Our Six Clinical Programmes
Heart Failure programme: A model for disease management programme
This programme was first implemented in 2002. Patients at NUHCS are cared for by a multidisciplinary team of heart failure physicians, case managers, advanced practice nurses, dietitians, medical social workers, pharmacists, physiotherapists and occupational therapists. From only about 50 patients in 2002, the programme now caters to about 700 heart failure patients.
Spanning from inpatient to outpatient care, it serves as a model for other developing chronic disease management programmes and is in a process of continual expansion and improvement. As compared to international benchmarks such as the Centre for Medicare and Medicaid Services and United States Joint Commission International (JCI), treatment outcome indicators attained by NUH has been comparable:
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Median length of hospitalization stay in NUH is 3 days compared to 9 days
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Re-admission to NUH within 30 days of discharge is at 12.4% as compared with 22%
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In-hospital mortality in NUH is 0.93% compared with 6.7%
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30-day mortality rate in NUH at 3.4% as compared with 11.1%
Congenital Heart Disease programme: Span-of-life care
Congenital heart disease (CHD) patients at NUHCS benefit from a continuum of care that spans a person's entire life. Under the care of a multidisciplinary team of specialists, parents with a history of congenital heart disease are offered pre-natal testing and genetic counseling, expectant mothers undergo ante-natal screening and imaging and newborns are screened for CHD.
NUHCS provides specialized care for patients with
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Heart arrhythmia
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Heart failure
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Pulmonary hypertension
The Centre also carries out surgeries for congenital heart conditions and percutaneous procedures (implanting devices and sealing congenital defects without open heart surgery). Setting NUHCS apart from other medical centres are these distinctive skills that will help meet the growing demand for CHD services in the Asia-Pacific region.
Acute Coronary Syndrome programme: timely help for heart attack patients
The NUHCS team has been working together with the nurses and specialists from the NUH Emergency Department and has reduced the time it takes to rush a patient suffering from a heart attack from the hospital doors to the procedural room for "ballooning". NUHCS's median 'door-to-balloon' time of 67 minutes is better than the international standards of less than 90 minutes, and 76% of NUHCS patients were treated within 90 minutes as compared to the 39% in the USA NRMI (National Registry of Myocardial Infarction) reports. The clinical pathway and therapy outcomes attained by the Centre have since been published in the Journal of Interventional Cardiology.
Further improvement of the care delivery process will be undertaken through working with the Singapore Civil Defence Force ambulance teams. They will administer pre-hospital ECG (electrocardiograms) for patients who are suspected with heart attacks while alerting the cardiac interventional team before arriving at the hospital. This is a practice that is rarely carried out worldwide.
Taking the lead in reporting treatment outcome indicators and also being an early adopter of innovative technology, the NUHCS will also develop a new statistical model through analyzing the large Singapore cardiovascular database to enhance the care, treatment and identification of patients.
Vascular medicine and therapy: saving limbs and prolonging life
The lack of awareness for atherosclerosis (hardening of the arteries) often leads to patients seeking late treatment for multi-level ailments that involve the brain, heart, kidney and lower leg arteries. This results in a higher incidence of lower limb amputation, diseases of the heart and blood vessels as well as death. The Vascular medicine and therapy programme brings together specialists from cardiovascular medicine, vascular surgery, radiology, neurology and nephrology to provide personalized care for patients including:
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Non-invasive diagnostic testing
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Modification of risk factors
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Medical therapy
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Minimally invasive endovascular techniques
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Vascular surgery
One key component of the programme is limb preservation service. By introducing a personalized patient care plan comprising of cardiologists and vascular surgeons, NUHCS aims to reduce the rate for lower limb amputation. Following which, a vascular disease-tracking programme will be instituted to capture the data of all the patients in this service to encourage collaboration, innovation and improved patient experience.
Women's Heart Health Programme: Fighting heart disease in women
Cardiovascular disease (heart disease and stroke) is the Number 1 killer of women in Singapore. However in 2009, less than 10% of the women taken part in the Singapore Heart Foundation’s Go Red for Women Heart Health Awareness Survey were aware of this important fact. Further, heart disease in women is not identical to that in men: some conditions affect women more than men (such as diastolic heart failure, apical ballooning syndrome or ‘broken heart syndrome’). Even with the same disease, presenting symptoms may be less obvious in women or the underlying mechanisms may be different, thus posing higher risks to women.
The NUHCS offers, for the first time in Singapore, a programme dedicated to women with and at risk of heart disease.
The aims of the Women's Heart Health Programme are three-fold:
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Patient care: to provide a comfortable, “one-stop” environment for evaluation and management of their cardiovascular risk factors and conditions, where women can be seen by a female cardiologist and receive integrated care with a dietician, occupational therapist and psychologist.
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Education: to raise awareness of the importance of heart disease in women and form a platform for women’s advocacy groups.
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Research: to provide a potential database for research into cardiovascular disease in women, particularly in Asian women, where data are sorely lacking.
The services that the Women's Heart Health Programme offers include:
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Risk Assessment: To identify risk factors for heart disease and for other diseases common to women.
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Cardiac Diagnostic Evaluation: An integrated approach tailored to unique features of this disease in women.
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Risk Management: A comprehensive approach accounting for the fact that, despite similar established risk factors in men and women, there are important differences in how strongly they affect women.
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Specialty Management: Of cardiovascular conditions that affect women more than men.
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Education: With specific emphasis on healthy cooking and eating, personalized exercise prescription, stress management, smoking cessation, blood pressure and lipid management.
The programme is the first in Singapore and modelled after similar well-established and successful clinical programmes in world-renowned centres, such as the Brigham and Women's Hospital for Cardiovascular Disease in Women, Mayo Clinic Women's Heart Clinic and Vanderbilt Women's Heart Center.
Heart Rhythm Programme: Arrthythmia Service
Heart rhythm disorders (arrhythmias) are commonly seen in the general public as well as in heart patients. As a subspecialty field of cardiology, cardiac electrophysiology encompasses the detailed evaluation of arrhythmias including their mechanism and treatment. Both non-invasive methods (such as ambulatory ECG monitoring, tilt table test, signal averaged ECG) and invasive procedures (such as electrophysiologic study and implantable loop recorder) may be employed.
Inappropriately slow heart rhythms (bradycardia) and conduction blocks are increasingly common with an ageing population. Treatment may involve the implantation of a pacemaker which is a small electronic device that maintains the heart rate. Specialized (biventricular) pacemakers may also be indicated in the treatment of heart failure to “resynchronize” the heart leading to an improvement in heart function, reduction in heart failure hospitalization and improvement in survival.
Patients with poor heart function are at risk of sudden death which is usually due to a life-threatening heart rhythm disorder. The advent of the implantable cardioverter defibrillator has brought about a reduction of mortality in these patients. This device is implanted in a similar fashion as a pacemaker and is capable of detecting a dangerous heart rhythm when it occurs. More importantly, is able to deliver a “shock” to rescue the patient.
The Arrhythmia Service forms an important partnership with the Heart Failure Programme, where it co-manages these high-risk patients who often have arrhythmias and require cardiac devices. The NUHCS has extensive experience in these tertiary-level cardiovascular services and is a regional referral centre for arrhythmia and heart failure related disorders.
