.3 9.4
Malaysia 9.4 8.2 8.5 7.8 6.7 5.9
Data as of July 2015 Data source: Sistem Maklumat Rawatan Perubatan (SMRP)-unpublished
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
51
Indicator: % of STEMI not given fibrinolytic therapy due to missed thrombolysis time (Table 6)
Data table 19: Percentage of STEMI patients receiving thrombolytic therapy within 30 minutes of presentation at the Emergency Department in 2013
Percentage of ST elevation Myocardial Infarction (STEMI)
patients receiving thrombolytic therapy within 30 minutes of
presentation at the Emergency Department
Non STEMI / Unstable Angina
Case Fatality Rate
STEMI Case
Fatality Rate
Indicator Data : 2013
≥ 70% ≤ 10% ≤ 15% Standard
173 2 21 Num Hospital Kuala
Lumpur 195 204 356 Deno
88.72% 0.98% 5.90% Perf
702 141 104 Num
Johor 761 5206 1508 Deno
92.25% 2.71% 6.90% Perf
40148 71 57 Num
Kedah 40270 2992 1187 Deno
99.70% 2.37% 4.80% Perf
467 46 54 Num
Kelantan 540 2281 706 Deno
86.48% 2.02% 7.65% Perf
18 0 2 Num
Labuan 18 51 28 Deno
100.00% 0.00% 7.14% Perf
186 42 45 Num
Melaka 202 2455 664 Deno
92.08% 1.71% 6.78% Perf
342 31 23 Num
N. Sembilan 351 2777 650 Deno
97.44% 1.12% 3.54% Perf
566 95 67 Num
Perak 657 3892 1343 Deno
86.15% 2.44% 4.99% Perf
2220 14 72 Num
Pahang 2354 1621 639 Deno
94.31% 0.86% 11.27% Perf
239 93 31 Num
Penang 279 2974 600 Deno
85.66% 3.13% 5.17% Perf
84 16 14 Num
Kangar 114 900 174 Deno
77.19% 2.40% 9.28% Perf
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
52
30 10 7 Num
Putrajaya 30 198 67 Deno
100.00% 4.40% 11.11% Perf
952 120 92 Num
Selangor 1077 6684 1448 Deno
88.39% 1.80% 6.35% Perf
189 23 35 Num
Terengganu 201 1621 432 Deno
94.03% 1.42% 8.10% Perf
283 19 29 Num
Sabah 299 1283 517 Deno
94.65% 1.48% 5.61% Perf
275 13 21 Num
Sarawak 353 947 324 Deno
77.90% 1.37% 6.48% Perf
Data source: Unit Survelan Pencapaian Klinikal, CKPP, BPP, Jan 2015 (Data 2013)
Indicator: % of STEMI not given fibrinolytic therapy due to missed thrombolysis time (Table 6)
Data table 20: Percentage of STEMI patients receiving thrombolytic therapy within 30 minutes of presentation at the Emergency Department in 2014
Percentage of ST elevation Myocardial Infarction (STEMI)
patients receiving thrombolytic therapy within (≤) 30 minutes of presentation at the Emergency
Department
Non STEMI / Unstable
Angina Case Fatality Rate
STEMI Case Fatality Rate
Indicator Data : 2014
≥ 85% ≤ 10% ≤ 15% Standard
37 0 5 Num
Perlis 47 0 76 Deno
78.72%
6.58% Perf
158 0 14 Num
Kelantan 168 0 203 Deno
94.05%
6.90% Perf
60 8 0 Num
Terengganu 64 478 196 Deno
93.75% 1.67% 0.00% Perf
408 0 2 Num
Selangor 432 0 206 Deno
94.44%
0.97% Perf
115 24 22 Num
Melaka 115 942 234 Deno
100.00% 2.55% 9.40% Perf
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
53
306 15 25 Num
Johor 332 657 247 Deno
