Prevention of Sudden Cardiac Death Perception & Reality

05 Jul 2008

By Mr Hawazi Daipi

Good Morning

Dr Wong Chiang Yin, President, Singapore Medical Association

Dr Abdul Razakjr Omar, Chairman, Organising Committee

Ladies and Gentlemen

1. It is my pleasure to be here today at the Singapore Medical Association’s 39th National Medical Convention. 

2. The choice of the theme for this year, “Prevention of Sudden Cardiac Death: Perception and Reality” is certainly a prescient one, as I understand it was decided last year. Sudden cardiac death, or SCD for short, is currently a hot topic. It was the subject of keen public discussion and debate in the newspapers recently. As its name suggests, SCD refers to sudden and unexpected death from heart diseases. In SCD, the heart stops pumping due to an abnormal heart rhythm.

3. In line with the theme, I would like to highlight a few areas where the perception of SCD differs from reality.

4. The popular image of SCD is that of fit and healthy young men collapsing and dying suddenly while exercising.  However, the reality is very different. Two out of three cases of SCD occur in the over 60 age group, and less than 3% of SCD victims in Singapore are under the age of 35. In fact, very few cases of SCD happen while exercising. Most cases occur at home.

5. However, when SCD does occur during sports or while exercising, it makes headlines in the newspapers. Dying suddenly at home is much less newsworthy.  We should not let scary headlines put us off from exercising. Medical evidence shows that the benefits of regular moderate exercise far outweigh the risks of exercise for healthy individuals.

6. Another widespread perception is that nothing much can be done to prevent SCD. Again, this is wrong. A local study showed that more than 80% of SCD is due to underlying blockage of the arteries that supply blood to the heart muscles. This is a condition called Coronary Artery Disease (or CAD), the same problem that causes heart attacks.  We know a lot about what can be done to prevent CAD – stop smoking, exercise regularly, eat wisely, detect and control chronic diseases that are risk factors, such as diabetes, high blood pressure and high cholesterol. 

7. The Health Promotion Board is our key partner in rolling out programmes to promote a healthy lifestyle and to encourage screening for diabetes, cholesterol and high blood pressure.  But doctors too, especially those in the primary care sector, have a major role to play to encourage their patients take responsibility for their health, by making healthy lifestyle choices, and going for regular screening for chronic diseases. By controlling diabetes, high blood pressure and high cholesterol in their patients, family doctors can also help reduce the incidence of sudden cardiac death.   

8. Despite our best efforts at prevention, sudden cardiac arrests will still happen.  In such cases, whether the patient lives or dies is influenced by certain key actions, known as the “chain of survival”. These key steps include: early access to emergency medical services (Dial 995), early Cardio-Pulmonary Resuscitation (CPR), early defibrillation and advanced cardiac life support.

9. Therefore, efforts to educate the public about the need for early recognition of cardiac arrest, and early CPR and defibrillation are important. I am sure that this public symposium, with SCD as the theme, will contribute towards this goal.    

10. During a cardiac arrest, there is little time to think about how to respond. Only a healthcare professional or by-stander who is already trained would be able to perform CPR.  Therefore, promoting CPR training is important, to increase the chances that a by-stander will be able to perform CPR. CPR training has come a long way since the launch of the programme in 1983. Every year, about 30,000 people are trained in CPR by various groups in the public, private and community sector. 

11. I am happy to learn that the Singapore Medical Association and Singapore Heart Foundation are leveraging on modern technology to promote CPR in an innovative way. They will be launching Mobile CPR later this morning. I’m told that this is an easy-to-understand animated package on CPR that can be downloaded to the hand phone.

12. In addition to CPR, defibrillation - administering an electric shock to try to return the heart to a normal rhythm, as early as possible is important. With advances in technology, there are now Automated External Defibrillators (AEDs) that can recognise the type of abnormal heart rhythm, decide whether a shock is needed, and give instructions to the user. They do not require specialised knowledge to use, although some training is useful.

13. All our SCDF ambulances are equipped with AEDs. SCDF also has fast-response teams that carry AEDs. We support efforts to improve access to AEDs at appropriate public locations with high human traffic (such as convention centres, integrated resorts and airports) and at mass participation high intensity sports events.

14. However, even in the best of settings, such as casinos – where everyone is closely monitored, and there are trained security staff on hand to respond to collapses quickly by performing CPR and defibrillation, more than 3 in 5 do not survive. Therefore, the main thrust of our efforts should remain prevention rather than cure.

15. I am sure that you will learn much more about SCD from the medical experts that are speaking later today. On that note, let me welcome all of you to this public symposium and the SMA’s 39th National Medical convention.

16. Thank you.