Clinical Practice Guidelines (CPG)

Cardiovascular Diseases (CVD) has been the leading cause of death in Malaysian since the early 1980s. The National Burden of Disease Study in early 2000s showed that coronary artery disease (CAD) and cerebrovascular disease (CVA) are the top two causes of death for both men and women. What is of concern is that the age of onset of CVD in Malaysia is younger compared to our neighbors and some western nations.

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Dyslipidaemia remains a significant problem in Malaysia, with the National Health and Morbidity survey in 2015 reporting an estimated 47% of the adult population having hypercholesterolaemia. In the main, dyslipidaemia is asymptomatic but its associations with serious vascular conditions such as acute myocardial infarction and stroke is well known.

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Infective endocarditis (IE) is an uncommon and potentially lethal infection affecting patients at risk. Despite advances in medicine, IE still causes significant morbidity and mortality. This is due to the changing epidemiology of the disease, the wide spectrum of presentation extending from the neonate to the elderly, diagnostic difficulties, delayed surgical interventions and embolic complications.

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Malaysia, with a crude birth rate of 16.9 per 1000 population and an annual population growth rate of 1.3%, has also seen a significant growth in attendances at the Ministry of Health’s antenatal clinics – from 5.7 million in 2013 to 6.1 million in 2014.

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Cardiovascular disease, till this day, remains the primary cause of mortality globally. Although it affects both genders, a greater emphasis appears to be placed on male patients, who appear to develop the disease at an earlier age compared to females. However, it is also known the incidence of cardiovascular disease in females rapidly rises to match males after menopause.

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Heart Disease is an important cause of morbidity and mortality in Malaysia. Most patients who survive a myocardial infarction or develop hypertension, will eventually develop heart failure. With ageing of the population, the prevalence of heart failure is expected to increase. Thus the publication of this Clinical Practice Guidelines on Heart Failure by the National Heart Association of Malaysia, Academy of Medicine and Ministry of Health is important and timely.

Cardiovascular diseases are undoubtedly the leading cause of death worldwide and certainly in Malaysia. In dealing with the increasing cardiovascular disease burden, it is paramount that contemporary clinical cardiology practice mirrors the ever-growing scientific medical knowledge. Cardiac magnetic resonance (CMR) being the latest addition to the clinical armamentarium of cardiovascular imaging is certainly no different. The importance of CMR is such that today it has already become the gold standard clinical test in some cardiac diseases.

Cardiovascular disease remains the world'd biggest killer with coronary artery disease (CAD) being the largest contributor. In Malaysia, it has surpassed infective diseases as the leading cause of death, making it the most important non-communicable disease that the nation has to combat against. Cardiac computed tomography (CCT) has been utilised in the last 20 years as one of the imaging modality used to diagnose CAD. Its tremendous growth in technology has seen its application grow from coronary calcium imaging and noninvasive coronary angiography to more functional cardiac and non-coronary work. With these advancements, Malaysia has to keep abreast with the contemporary use and application of this modality to be in parallel with the rest of the world.

This Appropriate Use Criteria (AUC) has been developed to serve as a supplement to the Clinical Practice Guideline (CPG). It does not replace the CPGs which are evidence based. The objective of the AUC document is to combine the best available scientific evidence with the collective judgement of experts to produce a statement regarding the appropriateness of performing procedure at the level of patient specific symptoms, medical history and test results. The aim is not to reflect the number of procedures being performed but to ensure that these are done appropriately based on current evidence.

ST segment myocardial infarction (STEMI) is the most deadly among the clinical presentations of acute coronary syndrome (ACS). Unlike many medical conditions, STEMI is associated with high mortality and morbidity in its early stages, including sudden death. The National Cardiovascular Disease (NCVD) ACS Registry revealed that there was a 10% mortality for patients who were admitted to hospital with STEMI in 2006-2008.