92.17% 2.28% 10.12% Perf
213 6 12 Num
Kedah 234 470 160 Deno
91.03% 1.28% 7.50% Perf
69 11 8 Num
HKL 77 178 182 Deno
89.61% 6.18% 4.40% Perf
32 0 0 Num JKWPKL & Putrajaya
36 0 0 Deno
88.89%
Perf
2 0 0 Num
Labuan 2 0 0 Deno
100.00%
Perf
103 1 0 Num
N. Sembilan 104 216 3 Deno
99.04% 0.46% 0.00% Perf
65 2 13 Num
Pahang 67 171 182 Deno
97.01% 1.17% 7.14% Perf
229 12 4 Num
Perak 252 587 259 Deno
90.87% 2.04% 1.54% Perf
136 0 6 Num
Penang 151 0 240 Deno
90.07%
2.50% Perf
87 0 4 Num
Sabah 109 0 202 Deno
79.82%
1.98% Perf
113 2 8 Num
Sarawak 118 293 105 Deno
95.76% 0.68% 7.62% Perf
Data source: Unit Survelan Pencapaian Klinikal, CKPP, BPP, Jan 2015 (Data 2014)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
54
Indicator: Median door-to-needle time (Table 6) Median door-to-balloon time
Data table 21: Door to needle and balloon time distribution for patients with STEMI by year, 2006-2013
Data source: Annual Report of NCVD-ACS Registry 2009-2010 (page 96) Annual Report of NCVD-ACS Registry 2011-2013 (page 85)
STEMI only
Year 2006 2007 2008 2009 2010 2011 2012 2013
Door-to-needle time, minutes
N 745 827 794 832 921 1009 960 1387
Mean (SD)
103 (143)
91 (131)
112 (195)
100 (186)
119 (217)
105.7 (201.8)
134.6 (240.1)
132.9 (226.9)
Median (min, max)
60 (2,1349)
53 (1,1435)
50 (1,1440)
45 (2,1440)
45 (3,1440)
40 (2,1390)
45 (1,1380)
49 (1,1440)
IQR 90 70 72 68 73 55 78.5 85
Door-to-balloon time, minutes
N 151 126 99 134 123 113 256 203
Mean (SD) 237
(292) 215
(266) 214
(260) 265
(338) 192
(224) 216.5 (252)
246.4 (321.1)
214.9 (301)
Median (min, max)
133 (35,1440)
112 (25,1410)
114 (11,1195)
119 (24,1391)
108 (13,1410)
120 (5,1305)
113.5 (15,1440)
104 (5,1440)
IQR 135 154 139 186 134 133 164 119
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
55
Indicator: Fibrinolytic therapy rate (%) (Table 6) Percutaneous Coronary Intervention (PCI) rate (%)
Data table 22: Summary of treatment for patients with ACS by ACS stratum, NCVD-ACS Registry, 2006-2010 (STEMI data ONLY)
Data source: Annual Report of NCVD-ACS Registry 2007 & 2008 (page 67) Annual Report of NCVD-ACS Registry 2009 & 2010 (page 84) Annual Report of NCVD-ACS Registry 2011 - 2013 (page 70)
STEMI only
Year 2006 2007 2008 2009 2010 2011 2012 2013
Fibrinolytic therapy, n (%)
Given 1018 (70)
1231 (73)
1143 (75)
1258 (75)
1347 (75)
1131 (80)
1109 (72)
1477 (74)
Given at another centre prior to transfer
- - - - - 446
(22.6) 577
(24.8) 747
(24.8)
Not given–proceeded directly to primary angioplasty
117 (8)
113 (7)
90 (6)
90 (5)
140 (8)
119 (6)
264 (11.3)
308 (10.2)
Not given-Contraindicated 70 (5) 63 (4) 56 (4) 82 (5) 64 (4) 63
(3.2) 92 (4)
130 (4.4)
Not given–Missed thrombolysis 193 (13)
226 (13)
168 (11)
201 (12)
202 (11)
216 (10.8)
279 (12)
332 (11)
Not given–Others** 47 (3) 54 (3) 77 (5) 50 (3) 49 (3) - - -
