Too few patients in Singapore aged 60 and above have implantable cardioverter defibrillator (ICD) that can help heart patients prevent sudden cardiac deaths, although most of them would be suitable for it.
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.
“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
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
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.
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 –
defined 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.