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What is Heart Failure?
Heart failure 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.
Singapore is seeing an ever-increasing number of patients living with heart failure. This is due to our aging population, as well as high prevalence of cardiovascular risk factors in our population (e.g. hypertension, diabetes mellitus, obesity). Chronic heart failure is a disease of high morbidity and mortality. Patients are often very symptomatic, requiring recurrent hospitalisation episodes. They also have impaired lifespans, due to this condition.
The treatment for heart failure is often prolonged and complex. In the National University Heart Centre, Singapore (NUHCS), our Heart Failure Programme believes in a multi-disciplinary approach towards heart failure management. We provide end-to-end care for our patients, taking care of them through their entire heart failure journey.
Together with our partners, NUHCS Heart Failure Programme serves as a tertiary referral centre for the diagnosis and management of patients with heart failure and cardiomyopathies (heart muscle diseases). We are also active in heart failure/ cardiomyopathy research, on top of providing training opportunities for cardiologists interested in a further career in heart failure.
What are the conditions treated by the NUHCS Heart Failure Programme?
The NUHCS Heart Failure Programme provides the diagnosis and management of:
- Acute heart failure
- Cardiogenic shock
- Use of mechanical circulatory support (MCS) devices
- Chronic heart failure
- Heart failure with reduced ejection fraction (HFrEF)
- Heart failure with preserved ejection fraction (HFpEF)
- Advanced heart failure
- Cardiorenal syndrome/ diuretic resistance
- Patients being evaluated for durable mechanical circulatory support or heart transplantation
- Cardiomyopathies
- Hypertrophic cardiomyopathy
- Non-ischaemic dilated cardiomyopathy
- Infiltrative cardiomyopathies (e.g. amyloid cardiomyopathy)
- Inflammatory cardiomyopathies (e.g. cardiac sarcoidosis)
- Peripartum cardiomyopathy
- Chemotherapy-induced cardiomyopathy
- Other genetic cardiomyopathies
What are the treatments offered by the NUHCS Heart Failure Programme?
The Heart Failure Programme offers holistic and personalised counselling for lifestyle change, medication use, as well as physical activities for our patients. The patient will be guided along the heart failure journey by a multi-disciplinary team who will be there to offer help at every stage of the patient’s life. Suitable patients will be considered for device implantation or surgical therapies.
In addition, this programme offers:
- Diagnostic tools for diagnosis and prognostication of heart failure syndromes/ cardiomyopathies. They include
- Cardiac ultrasound (transthoracic and transoesophageal echocardiogram)
- Computed tomographic (CT) coronary angiogram
- Cardiac magnetic resonance imaging (MRI)
- Nuclear scintigraphy
- Cardiopulmonary stress test (CPET)
- Coronary angiogram
- Invasive heart failure procedures
- Right heart catheterisation to guide heart failure treatment
- Endomyocardial biopsy (heart muscle tissue sampling)
- Invasive/ surgical treatment for suitable patients
- Percutaneous coronary intervention (stenting procedure)
- Transcatheter valve procedures (e.g. percutaneous mitral valve repair, transcatheter aortic valve implantation)
- Radiofrequency ablation (RFA) for arrhythmias
- Coronary artery bypass surgery/ open-heart valve surgery
- Evaluation and implantation of cardiac implantable electronic devices (CIEDs)
- Implantable defibrillators
- Cardiac resynchronisation therapy (biventricular pacemaker)
- Management of cardiogenic shock and acute heart failure, including use of short-term mechanical circulatory support (MCS) devices
- Intra-aortic balloon pump (IABP)
- Catheter-based left ventricular assist devices (Impella® device)
- Extra-corporeal membrane oxygenation (ECMO)
- Mechanical fluid removal (ultrafiltration) in diuretic resistance
- Evaluation for advanced heart failure therapies (durable left ventricular assist device, heart transplantation)
- Case management for chronic heart failure
- Nurse-led phone-based tele-monitoring of clinical progress
- Remote tele-monitoring of parameters
- Pharmacist-led medication titration and monitoring clinic (MTM-C)
- Shared chronic heart failure care with primary care partners
- Palliative care for end stage heart failure, including home inotrope infusion
- Diagnosis, work up and management of cardiomyopathies, including genetic counseling and testing
NUHCS Heart Failure Programme Team
NUHCS @ Kent Ridge |
NUHCS @ Jurong |
Our DoctorsOur Case Managers- Ms Aisha Aziz
- Ms Seow Yen Hoon
- Ms Tan Poh Tin
Our Advanced Practice Nurses- Ms Christina Chong
- Ms Juvena Gan
- Ms Lee Choy Yee
- Ms Lo Chew Yong
Our Pharmacists- Ms Chong Xue Jing
- Ms Low Peik Ching
- Ms Nancy Yong
- Ms Saw Yashi
| Our DoctorsOur Cardiology Specialty Nurses- Ms Christina Khoo
- Ms Lee Ying Ming
- Ms Toh Lay Cheng
Our Pharmacists- Dr Dennis Chua
- Dr Veronica Teo
- Ms Koh Shi Yi
- Mr Saw Yik Chuen
|
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Introduction
With the tagline “Growing up with you”, the Congenital and Structural Heart Disease (CHD) Programme offers CHD patients at NUHCS a continuum of care throughout their lifetime.