Not given–patients refusal - - - - - 7
(0.4) 8
(0.3) 19
(0.6)
Not applicable - - - - - 3 6 15
Not available - - - - - 11 11 26
Missing - - - - - 59 40 7
Total 1445 1687 1534 1681 1802 1982 2329 3013
PCI, n (%)
Yes 227 (21)
370 (18)
277 (17)
341 (20)
275 (15)
401 (24.2)
747 (34.6)
1070 (38)
No 965 (79)
1221 (82)
1133 (83)
1340 (80)
1527 (85)
1253 (75.8)
1409 (65.4)
1729 (61.2)
Unknown 253 (18)
96 (6)
124 (8)
- - - - -
Not applicable - - - - - - - 24
(0.8)
Missing - - - - - 401 230 238
Total 1445 1687 1534 1681 1802 2055 2386 3061
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
56
Indicator: 30-days all-cause mortality rate for registered STEMI patient after fibrinolytic therapy (Table 6)
Data table 23: Outcomes for patients with STEMI by fibrinolytic therapy
Outcome
In-hospital 30-day
Yes No Yes No
No. % No. % No. % No. %
2006 Alive 941 92 368 86 830 82 305 71
Died 77 8 59 14 188 18 122 29
2007 Alive 1123 91 390 86 1023 83 350 77
Died 108 9 66 14 208 17 106 23
2008 Alive 1045 91 343 88 993 87 314 80
Died 98 9 48 12 150 13 77 20
2009 Alive 1163 92 363 86 1130 90 345 82
Died 95 8 60 14 128 10 78 18
2010 Alive 1255 93 394 87 1213 90 377 83
Died 92 7 61 13 134 10 78 17
2011 Alive 1418 90 358 88.4 1402 89 349 86.2
Died 159 10 47 11.6 175 11 56 13.8
2012 Alive 1521 90.2 551 85.6 1508 89.4 540 84
Died 165 9.8 92 14.4 178 10.6 103 16
2013 Alive 2015 90.6 686 87 1990 89.4 676 85.6
Died 209 9.4 103 13 234 10.6 113 14.4
Data source: NCVD-ACS Registry 2009-2010 (page 117) NCVD-ACS Registry 2007-2008 (page 101) NCVD-ACS Registry 2011-2013 (page 106)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
57
Indicator: 30 days all-cause mortality rate for registered STEMI patient after primary PCI (Table 6)
Data table 24: Outcomes for patients with STEMI by Percutaneous Coronary Intervention
Outcome
In-hospital 30-day
Yes No Yes No
No. % No. % No. % No. %
2006 Alive 282 92 1027 90 259 84 876 77
Died 26 8 110 10 49 16 261 23
2007 Alive 270 91 1243 89 253 85 1120 81
Died 27 9 147 11 44 15 270 19
2008 Alive 233 90 1155 91 218 84 1089 85
Died 25 10 121 9 40 16 187 15
2009 Alive 322 94 1204 90 316 93 1159 86
Died 19 6 136 10 25 7 181 14
2010 Alive 252 92 1397 91 247 90 1343 88
Died 23 8 130 9 28 10 184 12
2011 Alive 376 93.8 1096 87.4 366 91.2 1087 86.8
Died 25 6.2 157 12.6 35 8.8 166 13.2
2012 Alive 682 91.2 1235 87.6 673 90 1222 86.8
Died 65 8.8 174 12.4 74 10 187 13.2
2013 Alive 987 92.2 1523 88 972 90.8 1504 87
Died 83 7.8 206 12 98 9.2 225 13
Data source: NCVD-ACS Registry 2009-2010 (page 117) NCVD-ACS Registry 2007-2008 (page 101) NCVD-ACS Registry 2011-2013 (page 106)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
58
Indicator: Prevalence of hypertension (Table 2)
Data table 25: Prevalence of overall, known and undiagnosed hypertension (Aged 18 years old and above)
