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Helping Malay heart patients live longer

29-Dec-2008 (Mon) Home, The Straits Times

By Salma Khalik

Mr Abdul Hamid lifting weights at a park. He is in much better condition after enrolling in the NUH heart programme. -- ST PHOTO: ALPHONSUS CHERN

MR ABDUL Hamid Shariff, 78, had a triple bypass in 1994, following a heart attack. In 2004, heart failure set in, with a leaking heart valve and a blocked artery.

He had to be admitted to hospital seven times for his heart problems in 2006.

But things changed after he enrolled in the National University Hospital's (NUH) heart failure programme the next year.

Watched by a case manager to ensure he went for clinic visits, took his medicine correctly and was eating properly and getting exercise, Mr Abdul Hamid has not needed to be re-admitted since.

NUH started taking such proactive steps to improve outcomes for Malay heart patients like Mr Abdul Hamid, as well as Indian patients. Patients from these two groups tend to fare less well than Chinese patients.

NUH doctors have been able to halve the number of Malays and Indians dying within six months of suffering from heart failure.

Dr Chai Peng, a cardiologist, said he and his NUH colleagues had noticed that Malay and Indian patients just did not seem to recover as well as their Chinese counterparts.

One in 10 Malays and one in eight Indians died within six months of discharge - compared to just one in 16 Chinese.

Similarly, 21 per cent of Malays and 31 per cent of Indians were re-admitted within six months for a serious problem, against 16 per cent of Chinese patients.

NUH's experience is corroborated by another study, of 668 patients at Tan Tock Seng Hospital, due to be published in an international journal soon.

That study, headed by Dr Raymond Lee, found that Malays and Indians were 35 per cent more likely than Chinese to be admitted for heart failure. Even more daunting, Malays were 3.5 times more likely to die of it than the other races.

While there may be genetic reasons for the higher levels of illness and deaths among some ethnic groups, Dr Chai suspected there are other factors too.

Looking through their database, they found Malay and Indian patients were more likely to stop going for checkups.

To tackle this, a Malay case manager, Ms Suzana Aziz, was employed to talk to patients and families about their illness and the symptoms to watch out for.

She found many patients had assumed that once they were fit for discharge, they were well, and did not have to exercise, eat properly or take their medicine regularly.

They soon learnt this was not so. She also gave them her phone number to call at any time, and she contacted them regularly to check on how they were doing.

Patients found it easier to talk to her, as she was not a doctor, she said.

Ms Aziz looks after more than 200 Malay and Indian patients while two other case managers handle Chinese patients.

Patients and their families were also taught to look out for symptoms that could spell the start of medical problems.

Mr Abdul Hamid's wife would call Ms Aziz whenever her husband started feeling breathless, for example.

Ms Aziz would then contact his doctor, who would decide if an adjustment in medication was needed.

The programme's multi-disciplinary team reviewed the medicine he was taking. Dr Chai said that although Mr Abdul Hamid was on several types of medicine, his 'treatment was not adequate'. This was then corrected.

Ms Aziz also referred Mr Abdul Hamid to a medical social worker, so he is now able to tap Medifund - the Government's medical safety net - to offset the cost of his check-ups, tests and medicine.

Some patients stopped follow-up treatments because they were too poor to pay for them, she said.

Mr Abdul Hamid, a retiree, now walks 3 km with his wife most days of the week.

'I walk 10 rounds on the track every morning. Last time, I only ate and slept. That's why I had all the problems,' the former army regular said.

Dr Chai said the average real cost per admission is more than $2,000. So keeping patients out of hospital is not just good for them but also for the health- care system.

Singapore hospitals see about 4,400 admissions for heart failure a year.

A spokesman for the National Heart Centre said the majority of its patients were Chinese and that higher readmission rate among Malay and Indian patients could be because they were more likely to have other illnesses, such as diabetes, as well.

WHAT IS HEART FAILURE?

HEART failure is an umbrella term used to describe the situation when the heart is no longer able to function properly.

The largest cause of heart failure is a heart attack that leaves the heart muscles weaker than they were previously.

Other causes include weakened muscles following a viral infection, prolonged heavy drinking or uncontrolled high blood pressure.

It may also be caused by leaking heart valves or problems with the heart's electrical system.

The result is that the heart is not able to pump blood efficiently to the other organs of the body.

Symptoms of heart failure include shortness of breath, fatigue, skipped heartbeats, swelling in the legs, ankles or feet, persistent cough or wheezing and difficulty in concentrating.