Time to Ditch 'Diurese & Discharge'- Spotlight on Heart Failure in Malaysia

Heart failure remains a major healthcare burden in South-East Asian and Asia Pacific countries, including Malaysia. Despite strong evidence advocating for early initiation of guideline-recommended medical therapy (GRMT), current practice remains unknown regionally. Based on previously published database and registries on acute heart failure admission in the country, we explore possible barriers in achieving optimum use of GRMT among heart failure patients including challenges surrounding existing healthcare services (i.e., inpatient GRMT initiation, poor utilization of community-based services), limited data collection especially surrounding ambulatory heart failure care, and limited focus on prevention of comorbidities linked to the condition. Moving forward, three key areas of interests worth tackling would be on (1) better utilization of GRMT in the inpatient and outpatient setting, which may benefit from decentralization of care from that of tertiary, cardiac centres to district hospitals and even community-based institution - possibly with specialist nurses and pharmacist at its helm, (2) improved data collection, specifically on ambulatory heart failure GRMT prescriptions & outcomes, and cardiac rehabilitation utilization and (3) initiating nationwide efforts on early detection & screening for heart failure, leveraging on digital health tools which has already been shown to be possible in the community setting.