Hypertension (%)
Overall Known Undiagnosed
2011 2015 2011 2015 2011 2015
Malaysia 32.7 30.3 12.8 13.1 19.8 17.2
Johor 36.4 27.4 14.0 11.2 22.4 16.2
Kedah 38.2 37.5 14.2 14.3 24.0 23.2
Kelantan 27.9 33.8 11.1 10.6 16.9 23.2
Melaka 32.8 25.8 16.0 13.1 16.9 12.7
Negeri Sembilan 34.1 32.5 15.1 16.1 19.0 16.4
Pahang 29.9 28.5 11.9 10.7 17.9 17.8
Penang 28.4 29.8 11.2 12.6 17.2 17.2
Perak 42.9 36.4 18.0 17.3 24.9 19.1
Perlis 41.1 35.4 12.8 14.2 28.3 21.1
Selangor 28.7 25.5 11.4 12.4 17.4 13.1
Terengganu 26.8 26.9 10.4 11.5 16.3 15.3
Sabah & WP Labuan 29.1 26.8 10.3 12.9 18.8 13.9
Sarawak 40.5 37.3 14.6 16.5 25.9 20.8
WP Kuala Lumpur 27.1 33.8 11.8 11.2 15.3 22.6
WP Putrajaya 22.5 24.1 9.8 10.0 12.7 14.1
Data source: NHMS 2011, Vol II (page 21-25) NHMS 2015, Vol II (page 33-37)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
59
Indicator: Prevalence of hypercholesterolemia (Table 2)
Data table 26: Prevalence of overall, known and undiagnosed hypercholesterolemia (Aged 18 years old and above)
Hypercholesterolemia (%)
Overall Known Undiagnosed
2011 2015 2011 2015 2011 2015
Malaysia 35.1 47.7 8.4 9.1 26.6 38.6
Johor 37.7 45.8 10.1 7.0 27.6 38.8
Kedah 43.4 53.5 7.9 7.4 35.5 46.1
Kelantan 33.8 51.7 3.6 5.3 30.2 46.5
Melaka 35.9 46.6 8.0 8.4 27.9 38.1
Negeri Sembilan 39.7 49.5 8.7 11.2 31.1 38.4
Pahang 31.7 56.2 6.5 6.1 25.2 50.2
Penang 32.7 52.2 7.9 12.2 24.8 40.1
Perak 45.0 48.3 13.8 11.8 31.2 36.5
Perlis 45.1 47.0 9.0 13.8 36.1 33.1
Selangor 31.9 43.5 8.5 9.5 23.5 34
Terengganu 34.9 52.1 4.4 7.7 30.4 44.4
Sabah & WP Labuan 31.1 40.9 5.3 8.3 25.8 32.6
Sarawak 33.5 48.6 8.9 12.6 24.6 36.1
WP Kuala Lumpur 29.4 52.9 10.8 8.6 18.6 44.4
WP Putrajaya 33.3 46.4 9.1 7.1 24.2 39.3
Data source: NHMS 2011, Vol II (page 27-31) NHMS 2015, Vol II (page 39-43)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
60
Indicator: Prevalence of diabetes mellitus (Table 2)
Data table 27: Prevalence of overall, known and undiagnosed diabetes mellitus (Aged 18 years old and above)
Diabetes Mellitus (%)
Overall Known Undiagnosed
2006 2011 2015 2006 2011 2015 2006 2011 2015
Malaysia 11.6 15.2 17.5 7 7.2 8.3 4.5 8 9.2
Johor 11.1 13.4 19.8 7 7.6 8.8 4.1 5.9 11
Kedah 13.6 22.5 25.4 9.3 9.1 9.3 4.3 13.4 16.1
Kelantan 11.7 19.7 18.5 6.8 8 7.1 4.9 11.7 11.3
Melaka 15.2 17.1 16.7 11.4 10.4 8.3 3.9 6.6 8.4
Negeri Sembilan 15.3 22 19.3 8.8 11.5 10.5 6.6 10.5 8.8
Pahang 12.1 16.7 14.8 8.1 8.6 6.3 4 8.1 8.6
Penang 14.9 15 18.1 8.9 8.5 9 6 6.4 9.1
Perak 12.6 16.2 19.4 7.6 10.1 11.9 5 6.1 7.4
Perlis 13.5 24.8 20.6 8 8.7 10.9 5.5 16.1 9.7
Selangor 12 16.5 15.5 8.3 6.5 7.8 3.8 10.1 7.7
Terengganu 11.1 11.6 18.6 5.7 7.1 8.7 5.4 4.5 9.9
Sabah 4.9 9 14.2 2.4 2.6 5.9 2.5 6.4 8.3
Sarawak 10 12.3 14.8 4.1 5.1 8.3 6 7.3 6.6
WP Kuala Lumpur 12.6 11.3 17.4 6.6 7.2 8.1 6 4.1 9.3
