Prof Chia Boon Lock receives the SMA Honorary ... - nuhcs

don’t bypass Cardiac Rehabilitation
Dr Eric Hong, Cardiac Dept @ NUH
Cardiac rehabilitation is increasingly
recognised as an integral component of
the continuum of care for patients with
cardiovascular disease. Its application is a
class I recommendation in most
contemporary cardiovascular clinical
practice guidelines. Despite the
documentation of substantial morbidity
and mortality benefits, cardiac
rehabilitation services are vastly underutilised.
Established in the late 1990s, the Cardiac
Rehabilitation Programme (CRP) at National University
Hospital (NUH) is characterized with a provisional
comprehensive long term services involving medical evaluation,
prescriptive exercise; cardiac risk factor modification, education,
counseling and behavioural interventions.
It is paramount that a good CRP is multifaceted and
multidisciplinary in nature consisting doctors, specialized cardiac
nurses, physiotherapists, dietitians, pharmacists, medical social
workers, occupational therapists, psychologist and psychiatrist. In
NUH, cardiologist Dr. Eric Hong Cho Tek leads this unique
specialised individualised programme. Dr Roger Ho, a psychiatrist,
is also part of this dynamic
multidisciplinary team.
Upon the completion of the
National University Heart Centre for
Cardiovascular Services, a dedicated
cardiac rehabilitation gym with the
state-of-the-art exercise equipment
and facilities will help to meet the
needs of the evolving society.
Numerous studies have demonstrated that cardiac
rehabilitation programmes can reduce the cardiac death rate by as
much as 20 to 25 per cent. It has been shown to be as important as
compliance to prescribed medication and following, of a strict
recommended diet. Despite the presence of cardiac rehabilitation,
only 15 to 20 per cent of appropriate candidates participated in a
formal CRP in Singapore. In our survey, most quoted ignorance
of the existence of a CRP.
In NUH CRP, our goals are manifolds. Besides reducing
morbidity and mortality, improvement of the quality of life,
reduction in subsequent rehospitalization, and getting patient
back to normality, if not better. We provide supervised exercise
training, multidisciplinary education programme to patients
1 st Singapore-Asia Cardiac Resynchronisation
Dr Seow Swee Chong & Dr Abdul Razakjr Omar, Cardiac Dept @ NUH
Heart failure is a major public health issue in developed countries,
exacting a heavy toll on medical resources and more importantly,
a high mortality and morbidity on the patients. Until recently, little
other than medication could be done for patients with chronic heart
failure who are not suitable for coronary revascularization or cardiac
transplant. Patients were forced to restrict their activities often to
minimally functional levels to adapt to their poor heart function
while they lived their lives under the spectre of certain death by
progressive heart failure or sudden cardiac arrest.
The advent of device therapy for chronic heart failure has
literally brought new life and hope for these patients. Individuals
with very poor heart function often have uncoordinated contraction
of their heart walls. By implanting a pacemaker with multiple leads,
these walls can be made to move together again in a coordinated,
synchronized fashion resulting in improved symptoms, cardiac
output and even a reduction in mortality. Aptly termed “cardiac
resynchronization therapy” (CRT), this modality has been shown
in large clinical trials to reverse the process of progressive heart
enlargement seen in chronic heart failure.
Heart failure patients are also at high risk of sudden cardiac
arrest due to life-threatening heart rhythm abnormalities. By
combining a CRT pacemaker with a defibrillator in a single device,
this other major cause of death in heart failure is addressed, and
results in a further reduction in mortality in the COMPANION
and MIRACLE-ICD trials.
THI PULSE | 8