The First Malaysian Multidisciplinary Team Heart Failure Clinic: A Tertiary Cardiac Centre Experience

Abstract

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