WP Labuan 7.9 - - 4.8 - - 3.2 - -
WP Putrajaya - 8.8 19.2 - 4.6 5.3 - 4.2 13.9
Data source: NHMS 2006, Vol II (page 254-263) NHMS 2011, Vol II (page 13-17) NHMS 2015, Vol II (page 25-30)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
61
Indicator: Prevalence of obesity (Table 2)
Data table 28: Prevalence of obesity (Aged 18 years old and above)
Obesity (BMI ≥ 27.5 kg/m2)
2006 2011 2015
Malaysia 14 27.2 30.6
Johor 14.1 28.6 29.8
Kedah 15.5 28.2 33.2
Kelantan 12.5 29.4 28.8
Melaka 17.4 29.3 36
Negeri Sembilan 18.6 28.2 35.6
Pahang 15.3 28.2 32.5
Penang 13.7 26.9 27.8
Perak 12.9 30.1 29.5
Perlis 17.2 34.6 36
Selangor 16 28.2 32.7
Terengganu 15.2 28.1 32.5
Sabah 9.7 21.1 23.9
Sarawak 11.5 26.7 32.3
WP Kuala Lumpur 12.5 22.8 29.6
WP Labuan 14.6 - -
WP Putrajaya - 27.4 43
Data source: NHMS 2006, Vol II (page 780) NHMS 2011, Vol II (page 57) NHMS 2015, Vol II (page 59)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
62
Indicator: Prevalence of current tobacco smoker (Table 3)
Data table 29: Prevalence of current tobacco smoker (Aged 18 years old and above)
Current Tobacco Smoker (%)
2006 2011 2015
Johor 20.7 19.9 22.2
Kedah 25.6 21.7 26.5
Kelantan 27.3 18.7 24.6
Melaka 20 17.1 16.9
Negeri Sembilan 23.3 19.4 20.9
Pahang 27.4 20.6 25.5
Penang 18.5 16.5 19.2
Perak 20.9 16.1 21.0
Perlis 33.1 22.6 22.2
Selangor 18.1 18.8 20.9
Terengganu 26.5 20.5 22.2
Sabah & WP Labuan - 23.0 28.4
Sarawak 19.3 19.1 25.4
WP Kuala Lumpur 15.7 17.4 19.1
WP Putrajaya - 15.6 12.4
Data in 2011 for aged 10 years old and above Data source: NHMS 2006, Vol II (page 614) NHMS 2011, Vol III (page 127) NHMS 2015, Vol II (page 92)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
63
Data table 30: Cardiovascular disease, estimated mortality rates (per 100 000), 2012
Country 2012
Korea, Rep. 89.5
Sweden 167.3
Japan 96.5
Finland 170.5
Israel 98.6
Austria 176.4
Canada 104.8
Thailand 180.2
Singapore 110.1
Cambodia 187.0
France 111.8
Greece 195.3
Australia 112.1
Solomon Islands 202.8
Spain 116.9
Viet Nam 210.1
New Zealand 119.0
Nepal 233.6
Netherlands 120.3
Asia-20 241.6
Switzerland 121
Pakistan 243.4
Chile 122.4
Sri Lanka 258.0
Denmark 123.1
Czech Republic 258.8
Portugal 124.8
Malaysia 265.6
Luxembourg 127.2
Poland 274.8
Italy 129.7
India 284.4
Ireland 129.8
China 286.1
Papua New Guinea 130.0
Myanmar 286.4
United Kingdom 130.3
Turkey 286.7
Iceland 132.9
Estonia 288
Belgium 134.5
Lao PDR 302.1
Norway 139.9
Korea, DPR 304.6
Mexico 149.8
Hungary 315.4
Bangladesh 155.2
Slovakia 320.8
Slovenia 155.6
Fiji 322.0
Brunei Darussalam
157.6
Philippines 335.0
United States 158.3
Indonesia 336.0
Germany 158.6
Mongolia 510.7
OECD 160.6
Age standardized Source: WHO Global Burden of Disease, 2014; Department of Health, Hong Kong, China, 2014; Disease Registry, Macao, China, 2014.