Additionally, under the care of a multi-disciplinary team of specialists, parents with a history of CHD are offered specialised care from before pregnancy till after their child is born. These include:
- Pre-natal testing
- Genetic counselling
- Ante-natal screening and imaging during pregnancy
- Screening of their newborns for CHD
The programme also manages patients with acquired structural heart disease such as valvular heart disease
Specialised conditions
This programme includes the diagnosis and management of:
- Congenital heart disease in children
- Adults with congenital heart disease
- Complications of congenital heart disease such as:
- Heart arrhythmia
- Heart failure
- Pulmonary hypertension
- Acquired valve disease/structural heart disease
Treatments offered
The treatments offered include:
- Congenital heart disease correction surgeries
- Specialised percutaneous implantation of devices in the heart to seal congenital defects without the need for an open-heart surgery
Specialised care for complications arising from CHD such as:
- Heart arrhythmia
- Heart failure
- Pulmonary hypertension
- Transcatheter aortic valve implantation
- Mitraclip mitral valve repair
- Left atrial appendage closure
- Paravalvular leak closure
- Percutaneous mitral Valvuloplasty
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Introduction
Cardiovascular disease (heart disease and stroke) is the number 1 killer of women in Singapore. However in 2009, < 10% of the women taking part in the Singapore Heart Foundation’s Go Red for Women Heart Health Awareness Survey were aware of this important fact.
The NUHCS’ Women’s Heart Health Programme offers a programme dedicated to deliver holistic care to women with and at risk of heart disease.
This programme offers a wide range of cardiovascular services tailored just for women focusing on personalised and holistic patient care. We work closely with specialists and health professionals from other medical fields to provide one-stop, multidisciplinary patient care.
Its unique feature is the collaborative care of women with or at risk of heart disease by an all women’s multi-disciplinary team consisting of:
- Fitness experts
- Nutritionists
- Mental health experts
- Occupational therapists
- Obstetricians and gynaecologists
- Rheumatologists
- Women health nurse clinicians
Specialised services
- Preconception counselling in women with heart diseases and high cardiovascular risks
- Heart diseases in pregnancy
- Heart diseases in women including Takotsubo cardiomyopathy, non-obstructive coronary artery diseases, heart diseases related to autoimmune conditions, heart failure with preserved ejection fraction
- Cardiovascular health screening and risks management
Treatments
Treatment plans offered involve a personalised, holistic approach with cardiac treatment options and technologies, involving cardiologists from all sub-specialty areas and medical experts from other disciplines.
In addition, this programme offers:
- Cardiovascular risks evaluation to identify risk factors for heart diseases and other common diseases that affect women
- Cardiac diagnostic evaluation with an integrated approach tailored to the unique features of heart diseases in women
- Cardiovascular risk management that encompasses a comprehensive approach of managing cardiovascular risk factors unique to women
- Specialty management of the cardiovascular conditions that affect women more than men
- Services with specific emphasis on lifestyle modifications to achieve heart healthy lifestyle including healthy cooking and eating, personalised exercise prescription, stress management, smoking cessation and more
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Introduction
The Acute Coronary Syndrome Programme is aimed at providing timely care for patients presenting with a heart attack (myocardial infarction).
In medical jargon, the term “door-to-procedure” is defined as the time taken from presentation at the hospital to the initiation of a treatment procedure. This “door-to-procedure” time is currently set internationally at < 90 minutes. This is the duration from diagnosing a patient with a heart attack to the moment the affected coronary artery is unblocked by coronary angioplasty.
