Evolution of Heart Failure Management
The making of a holistic Heart Failure & Cardiomyopathy Programme
PULSE Issue 40 | January 2023
What is Heart Failure (HF)?
HF is a condition characterised by shortness of breath, effort intolerance, and fluid retention, secondary to dysfunction of the heart muscles. This dysfunction can be a result of poor contraction strength of the heart muscles, or failure of adequate muscle relaxation.
Couple with frequent hospitalisations and longer average hospital stays compared to patients suffering from diabetes to hypertension, people with HF report a poor quality of life with a huge physical and psychological stress. Symptoms can be severe such that it affects everyday tasks, including showering or crossing an overhead bridge.
The treatment for HF is often complex and can last over extended periods of time. How patients cope with HF is highly dependent on the time they receive their diagnosis and treatment, as well as their body's receptivity to key medication adjustments. This calls for holistic, personalised care with close monitoring and reviewing of the patient's ongoing condition and medications.
Heart Failure at NUHCS
Aligned with international practice guidelines and recommendations, the National University Heart Centre, Singapore (NUHCS) takes a multidisciplinary approach towards the management of HF and cardiomyopathy, providing end-to-end care for patients. In addition to their treatment, patients receive a holistic and personalised care approach with advice and guidance on lifestyle changes, medication use, health monitoring as well as appropriate physical activities at every stage of HF - from "high risk of developing HF" to "advanced HF".
This requires a team of healthcare professionals with different expertise. Our team comprises of dieticians, pharmacists, physiotherapists, HF specialist nurses amongst others, working together to map out an integrated care plan to achieve a seamless experience for the patient.
Today, the HF and Cardiomyopathy Programme at the NUHCS boasts of 10 specialised cardiologists working with a team of 15 allied health professionals to provide specialised heart failure and cardiomyopathy care for patients.
2001 - The birth of HF Programme in National University Hospital (NUH):
- Dr Chai Ping appointed as the first Programme Director
2007 - HF Device Clinic established as part of the programme:
- Led by Dr Seow Swee Chong
Cardiac Implantable Electronic Device (CIED) therapy became part of mainstream HF care
2011 - With the opening of NUHCS as a National Centre:
Treatment services expanded to include acute HF / intensive care, HF inpatient consults and management of cardiomyopathies. New treatment procedures were introduced, such as endomyocardial biopsy and ultrafiltration.
2015:
- First durable left ventricular assist device (LVAD) implanted - a battery-operated mechanical pump surgically implanted to help end-stage HF patients pump blood to the rest of the body. Modern devices allow patients to return home after surgery and resume normal activities with some lifestyle adjustments.
- Advance Care Planning incorporated - the process where a patient's future medical care plans are discussed with their family members, surrogate decision-makers, and healthcare providers. This allows patients to decide on their preferred treatment at the end of life while their condition is still stable.
2020:
- Multidisciplinary cardiogenic shock team formed, utilising the latest mechanical circulatory support devices for our critically ill patients.
2021:
- Launch of Advanced HF Fellowship Programme to train doctors from other countries in the aspect of HF management.