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
64
Data table 31: Prevalence of daily smoker male, 2015 (or nearest year)
Country 2015
Australia 14.7
Korea 36.6
Austria 26.5
Latvia 37
Belgium 21.6
Luxembourg 16
Canada 16.3
Mexico 11.9
Czech Republic 26.4
Netherlands 21.7
Denmark 16
New Zealand 16.1
Estonia 31.4
Norway 13
Finland 17.2
Poland 28.8
France 25.8
Portugal 23.5
Germany 25.1
Slovak Republic 30.4
Greece 33.8
Slovenia 21.8
Hungary 31.6
Spain 27.6
Iceland 10.2
Sweden 12.1
Ireland 20
United Kingdom 22
Israel 23.2
United States 14
Italy 24.9
OECD-32 22.8
Japan 32.2
Source: stats.oecd.org
Data table 32: Prevalence of daily smoker female, 2015 (or nearest year)
Country 2015
Australia 11.3
Korea 4
Austria 22.1
Latvia 14.6
Belgium 16.4
Luxembourg 13.9
Canada 11.7
Mexico 3.6
Czech Republic 18.5
Netherlands 16.7
Denmark 17
New Zealand 13.9
Estonia 15.8
Norway 13
Finland 14
Poland 17.2
France 19.4
Portugal 10.9
Germany 17.1
Slovak Republic 15.8
Greece 21.4
Slovenia 16
Hungary 20.8
Spain 18.6
Iceland 10.7
Sweden 11.7
Ireland 17
United Kingdom 17
Israel 11.4
United States 11.8
Italy 15.8
OECD-32 16.3
Japan 8.5
Source: stats.oecd.org
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
65
Data table 33: Prevalence of obesity, 2014 (or nearest year)
Country 2014
Austria 14.7
Korea 2.6
Belgium 14
Latvia 21.3
Canada 19.6
Luxembourg 15.6
Czech Republic 19.3
Netherlands 13.3
Denmark 14.9
Poland 17.2
Estonia 20.4
Portugal 16.6
Finland 18.3
Slovak Republic 16.3
France 15.3
Slovenia 19.2
Germany 16.9
Spain 16.7
Greece 17.3
Sweden 14
Hungary 21.2
Turkey 19.9
Ireland 23
United Kingdom 20.1
Israel 17.8
United States 29.5
Italy 10.3
OECD-27 17.2
Source: stats.oecd.org
Data table 34: Prevalence of diabetes, 2015
Country 2015
Australia 5.1
Korea, Rep. 7.2
Austria 6.9
Luxembourg 4.7
Belgium 5.1
Mexico 15.8
Canada 7.4
Netherlands 5.5
Chile 10
New Zealand 7.3
Czech Republic 7.4
Norway 6
Denmark 7.2
Poland 6.2
Estonia 4.4
Portugal 9.9
Finland 6
Slovak Republic 7.8
France 5.3
Slovenia 7.8
Germany 7.4
Spain 7.7
Greece 5.2
Sweden 4.7
Hungary 7.3
Switzerland 6.1
Iceland 6.1
Turkey 12.8
Ireland 4.4
United Kingdom 4.7
Israel 7.5
United States 10.8
Italy 5.1
OECD-34 7.01
Japan 5.7
Source: IDF 2015 (page 112)
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
66
Data table 35: In-hospital case-fatality rates within 30 days after admission for AMI, 2011 (or nearest year)
Country 2011
Denmark 3.0
Belgium 7.6
New Zealand 4.5
Slovak Republic 7.6
Norway 4.5
Austria 7.7
Sweden 4.5
United Kingdom 7.8
New Zealand 4.5
OECD-32 7.9
Australia 4.8
Portugal 8.4
Poland 5.2
Spain 8.5
United States 5.5
Luxembourg 8.8
Canada 5.7
Germany 8.9
Iceland 5.7
Korea 8.9
Italy 5.8
Philippines 8.9
Switzerland 5.9
Malaysia 9.7
France 6.2
Turkey 10.7
Czech Republic 6.8
Chile 10.8
Ireland 6.8
Japan 12.2
Netherlands 6.8
Singapore 12.5
Finland 7.0
Hungary 13.9
Slovenia 7.0
Mexico 27.2
Israel 7.1
Age and sex standardized Source: Health at a Glance 2014 (page 93)
Data table 36: 30 day mortality after admission to hospital for AMI based on admission data, 2013
Country 2013
Australia 4.1
Korea 8.3
Austria 10
Latvia 15.4
Canada 6.7
Mexico 28.2
Czech Republic 6.7
New Zealand 6.6
Denmark 5.7
Norway 6.7
Estonia 11.5
Poland 4.7
Finland 6.5
Portugal 9.4
France 7.2
Slovenia 5.2
Germany 8.7
Spain 7.8
Ireland 6.4
Sweden 4.5
Israel 6.7
United Kingdom 7.6
