Speech by Mr Chee Hong Tat, Senior Minister of State for Health, at the Singapore Cardiac Society 30th Annual Scientific Meeting, 7 April 2018

Adjunct Assistant Professor Jack Tan, President of the Singapore Cardiac Society

Distinguished guests

Ladies and gentlemen  

1.            Good Afternoon. I am happy to join you at the opening ceremony of the Singapore Cardiac Society’s 30^th Annual Scientific Meeting.

Disease Burden of Cardiovascular Diseases in Singapore

2.            Cardiovascular disease is the world’s number one killer, and is responsible for about one-third of all global deaths^[1]. According to the Singapore Burden of Disease Study, cardiovascular disease, including ischemic heart disease and stroke, contributed to 20% of the total disease burden^[2], making it a serious concern for us in Singapore.

3.               Through intellectual discourse and the hard work of thought leaders and experts like you, we have made good progress in the treatment of cardiovascular diseases over the years. The age-adjusted mortality rate from myocardial infarctions in Singapore has fallen steadily over the years. In 2007, myocardial infarctions were responsible for as many as 40 deaths per 100,000 people. In 2013, this number had fallen by about one-third to 26 deaths per 100,000 people^[3].

Prevention as a Strategy in the War on Diabetes and Associated Cardiovascular Complications

4.               Currently, about three in four Singapore Residents aged 65 and above are affected by one or more of the three cardiovascular risk factors — diabetes, high cholesterol and hypertension^[4]. The prevalence of these conditions in Singapore will likely increase as our population ages.

5.               Diabetes is of particular concern as it is the second leading cause of disease burden in Singapore and affects the health outcomes of patients with cardiac conditions. Diabetes also has other multi-systemic complications, like retinopathy, peripheral vascular disease and renal failure. This is why Singapore is waging a war on diabetes.

6.               Prevention is better than cure. We can reduce our risk of diabetes and cardiovascular diseases by encouraging Singaporeans to adopt a healthy lifestyle. Simple lifestyle changes like healthy eating and incorporating physical activity into our daily lives can go a long way. Initiatives like the Health Promotion Board’s (HPB’s) “Healthier Dining Programme” and the “National Steps Challenge” in 2015 are some of the many programmes in place to help Singaporeans stay healthy.

7.            Beyond primary prevention efforts, emphasis should also be placed on regular health screening. To encourage evidence-based screening and follow up, the Ministry of Health (MOH) enhanced the Screen for Life initiative last year so that eligible Singaporeans now pay no more than $5 for basic health screening and the first post-screening follow up. Community Health Assist Scheme (CHAS) card holders pay a further discounted rate of $2, while Pioneers do not need to pay.

8.            For patients diagnosed with cardiac conditions, they need early access to treatment options to prevent further complications. Currently, the major risk factors of cardiovascular diseases including diabetes, hypertension and lipid disorders are covered under the Chronic Disease Management Programme (CDMP). MOH will include Ischaemic Heart Disease (IHD) under CDMP from June this year. Pioneer Generation and CHAS cardholders can also tap on CHAS Chronic subsidies for these treatments at CHAS General Practitioner (GP) clinics. 

9.            MOH has also set up a national Heart Failure Services Improvement team in 2017 to develop a cohesive heart failure strategy, and to strengthen patient care from a systems perspective. This national-level team will develop standardised quality measures and processes to improve care outcomes, through a coordinated and effective approach. For example, the team has identified and gained consensus amongst the public hospitals on 13 core quality standards for inpatient heart failure care. These indicators are monitored and fed back regularly to the institutions to provide feedback for them to adjust and improve their processes.

Importance of Research in Cardiology

10.         The theme for this year’s meeting, “Future of Cardiology and Beyond” is relevant and timely as we tackle the evolving healthcare challenges that Singapore faces. Cardiovascular disease is one of the five key therapeutic areas of focus identified under MOH’s Healthcare Research Strategy 2020. Please allow me to share some examples of the ongoing studies funded by the National Medical Research Council (NMRC).  

11.         In the area of mobile health, a team in the National University Health System (NUHS) is currently looking into the effectiveness of a nurse-led, home based programme^[5] that utilises a smartphone app to reach out to patients with heart failure, in the convenience of their homes. The app will have a Cardiac Manual with useful information for patients ranging from practical tips on how to eat healthier meals to information on the common medications that are taken for heart failure.

12.         As we embark on research to advance our knowledge and improve patient outcomes, it is important to review existing processes to translate research into practice. This requires collaborations across disciplines and providers in the care spectrum, to ensure that care is streamlined for our patients. For example, Changi General Hospital’s (CGH) ValuedCare Heart Failure Programme, which enrols patients with heart failure, works with primary care partners such as Family Medicine Clinics and Polyclinics to provide a coordinated care plan. So far, this initiative has achieved a 4% reduction in the 30-day readmission rate for heart failure patients. 

Conclusion

13.         In conclusion, I would like to commend the Singapore Cardiac Society for organising this meeting to facilitate the exchange of ideas in the prevention and treatment of cardiovascular disease. Let us continue to work together to bring about better health outcomes for our patients.  Thank you. 

^[1] World Health Organization, Fact Sheet on Cardiovascular Diseases, May 2017.

^[2] Ministry of Health (Singapore). The Singapore Burden of Disease (SBoD) Study 2010.

^[3] National Registry of Diseases Office (NRDO), Trends on Acute Myocardial Infarction in Singapore 2007-2013.

^[4] National Health Survey 2010. 

^[5] HOMe-based HEart Failure Self-Management Programme Study (The HOM-HEMP Study): A Randomised Controlled Trial led by PI Dr Wang Wenru (NUHS).