Heart Failure Programme

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 and Cardiomyopathy 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 and Cardiomyopathy 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.

The NUHCS Heart Failure and Cardiomyopathy 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

The Heart Failure and Cardiomyopathy 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