Italy 5.5
OECD-23 8.3
Age and sex standardized Source: stats.oecd.org
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
67
INDICATOR OPERATIONAL DEFINITION
No. Indicator Numerator Denominator Constant
1 Density of Cardiologist by state and year
Number of Cardiologist by state and year
Total midyear population
per 1 000 000
2 Density of Cardio-thoracic surgeon by state and year
Number of Cardio-thoracic surgeon by state and year
Total midyear population
per 1 000 000
3
% of ST elevation Myocardial Infarction (STEMI) patients receiving thrombolytic therapy within 30 minutes of presentation at the Emergency Department
Number of patients with STEMI who received thrombolytic therapy < 30 minutes of presentation in the Emergency Department
Patients with STEMI who received thrombolytic therapy
per 100
4
% of STEMI not given fibrinolytic therapy due to missed thrombolysis time
Number of patients who had STEMI not given fibrinolytic therapy due to missed thrombolysis time
Total number of patients who had STEMI
per 100
5 Rate of fibrinolytic therapy
Number of fibrinolytic therapy
Total number of patients who had STEMI
per 100
6 Rate of primary PCI Number of primary PCI Total number of patients who had STEMI
per 100
7 Admission rate for unstable angina (UA)
Total number of hospital discharge with UA
Total midyear populations of 15 years old and above
per 100 000
8 Admission rate for STEMI
Total number of hospital discharge with STEMI
Total midyear populations of 15 years old and above
per 100 000
9 Admission rate for NSTEMI
Total number of hospital discharge with NSTEMI
Total midyear populations of 15 years old and above
per 100 000
10 30-day case fatality rate for STEMI
Total number of patients who died within 30 days post STEMI
Total number of patients who had STEMI
per 100
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
68
11 30-day case fatality rate for AMI
Total number of patients who died within 30 days post STEMI/ NSTEMI
Total number of patients who had STEMI/ NSTEMI
per 100
13 STEMI case fatality rate
Number of patients admitted with STEMI and died in hospital
Total number of STEMI hospital discharge cases
per 100
14 UA/NSTEMI case fatality rate
Number of patients admitted with NSTEMI and died in hospital
Total number of NSTEMI /UA hospital discharge cases
per 100
15 Prevalence of hypertension
Number of persons with known and undiagnosed hypertension
Total midyear populations of 18 years old and above
per 100
16 Prevalence of hypercholesterolemia
Number of persons with known and undiagnosed hypercholesterolemia
Total midyear populations of 18 years old and above
per 100
17 Prevalence of diabetes Total number of persons with known and undiagnosed diabetes
Total midyear populations of 18 years old and above
per 100
18 Prevalence of obesity Number of persons with obesity (BMI ≥ 27.5 OR BMI ≥ 30.0)
Total midyear populations of 18 years old and above
per 100
19 Prevalence of daily tobacco smoker, male
Number of male who reported daily tobacco smoking
Total midyear populations of 15 years old and above
per 100
20 Prevalence of daily tobacco smoker, female
Number of female who reported daily tobacco smoking
Total midyear populations of 15 years old and above
per 100
This report is intended only for the use of the individual entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure.
69