Original article

ASEAN Heart Journal

, 22:15

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Physicians’ Perception of the Patient Care Pathway for Acute Heart Failure in Asian Countries: Implications for Resource Allocation, Preventive Strategies and Clinical Trial Design

  • Elvira Zenaida LansangAffiliated withQuintiles East Asia
  • , David HorsburghAffiliated withQuintiles East Asia
  • , Yun Ning LeeAffiliated withQuintiles East Asia
  • , Adeline SngAffiliated withQuintiles East Asia
  • , Ralph MoussalliAffiliated withQuintiles East Asia
  • , Karen WaiAffiliated withQuintiles East Asia
  • , Inder AnandAffiliated withVA Medical Center
  • , Shu ZhangAffiliated withFuwai Hospital
  • , Wataru ShimizuAffiliated withNational Cerebral and Cardiovascular Center and Nippon Medical School
    • , Calambur NarasimhanAffiliated withCARE Hospital
    • , Sang Weon ParkAffiliated withKorea University Anam Hospital
    • , Cheuk-man YuAffiliated withPrince of Wales Hospital, The Chinese University of Hong Kong
    • , Tachapong NgarmukosAffiliated withRamathibodi Hospital, Mahidol University
    • , Razali OmarAffiliated withInstitut Jantung Negara
    • , Eugene B. ReyesAffiliated withManila Doctors Hospital
    • , Bambang Budi SiswantoAffiliated withNational Cardiovascular Center University Indonesia
    • , Arthur Mark RichardsAffiliated withCardiovascular Research Institute
    • , Carolyn S.P. LamAffiliated withCardiovascular Research Institute Email author 



Heart failure (HF) is a growing epidemic in Asia. However, data are scarce regarding the patient care pathway of HF in Asia. We aimed to investigate the HF patient pathways in Asia using a questionnaire-based survey.

Methods and Results

Seventy physicians in 12 Asian countries were surveyed using standardized questionnaires regarding patient source, precipitating factors, clinical presentation, referral pattern, and discharge plans for patients with Acute Heart Failure (AHF). Direct self-referral was reported as the most common source of admission. Majority (70%) of patients presented at the emergency department for worsening of chronic HF, with acute coronary syndrome being the most common precipitating factor, and acute pulmonary edema the most common presentation. Patients spent an average of 10 hours in the Emergency Department and majority were admitted to Cardiology Wards. HF with reduced ejection fraction (HFrEF) were the majority of cases except in Hong Kong and Japan. Most patients were discharged home and only 13-15% were enrolled in outpatient HF programs.


This survey highlights the heterogeneity of AHF patient pathways in Asian countries. These findings underscore the need for prospective studies to validate physicians’ reports, evaluate these differences and guide resource allocation and design of AHF clinical trials.


Cardiovascular Emergency Congestive Referral