SM Tharman Shanmugaratnam at the Inaugural International Conference on Interventional Cardiology

Prof Tan Huay Cheem, 
Course Director of the inaugural AICT-AsiaPCR conference

Course Directors,
Distinguished Guests, 
Ladies and Gentlemen,

Good morning. It is a real pleasure for me to be here at this inaugural international conference on interventional cardiology, the AICT AsiaPCR.

My heartiest congratulations (pun intended) to the Asian Pacific Society of Interventional Cardiology (APSIC) and AsiaPCR, a member of the PCR family of meetings, for bringing you all together for three days of professional sharing and learning. 

Growing Cardiovascular Disease Burden

Cardiovascular disease (CVD) is a major and increasing cause of morbidity and mortality globally. Cardiovascular disease is responsible for almost a third of all annual deaths worldwide and in Singapore, and the number one ranked cause of death globally. But it will also grow. 

Improved healthcare standards and advances in medical science are fortunately prolonging life. But as the world ages, many more people will be living with disabilities attributed to cardiovascular disease – in fact this increase will be higher than for other diseases such as cancer. Within the Asia Pacific, the more advanced East Asian nations already face with this challenge as their populations age. More nations will follow.

This issue demands effective whole-of-government and whole-of-society solutions. We should continue investing in medical science and study of cardiovascular disease, and translating research findings through work on more effective interventions and treatments. We must also expand our upstream interventions, through preventive public health strategies. Let me say a few words on each of these two priorities.

Research and Innovation to Advance Evidence-based and Cost-effective Cardiology Practices

Research and innovation are essential to our ability to deliver safer and more effective care for patients. Conferences such as the AICT AsiaPCR not only help spread the latest findings, but can also spur collaboration in research.

One example of collaborative research is a study on Obstructive Sleep Apnea (OSA). Conducted by National University Heart Centre Singapore (NUHCS) together with its partners in India, China, Brazil and Myanmar, it studies OSA as an emerging risk factor for coronary artery disease, after NUHCS discovered that almost two-thirds of patients who had heart attack had varying degrees of OSA. The study involved 1,300 patients with OSA in the 5 countries who had percutaneous coronary intervention (PCI) procedures. The study found OSA is a risk marker for adverse outcomes after stenting procedures. NUHCS and its partners are now studying this further, to evaluate the effectiveness of OSA-directed therapies in ameliorating these risks.

Amongst many other innovations and technological advances discussed at this conference, there is another example that I understand Clinique Pasteur from Toulouse in France will demonstrate, which is shockwave coronary intravascular lithotripsy. I am told this entails using a disposable catheter that contains multiple emitters enclosed within a balloon, creating sonic pressure waves that fracture calcium in hard coronary plaques. This technology potentially allows treatment of high risk complex plaques for our patients in the Asia Pacific region.

Beyond using sonic waves and other new technologies, healthcare research and innovation at heart should seek to deliver care that is of value to people. The holy grail is in ensuring that patients receive the best care, while ensuring that the healthcare system is financially sustainable.  It is critical therefore that we remain evidence-based, and develop systems nationally as well as within each hospital to ensure that interventions and treatments are appropriate, value-based and cost-effective.

I am pleased that NUHCS has introduced a value-driven outcome (VDO) analysis regarding ST-segment elevation myocardial infarction (STEMI) patients. I know the concept of value-based care is an area of interest among many institutions that are here today as well, and I hope we can exchange notes on workable strategies to achieve value in our medical interventions.

Continuum of Care for Better Health Outcomes

Finally, better health outcomes can only result from the entire care continuum – from prevention and early intervention, to treatment and post-treatment follow-up. The risk factors leading to cardiovascular diseases are well-studied. Many of them, such as obesity, smoking, sedentary lifestyles and poor eating habits are best tackled early, well before cardiovascular and other diseases show up.

Doctors play a crucial role in these population-wide public health strategies. Raising public awareness of the very substantial benefits of a healthy lifestyle and empowering citizens to adopt healthier habits, starting from young.Working with public agencies and community bodies to implement appropriate screening programmes -  which are vital for detection and management of cardiovascular-related illnesses and other conditions.

We had previously focused on the coordinated and timely intervention of individuals presenting with symptoms of Acute Myocardial Infarction (AMI). We now also work on post-AMI measures to prevent recurrence of AMI or associated complications such as heart failure and death.

This needs partnerships between healthcare institutions and relevant agencies to establish a coordinated and accessible care model beyond hospitals so that patients can receive adequate support in the community. To facilitate this, home telemonitoring of post-heart attack patients can improve health outcomes. Singapore is working on this, similar to countries such as Australia and Canada, and we have seen good results.

Conclusion

There are many issues that will benefit from the deep professional exchanges between the experts gathered here, and I am confident that the next three days will be of great learning value. I wish all of you a successful and meaningful conference.