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Community-based cardiac rehabilitation in Singapore
Cardiac rehabilitation (CR) programmes for patients after a cardiac episode or heart surgery, have been shown to improve patient outcomes like reducing mortality and as such, CR is an important avenue to deliver effective preventive care. The benefits of CR have been reviewed extensively in Western countries, but the impact of Singapore’s CR programme on clinical outcomes have not been known until last year. Tay Hung Yong shares the findings.

Following a cardiac episode or after a heart surgery, the patient may be recommended by his doctor to participate in a cardiac rehabilitation programme. This helps him recover and resume a normal life while maintaining a healthy lifestyle, as cardiac rehabilitation is a medically supervised programme designed to help improve one’s cardiovascular health[1].

In Singapore, the Singapore Heart Foundation’s Heart Wellness Centre (HWC) is the only institution that provides a structured community-based cardiac rehabilitation, named the Heart Wellness Programme, to cater to cardiac and at-risk patients.

The Heart Wellness Programme is conducted in groups under the guidance of a physiotherapist, who will assess and tailor the exercise routine to each individual participant. Under the care of the physiotherapist, all patients are supervised and monitored throughout the sessions to ensure utmost safety.

Besides exercise-based rehabilitation, the HWC also offers other lifestyle services to encourage risk factor modification such as nutrition consultation to promote healthy eating and regular health talks. In addition, the Heart Support Group provides invaluable peer and emotional support to heart patients and their families, adjusting to life after a heart attack.

Ultimately, the HWC strives to instil positive behavioural changes to the cardiac patients, in view of a smooth recovery and maintenance of good heart health. They believe that everyone should play an active role in making the necessary changes to adapt to a healthier lifestyle and at the same time, the centre provides the follow-up intervention throughout their rehabilitation period.

Effectiveness of community-based rehabilitation programme for cardiovascular prevention

With the growing incidence of cardiovascular disease in Asia, lifestyle modification such as weight loss and routine exercise, do play an important role in early primary cardiovascular disease prevention. While it is widely known that patients with cardiovascular conditions will benefit from recuperating in a structured cardiac rehabilitation programme (particularly in a convenient and affordable community-based setting), there is no published data to show the effectiveness of a long-term programme in the Asian population to date.

Thus, a research collaboration with the National University of Singapore was conducted in 2014, to assess the overall wellness improvement of about 100 local patients with cardiovascular conditions. These patients continued their maintenance rehabilitation programme in the community after their hospital-based cardiac rehabilitation programme from the period of 2009 to 2013.

After undergoing the individualised series of exercise programmes, nutritional reviews, and psycho-social counselling, core components such as baseline vitals (i.e. heart rate and blood pressure), body weight, body fat, and exercise tolerance were measured.

Compared to those patients who received usual care, these patients were found to have an overall improvement of 12% in “bad” cholesterol, 7.8% triglycerides, 7% total cholesterol, 8.2% fasting blood glucose, 2.5% systolic BP and 3.5% diastolic BP after one year of community rehabilitation[2].

These positive results highlighted the Heart Wellness Programme’s potential in improving health and delaying disease progression, which lends support to the need to expand such community-based programmes for early cardiovascular intervention.

Helping needy heart patients

However, cost has been cited in many countries as one of the barriers to receiving prompt cardiac rehabilitation. Thankfully, with the generosity of supportive long term donors, the Foundation, being a non-profit organisation, is able to offer heavily-subsidised rehabilitation to all patients and financial aid for those at a disadvantage through the Heart Support Fund.

SHF works closely with medical social workers from the various healthcare institutions to identify cardiac patients who may be facing financial difficulties, as well as those who require financial aid but do not qualify for any assistance scheme. The fund will help to defray the cost of a mechanical heart device, heart transplant/surgery or provide an emergency relief fund for those with income less following the surgery.

Heart support group

Support groups have been shown to help with coping and managing of changes after an event. That is why, all cardiac clients of the HWC are invited to join the Heart Support Group. The key objective of the group is to provide invaluable peer and emotional support to heart patients and their families, adjusting to life after a heart attack. It is also a good platform for them to share tips, information and encourage each other to lead a heart healthier lifestyle.

References:

  1. American Heart Association (2016). What is Cardiac Rehab? Retrieved from http://www.heart.org/HEARTORG/Conditions/More/CardiacRehab/Cardiac-Rehab_UCM_002079_SubHomePage.jsp

  2. Ong, K. Y., Yap, E., Chia, Y. M. F., Tay, H. Y., Ting, P. Chan, S. Y., Kwan, Y. H. (2016). Impact of community-based cardiac rehabilitation on clinical parameters of patients with cardiovascular diseases. ASEAN Heart Journal, 24 (1), 91-97. Retrieved from https://www.globalsciencejournals.com/article/10.7603/s40602-016-0005-4/fulltext.html. DOI: 10.7603/s40602-016-0005-4

About the Author

Tay Hung Yong
Principal Physiotherapist & Manager
Singapore Heart Foundation –
Heart Wellness Centre

Hung Yong has been working with the Singapore Heart Foundation (SHF) since 2008, as a registered physiotherapist. Prior to this, he had gained invaluable experience during his 6.5-year stint with the National University Hospital (NUH).

Hung Yong’s areas of interest lie in exercise therapy and cardiac rehabilitation. He manages the cardiac rehabilitation programme conducted at the SHF-Heart Wellness Centre, where he is involved in the care of patients who suffer from overweight issues, diabetes mellitus, high blood pressure and high cholesterol.

In addition, he is currently involved in a few research projects that are in the field of preventive cardiology.

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APBN Editorial Calendar 2017
January:
Healthcare Focus: LUNGS
February:
War on CANCER
March:
Get to Know TCM
April:
Diabetes: The Big Picture
May:
The Piece of Your Mind - Brain Health/Science
June:
Advocacies in Support of Rare Disease Patients
July:
Food Science & Technology
August:
Eye – the Window to your Soul
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Infectious Diseases
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A change of heart — Cardiovascular diseases
November:
Diseases threatening our Children
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