Heart is where the killer is

BY PMA RASHEED

The Gulf Today, 4 Feb 2010

Cardiac disease has been accounted as the current high-risk and high volume disease in Dubai, as over 45 per cent of hospital admissions are associated with coronary artery disorders.

Based on cardiac patients admitted and treated at Rashid Hospital, Dr Fahad Baslaib, Consultant and Head of Cardiology Department at the Hospital told The Gulf Today that the phenomenon has emerged as the high risk and high volume disease of our time.

This correspondent has witnessed a live coronary angioplasty, an advanced surgery used to open narrowed or clogged blood vessels of the human heart, at the hospital's catherisation laboratory on Thursday.

The cath suite has the latest technology required for coronary angiography. It is equipped with intravascular ultrasound machine, which does an ultrasound inside the artery and also checks the pressure of the artery.

The procedures conducted in the Cath suite include primary angioplasty, coronary angioplasty with stent implantation, balloon valvuloplasty and permanent peacemaker implantation.

Rashid Hospital has emerged as the region's only hospital to get a disease specific international certification for the cardiology section from JCI. The disease specific certification is for best practices in Acute Coronary Syndrome.

During the live coronary angioplasty at the region's one-of-a-kind facility, Dr Baslaib, said from the moment a patient is brought to the hospital until his artery is unblocked by either an injection or an angioplasty, the time is monitored.

"The cardiology department has surpassed the international 'door-to-needle' time. We take 24 minutes as compared to the international requirement of 30 minutes. The 'door-to-balloon' time also has been surpassed at the Rashid hospital facilities. We take 74 minutes whereas the international standard is less than 90 minutes," he explained.

Dr Baslaib observed that heart attack cases are critical and time is muscle for us, which means that the longer the time taken to unblock the artery, the more damage to the muscle, which essentially means more damage the heart.

"The cardiology admissions at Rashid Hospital have been accounted at 40 per cent with 1552 patients of the hospital's total annual medical admissions of about 5,000 patients. The department also has received about 5924 cardiac outpatients in 2009."

"Among the total in-patients of the hospital during the last five years, the disorders associated with coronary artery disease has accounted to over 45 per cent, with acute heart attack at over 25 per cent and angina chest pain at about 20 per cent. In 2008, the cardiology section conducted between 850-900 cardiac procedures," he explained.

According to him, the cath unit is the third busiest department after the trauma centre and the general surgery department. And the number of patients seeking medical attention has been increasing over the years.

"Dubai's typical cardiac patient today is a male at his 40s against mid late 60s in Europe and in North America. Over 25 per cent of the patients have diabetes and about 25 per cent of the remaining receiving the diagnosis during admission," said Dr Baslaib.

"Amazingly, 25 per cent of the remaining non-diabetics will turn out pre-diabetics if challenged, this brings the number of diabetics, the known and the newly diagnosed and the diabetes-prone population to about 50 per cent," he pointed out.

"Meanwhile, the hospital has witnessed a decline in in-hospital deaths due to heart attack from 20s in 1980 to 12 per cent in mid 90s. The department's current in-patient mortality rate is 2 per cent, and 98 per cent of patients treated for acute heart attack go hoe safely," he noted.

Dr Ahmed Gabroun, Specialist Registrar in the Cardiology Section said, "We have introduced a 'patient map' system to inform the patient about the procedure the patient has undergone and the next steps that the patient needs to follow including the diet, counselling, medication and rehabilitation."

"The patient education guide becomes significant as it allows the patient to understand what has happened and what are the next steps shall be," he added.

He revealed, that Rashid Hospital will open an advanced Cardiac Intervention Suite soon, providing further training to department staff to hand-on practice and research studies in the field. A team of junior cardiologists and coronary nursing staff will serve the post-cath 8-observational beds at the suite.

"The cardiac interventions include primary and elective angioplasty, specialised studies of coronary blood flow by way of intravascular ultrasound and fractional flow reserve."

"Other interventions include balloon opening of diseased and tight heart valves and insertion of permanent pacemakers to patients with disturbances," he explained.

According to him, the hospital's current cardiac practice is blended with rehabilitation and regular cardiac seminars to our post heart attack and heart failure patients in a bid to enhance patients' understanding and coop with the disease as well as to curb the burden of expenditure involved in the treatment of its chronic complications.