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

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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
Programme recovering from cardiac events such as a heart attack, interventional procedures like angioplasty, heart surgery (bypass, transplant or valvular) and congestive heart failure. This is to target the motivated individuals who want to reduce traditional cardiovascular risk factors. In NUH, we have also developed a dedicated smoking cessation programme In our experience, we are aware that many cardiac patients have high levels of stress and anxiety. Depression is prevalent after acute cardiac events, with 20 to 45 per cent of patients having significant depression after acute myocardial infarction (AMI). Depression is an independent risk factor for mortality in patients with AMI, or unstable angina. Several studies suggest improvement with cardiac rehabilitation intervention. Patients with depressive symptoms have a fivefold increased risk of non-completion of cardiac rehabilitation and therefore require enhanced attention and support. We have also dedicated a team to focus on neuropsychological aspect of these patients. A review of 46 randomised trials of secondary prevention, in 18821 patients with coronary heart disease was recently conducted by the agency for Health care research and quality: Secondary prevention programs were demonstrated to reduce hospitalization, recurrent MI and long term mortality. Physicians can initiate the referral if their patient is appropriate for CRP in NUH. Please visit www.nuh.com.sg/_cardiac/ ourServices_cardiacRehabilitation.htm or contact the CRP nurses for more information. Lai Shuet Ming – 67725563 / 95402582 Rachel Chan Wang Hia – 67722436 / 95669078 Ooi Lean See – 67722497 / 98028205 (CRT) Therapy Course It is little wonder therefore that there is much interest worldwide in the technique of performing CRT implants, which is more complex than a routine pacemaker implant. With the generous support of St Jude Medical, the Cardiac Department at the National University Hospital was able to conduct the 1 st Singapore-Asia CRT implant course, which hosted foreign doctors from South Korea and the Philippines. Over the course of 3 days from 28 th till 30 th April 2008, live cases of CRT implant were performed, spaced apart by didactic lectures on the indications and trial evidence for such therapy as well as methods for optimization of CRT devices post-implant. Led by course directors Dr Abdul Razakjr Omar and Dr Seow Swee Chong, the programme also included a practical session demonstrating optimization of the devices using echocardiography. With overwhelmingly positive feedback from course participants, the Department is geared up to continue conducting such courses on a regular basis; sharing knowledge and experiences and fostering friendships with fellow cardiologists across the region. THI PULSE | 9
Page 1 and 2: MICA (P) 023/09/2007 Issue No. 11
Page 3 and 4: AWARD Lock Dept @ NUH in 2006. Othe
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Page 7: NHG HMDP EXPERT VISIT 26-20 MAY 200
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Page 19 and 20: publications 1. European Heart Jour

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

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