Browsing by Author "Yvonne Mei Fong Lim"
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- PublicationEligibility of Asian and European registry patients for phase III trials in heart failure with reduced ejection fraction(Wiley Online Library, 2024)
;Yvonne Mei Fong Lim ;Folkert W. Asselbergs ;Ayoub Bagheri ;Spiros Denaxas ;Wan Ting Tay ;Adriaan Voors ;Carolyn Su Ping Lam ;Stefan Koudstaal ;Diederick E. GrobbeeIlonca VaartjesAims: Traditional approaches to designing clinical trials for heart failure (HF) have historically relied on expertise and past practices. However, the evolving landscape of healthcare, marked by the advent of novel data science applications and increased data availability, offers a compelling opportunity to transition towards a data-driven paradigm in trial design. This research aims to evaluate the scope and determinants of disparities between clinical trials and registries by leveraging natural language processing for the analysis of trial eligibility criteria. The findings contribute to the establishment of a robust design framework for guiding future HF trials. Methods and results: Interventional phase III trials registered for HF on ClinicalTrials.gov as of the end of 2021 were identi fied. Natural language processing was used to extract and structure the eligibility criteria for quantitative analysis. The most common criteria for HF with reduced ejection fraction (HFrEF) were applied to estimate patient eligibility as a proportion of registry patients in the ASIAN-HF (N = 4868) and BIOSTAT-CHF registries (N = 2545). Of the 375 phase III trials for HF, 163 HFrEF trials were identified. In these trials, the most frequently encountered inclusion criteria were New York Heart Association (NYHA) functional class (69%), worsening HF (23%), and natriuretic peptides (18%), whereas the most frequent comorbidity-based exclusion criteria were acute coronary syndrome (64%), renal disease (55%), and valvular heart disease (47%). On average, 20% of registry patients were eligible for HFrEF trials. Eligibility distributions did not differ (P = 0.18) be tween Asian [median eligibility 0.20, interquartile range (IQR) 0.08–0.43] and European registry populations (median 0.17, IQR 0.06–0.39). With time, HFrEF trials became more restrictive, where patient eligibility declined from 0.40 in 1985–2005 to 0.19 in 2016–2022 (P = 0.03). When frequency among trials is taken into consideration, the eligibility criteria that were most restrictive were prior myocardial infarction, NYHA class, age, and prior HF hospitalization. Conclusions: Based on 14 trial criteria, only one-fifth of registry patients were eligible for phase III HFrEF trials. Overall eligibility rates did not differ between the Asian and European patient cohorts. - PublicationHigh-risk nonsteroidal anti-inflammatory drugs prescribing in primary care: results from National Medical Care Survey Malaysia(SpringerNature, 2020)
;Wen Yea Hwong ;Yvonne Mei Fong Lim ;Ee Ming KhooSheamini SivasampuBackground: Information on the extent of high-risk prescribing for nonsteroidal anti-infammatory drugs (NSAIDs) across developing countries is scarce. Objectives This study examines the prescribing pattern for NSAIDs in primary care, assesses the extent of high-risk NSAIDs prescribing and identifes associated factors. Setting 129 public and 416 private primary care clinics in Malaysia. Methods Data were derived from the National Medical Care Survey 2014, a cross-sectional survey on primary care morbidity patterns and clinical activities in Malaysia. Types of NSAIDs, indications for NSAIDs use and propor tion of high-risk NSAIDs prescribing were assessed. Factors associated with high-risk NSAIDs prescribing were identifed with a multivariable logistic regression. Weighted results, adjusted for sampling design and non-response were presented. Main outcome measures: Prescribing pattern of NSAIDs, proportion of high-risk NSAIDs prescribing and its associated factors. Results Among the 55,489 patients who received NSAIDs, diclofenac was the most frequently prescribed NSAID (40.5%, 95% CI 40.1–40.9%), followed by mefenamic acid (29.2%, 95% CI 28.8–29.6%). The commonest indications for NSAIDs use were musculoskeletal condition and respiratory tract infection, both at 17.8% (95% CI 17.4–18.1%). A total of 22.9% (95% CI 22.6–23.3%) patients received high-risk NSAID prescriptions. Of these, 47.8% (95% CI 46.9–48.7%) did not receive adequate gastroprotection despite being at risk, 24.8% (95% CI 24.0–25.5%) were prescribed NSAIDs despite having cardiovascular comorbidities and 22.4% (95% CI 21.7–23.2%) were prescribed high-dose NSAIDs. The odds of receiving high-risk NSAID prescriptions increased with the number of drugs prescribed (OR 1.23, 95% CI 1.06–1.43) and the number of diagnoses in one visit (OR 2.21,95% CI 1.71–2.86). The odds of being prescribed high-risk NSAID prescriptions were lower in patients with secondary (OR 0.52, 95% CI 0.35–0.77) and tertiary education (OR 0.39, 95% CI 0.22–0.68) compared to patients without formal education. Patients’ citizenship, indication for NSAID prescriptions and whether a medical certifcate was issued were also signifcantly associated with the likelihood of receiving high-risk NSAID prescriptions. Conclusions: A quarter of NSAIDs prescribed in Malaysian primary care setting is categorised as high-risk prescribing. Targeted strategies are necessary to improve patient safety. - PublicationIntra-cluster correlation coefficients in primary care patients with type 2 diabetes and hypertension(BMC, 2020)
;Yi Lin Lee ;Yvonne Mei Fong Lim ;Kian Boon LawSheamini SivasampuIntroduction: There are few sources of published data on intra-cluster correlation coefficients (ICCs) amongst patients with type 2 diabetes (T2D) and/or hypertension in primary care, particularly in low- and middle-income countries. ICC values are necessary for determining the sample sizes of cluster randomized trials. Hence, we aim to report the ICC values for a range of measures from a cluster-based interventional study conducted in Malaysia. Method: Baseline data from a large study entitled Evaluation of Enhanced Primary Health Care interventions in public health clinics (EnPHC-EVA: Facility) were used in this analysis. Data from 40 public primary care clinics were collected through retrospective chart reviews and a patient exit survey. We calculated the ICCs for processes of care, clinical outcomes and patient experiences in patients with T2D and/or hypertension using the analysis of variance approach. Results: Patient experience had the highest ICC values compared to processes of care and clinical outcomes. The ICC values ranged from 0.01 to 0.48 for processes of care. Generally, the ICC values for processes of care for patients with hypertension only are higher than those for T2D patients, with or without hypertension. However, both groups of patients have similar ICCs for antihypertensive medications use. In addition, similar ICC values were observed for clinical outcomes, ranging from 0.01 to 0.09. For patient experience, the ICCs were between 0.03 (proportion of patients who are willing to recommend the clinic to their friends and family) and 0.25 (for Patient Assessment of Chronic Illness Care item 9, Given a copy of my treatment plan). Conclusion: The reported ICCs and their respective 95% confidence intervals for T2D and hypertension will be useful for estimating sample sizes and improving efficiency of cluster trials conducted in the primary care setting, particularly for low- and middle-income countries. - PublicationTrends in cataract surgery and healthcare system response during the COVID-19 lockdown in Malaysia: Lessons to be learned(Elsevier, 2024)
;Amanda Wei-Yin Lim ;Chin Tho Leong ;Mohamad Aziz Salowi ;Yvonne Mei Fong Lim ;Wen Jun WongWen Yea HwongBackground: Elective surgeries were suspended during the national lockdown in March 2020 to curb the spread of the COVID-19 pandemic in Malaysia. We sought to evaluate the impact of the lockdown on cataract surgeries and suggest lessons for future outbreaks. Study design: We conducted an interrupted time series analysis to examine rates of cataract surgery before and during the lockdown. Methods: We used national cataract surgical data between 2015 and 2021 from the Malaysian Cataract Surgery Registry. Segmented regression with a seasonally adjusted Poisson model was used for the analysis. Stratified analyses were performed to establish whether the effect of the lockdown on cataract surgeries varied by hospital designation, type of cataract service, sex, and age groups. Results: Cataract surgeries began falling in March 2020 at the onset of the lockdown, reached a trough in April 2020, and subsequently increased but never recovered to pre-lockdown levels. Cataract surgical rates in December 2021 were still 43 % below the expected surgical volume, equivalent to 2513 lost cataract surgeries. There was no evidence of a differential effect of the lockdown between COVID-19 designated and non-COVID-19 designated hospitals. The relative decrease in cataract surgical rates appears to have been greatest in outreach services and in people 40 years and older. Conclusions: The lockdown caused an immediate reduction in cataract surgical rates to nearly half of its baseline rate. Despite its gradual recovery, further delays remain to be expected should there be no redistribution or increase in resources to support backlogs and incoming new cases.