OBJECTIVES: The objective of this research was to examine the differences in quality of life (QOL) results of Malaysian post-acute coronary syndrome (post ACS) patients calculated using utility tariffs from different countries. METHODS: This study utilizes primary data that was collected as part of a study on the cost-effectiveness of a cardiac rehabilitation programme at the Sarawak General Hospital, Malaysia. QOL of post ACS patients were obtained using English and Malay versions of the EQ-5D questionnaire that have been validated for use in the Malaysian population. QOL scores were determined using visual analogue scale (VAS) and calculated using a recently developed Malaysian utility tariff (derived from  VAS valuation of Malaysians) as well as  existing EQ-5D tariffs from several  other countries. RESULTS: A total of 112 (female 11.6%, male 88.4%) post-ACS patients with an average age of 56 (10.38) years answered the EQ-5D questionnaire of which 110 were usable for analysis. The patients had average left  ventricular ejection fraction (LVEF) of 50.2% on admission. Average length-of-stay in hospital and cardiac care was 6 and 3 days respectively.  Mean quality of life was 59.7 on the VAS score and the mean predicted QOL index score using different tariffs from Malaysia, UK (TTO), UK (VAS), Japan (TTO), Korea (TTO), New Zealand (VAS) and US (TTO) were 0.80, 0.72, 0.72, 0.74, 0.83, 0.68 and 0.79 respectively.  CONCLUSIONS: Recent research argues for the use of locally and culturally appropriate tariffs for different populations. QOL scores  in this sample of post ACS were different when calculated using utility tariffs from different countries. Our findings suggest that the health preferences of Malaysians are unique compared to those of other countries and underscores the importance of applying country specific utility tariffs for QOL and cost effectiveness studies.