National Heart Institute (IJN) expands Cardiovascular Risk Reduction Clinic (CRRC)July 22, 2024
Health Minister Datuk Seri Dr Dzulkefly Ahmad signing the plaque while Dato' Sri Dr Haji Azhari Rosman, Senior Consultant Cardiologist of IJN (first left), and Chief Executive Officer Datuk Dr Aizai Azan Abdul Rahim (fifth left) look on.
The National Heart Institute (IJN) today announced the expansion of its groundbreaking Cardiovascular Risk Reduction Clinic (CRRC), a first-of-its-kind initiative designed to tackle the pervasive challenges posed by Atherosclerotic Cardiovascular Disease (ASCVD). This innovative clinic aims to revolutionize cardiovascular healthcare across Malaysia, a country grappling with high rates of non-communicable diseases (NCDs) and premature deaths.
Non-communicable diseases, such as ASCVD, account for a staggering 71% of premature deaths in Malaysia. Of these, ASCVD alone is responsible for 54% of NCD-related fatalities. Particularly concerning is Malaysia's distinction of having the highest 1-year mortality rate for STEMI (ST-Elevation Myocardial Infarction) in the Asia Pacific region, with a rate of 17.9%. STEMI, a severe type of heart attack caused by a complete blockage of a coronary artery, poses significant risks of complications and mortality. A comprehensive study conducted in the United States and published in the Journal of the American Heart Association reveals that patients with Acute Coronary Syndrome (ACS) face a six-fold higher risk of recurrent cardiovascular events within a year post-discharge. This alarming statistic underscores the critical need for improved cardiovascular care and prevention strategies, a need that the IJN’s CRRC aims to fulfill. The establishment and expansion of the CRRC reinforce IJN’s status as a leader in cardiovascular care, research, and education. By broadening the CRRC’s reach, IJN seeks to provide specialized care to more patients while revolutionizing cardiovascular healthcare nationwide. This initiative aligns with the Ministry of Health's National Strategic Plan for Non-Communicable Diseases (NCD) 2016-2025, which aims to reduce NCD deaths from 20% to 15% by 2025. CRRC's impact Speaking at the plaque signing ceremony, Minister of Health Datuk Seri Dr Dzulkefly Ahmad highlighted the significance of the CRRC in the ministry's efforts to optimize care for vascular diseases, particularly ASCVD. Cardiovascular disease accounts for nearly one in four deaths in Malaysia. The 2023 National Health and Mobility Field Survey indicates that one in three Malaysian adults, or 33%, suffer from this condition. Additionally, one in two adults have high cholesterol levels but are asymptomatic and unaware of their condition. Since its establishment two years ago, the CRRC has treated close to 600 patients, significantly improving their quality of life and health outcomes. These patients have successfully managed and reduced their cardiovascular disease risks. “CRRC represents a groundbreaking and innovative public-private partnership to transform treatment paradigms for cardiovascular disease, underscoring IJN’s leadership in cardiac care and its ongoing pursuit to ensure its services reach its targeted demographic groupings. The CRRC operates under a systematic management protocol with well-defined inclusion criteria and checklists,” said Dr Dzulkefly. The clinic adopts a multidisciplinary approach, involving highly trained clinicians, nurses, dietitians, pharmacists, and physiotherapists in the management of cholesterol, diabetes, hypertension, and obesity. The primary objective is to aggressively manage lipids and other cardiovascular risk factors in patients with cardiovascular disease, with a strong focus on primary lipid disorders. Multidisciplinary approach and patient care Dr Dzulkefly was pleased to learn that a bottom-up approach, rather than a top-down strategy, is being implemented to enhance healthcare. This approach seamlessly integrates allied health professionals and clinicians for closer follow-up and monitoring, creating valuable research opportunities on CRRC outcomes. It also facilitates close auditing of the latest innovative therapies while addressing diabetes, hypertension, and obesity as critical factors in comprehensive patient care. He added that the CRRC has a profound impact on helping patients achieve their target LDL cholesterol goals, potentially reducing the recurrence of ASCVD and hospitalizations. The clinic represents a new approach to managing ASCVD, emphasizing prevention, multidisciplinary care, and patient empowerment for improved awareness and health outcomes. This initiative marks a shift towards not just patient care but population health management. Precision patient care and future goals “We will have population management or precision public health with more big data analytics driving our policies. IJN’s alliance perfectly resonates with our Health Ministry's national strategic plan for non-communicable diseases for 2016-2025. The ministry hopes to see more innovative solutions through comprehensive care models to improve health literacy, health outcomes, and the well-being of citizens,” said Dr Dzulkefly. Earlier, Dato’ Sri Dr Haji Azhari Rosman, Senior Consultant Cardiologist at IJN, revealed significant statistics. From 2007 to 2020, IJN performed 41,709 angioplasty cases, half of which involved patients with hypertension, a major risk factor. Many patients also had diabetes; in primary prevention, only 17.1% of diabetic patients used lipid-lowering therapy, and only 10.5% of those in the higher risk group were on such therapy. In secondary prevention, only 25.8% of patients with existing cardiovascular disease were on lipid-lowering therapy, while the remaining 74.2% were not. A retrospective study by IJN from January 2020 to February 2021 showed that over 50% of patients failed to achieve their LDL-C goal despite statin use (n=431). Achieving target levels is crucial for preventing recurrent events and stabilizing patients, preventing chest pain and progression of heart attacks. Dr Azhari highlighted that 13.7% of patients, or one in ten, experienced an event within the first year. IJN's efforts to provide quality medication and treatment regimes are vital for controlling cardiovascular disease in Malaysia, where the disease presents aggressively, often requiring interventions at young ages. Future initiatives and community engagement Looking ahead, the IJN is engaging the Ministry of Health (MOH) to extend CRRC services to peripheral clinics and establish CRRC-Pharma beyond hospital bases. The vision includes integrating tertiary care with MOH hospitals and general practitioners within the community and training pharma retail pharmacists to be familiar with new treatments. “We are building a bottom-up approach, engaging institutions and partners, even in high-risk regions. Small centers are trained, guided, and integrated into a system, accredited through training programs. This approach is more approachable and integrated than the top-down method,” explained Dr Azhari. Patients benefit from extra time with healthcare providers, including nutritionists, physiotherapists, and pharmacists, to address their issues comprehensively. IJN’s CRRC aims to upscale doctors through certification and training programs, expanding the idea once a core group of trained individuals is established. The CRRC model is designed to be transformative, potentially evolving into a regional center, beyond just the IJN. This hospital-based model can be adopted by doctors and family medicine specialists, eventually integrating into the community. Leveraging technology, CRRC provides a digital training program and learning platform to keep healthcare providers updated and facilitate patient care. Empowering the community This initiative moves primary care into community clinics, empowering the community and patients, and focusing on preventive and primary healthcare. By adopting this patient-based clinical community model, IJN hopes to create a sustainable and scalable approach to cardiovascular risk reduction and management. |
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