NHCS Study: Heart device slashes death risk but few opt for it

14 July 2017 | ResearchClinical Care and Innovation 

​An implantable cardioverter defibrillator PHOTO: ST FILE
By Felicia Choo, The Straits Times

Although two-thirds of the 1,066 patients studied in Singapore are eligible for an ICD, only 9.4 per cent of them received one.

A small device, placed under the skin to track and regulate one's heart rate, can help heart patients prevent sudden cardiac deaths.

Yet too few patients in Singapore aged 60 and above have such a life-saving implant, although most of them would be suitable for it.

This finding stems from a study that has been conducted in 11 Asian territories, including Singapore, since 2012. The average age of patients involved is 60.

Called an implantable cardioverter defibrillator (ICD), the device is inserted under the skin in the chest and linked to the heart through wires to monitor the heart rhythm. When it detects an abnormal rhythm, it delivers an electric shock to restore a normal heartbeat.

Although two-thirds of the 1,066 patients studied in Singapore are eligible for an ICD, only 9.4 per cent of them received one.

On the whole, ICDs are under-utilised in Asia, used by only 12 per cent of eligible patients.

"This is despite Singapore having one of the highest ICD eligibility rates in Asia, after India and Indonesia," said Professor Carolyn Lam, senior consultant at the department of cardiology of the National Heart Centre Singapore (NHCS).

This device has been available here for at least a decade or so.

Its low utilisation rate in Singapore could be due to people's unwillingness to have an unnatural object in their body, and a belief that they are too old to benefit from it, according to a separate study by Prof Lam, which was published in 2013.

Surprisingly, cost was not a major factor, although the device cost $3,883 last year even for a subsidised patient at the NHCS.

Patients who do not use an ICD can take medication to treat their heart condition.

As doctors can only advise patients to use an ICD, more education is needed to encourage people to use the device, said Prof Lam.

The study, led by Prof Lam, also found that an ICD implant slashes sudden cardiac deaths by 66 per cent. One's overall risk of death - be it due to heart issues or other reasons - is reduced by 29 per cent.

Besides Singapore, the study is being done in Indonesia, Malaysia, the Philippines and Thailand, as well as China, India, Hong Kong, Japan, Taiwan and South Korea.

Out of these, Japan has the highest ICD utilisation rate at 52.5 per cent, based on 305 patients eligible for the device. It is followed by Hong Kong at 21.1 per cent, based on 19 eligible patients. China is third at 17.9 per cent, based on 229 eligible patients.

On the whole, ICDs are under-utilised in Asia, used by only 12 per cent of eligible patients.

The study's findings were presented at the 21st Asian Pacific Society of Cardiology Congress at Suntec Convention Centre yesterday.

Surprisingly, cost was not a major factor, although the device cost $3,883 last year even for a subsidised patient at the NHCS.

At the opening ceremony, Health Minister Gan Kim Yong said Singapore has made good progress in treating cardiovascular diseases, but people should continue to take responsibility for their health.

The premature mortality rates - def​ined as potential years of life lost before a certain age - for coronary heart disease and stroke in Singapore were halved between 2000 and 2015, noted Mr Gan.

"However, significant challenges remain. In 2015, about one in three deaths was attributed to cardiovascular diseases," he added.

Cardiovascular conditions are strongly associated with diabetes, he added, with one in two heart attack patients and two in five stroke patients also suffering from diabetes. This is why the Ministry of Health launched "a war on diabetes" last year, he added.

SOURCE: THE STRAITS TIMES SINGAPORE PRESS HOLDINGS LIMITED. REPRODUCED WITH PERMISSION.



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