By working with the nurses and specialists from the NUH Emergency Department, the NUHCS team has reduced the “door-to-procedure” time for a patient suffering from a heart attack to 45 minutes. In fact, 96.5% of NUHS patients were treated within 90 minutes compared to 37% in the United States of America (USA) National Registry of Myocardial Infarction (NRMI) reports.
Additionally, we now work collaboratively with NTFGH and the Singapore Civil Defence ambulance service in expediting patient care for patients with suspected acute coronary syndromes.
Specialised conditions
This programme includes the diagnosis and management of acute coronary syndrome which include heart attacks or its prelude.
The treatments offered include:
- Medical treatment with medications to help relieve symptoms and improve blood flow in the coronary arteries
- Specific surgeries depending on the severity of the condition such as:
- Coronary angioplasty and stenting
- Coronary artery bypass grafting surgery (CABG)
- Emergency treatment for patients presenting with a heart attack that includes
- Thrombolysis (the use of medications to break down clots which may have caused the heart attack)
- Coronary angioplasty and stenting/ballooning
- Optimisation of cardiovascular risk factors and care to minimize disease recurrence.
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Introduction
Heart rhythm conditions (arrhythmias) often require complex procedures that are available in tertiary cardiovascular centres such as NUHCS.
The NUHCS’ Heart Rhythm Programme or Arrhythmia Service forms an important partnership with the Heart Failure Programme, where it co-manages high-risk patients.
The collaboration between the heart rhythm and heart failure programmes is important as heart failure patients frequently have arrhythmias. Cardiac devices such as biventricular pacemakers and defibrillators improve outcomes and quality of life in heart failure patients. Electrophysiological study and ablation may also be required in these patients to manage rhythm disorders.
With an ageing population, inappropriately slow heart rhythms (bradycardia) and conduction blocks are increasingly common as is arrhythmias such as atrial fibrillation.
In addition to having experience in these tertiary-level cardiovascular services, NUHCS is a regional referral centre for arrhythmia and heart failure related disorders.
Specialised conditions
This programme includes the diagnosis and management of:
- Heart arrhythmias such as:
- Premature (extra) bears
- Supraventricular arrhythmias
- Ventricular arrhythmias
- Bradyarrhythmias
- Heart failure
- Congenital and structural heart disease with arrhythmia
- Cardiac implantable devices
- Pacemakers
- Biventricular pacing (cardiac resynchronisation therapy)
- Implantable defibrillators
- Implantable loop recorders
Treatments offered
The treatments offered include:
- Counselling on lifestyle changes
- Medications that help:
- Control and regulate the heart rate
- Reduce the risk of stroke
- Surgical procedures such as:
- Electrophysiological study (EPS) with radiofrequency ablation
- With/without 3-dimensional electroanatomical mapping
- The implantation of a pacemaker, which is a small electronic device that maintains the heart rate
- Specialised (biventricular) pacemakers in the treatment of heart failure to “resynchronise” the heart leading to an improvement in heart function, reduction in heart failure hospitalisation and improvement in survival.
- Implantation of a cardioverter defibrillator that is capable of detecting a dangerous heart rhythm when it occurs and deliver a “shock” to rescue the patient
- Implantation of a loop recorder to diagnose infrequent arrhythmias, aid diagnosis in unexplained syncope or suspected occult atrial fibrillation
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Introduction
The Vascular Medicine and Therapy Programme brings together specialists from cardiovascular medicine, vascular surgery, radiology, neurology and nephrology to provide personalised care for patients.
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 (mortality).
One key component of the programme is limb preservation service. By introducing a personalised patient care plan comprising of cardiologists and vascular surgeons, NUHCS aims to reduce the rate for lower limb amputation in these patients.
Specialised conditions
This programme includes the diagnosis and management of vascular disease or diseases of the blood vessels (both arteries and veins) such as:
- Atherosclerosis
- Varicose veins/Chronic Venous Insufficiency/Venous ulcer
- Deep vein thrombosis
- Diabetic vascular disease
Treatments offered
The treatments offered include:
- Counselling for lifestyle changes
- Medical treatments
- Surgical procedures to repair the affected blood vessels
- Other non-surgical treatments such as:
- Structured exercise programmes
- Compressions bandaging
- Physical therapy
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