Cardiologist Dr Koh Choong Hou wants to move the focus to prevention for a healthier Singapore.

The concept of saving money early and compounding more interest over the years is probably the furthest thing from the mind when one thinks about cardiovascular health. Yet, the two concepts have something in common, according to Dr Koh Choong Hou, Clinical Assistant Professor and Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS).

“An early start is key in both cases,” explained the cardiac specialist. “You need to start saving early in your 20s so that you can reap the most benefit. It’s the same for your cardiovascular fitness. You need to invest in it from young. Exercising regularly and staying active from an early age is one of the best ways to ensure good heart health.”

Dr Koh believes the avenues have been provided in the form of exercise corners, park connector networks, and accessible gyms. But motivating people is a different matter altogether. “The only cost to exercise is time, but it is time well spent. How do we convince people of that? We need to find ways to motivate and educate them so they understand the importance of taking ownership of their own health.”

However, exercise is only one facet. As Singapore moves towards achieving a fitter population with its Healthier SG national initiative, preventive health is now in the spotlight. Singaporeans are encouraged to not just exercise, but to also take proactive steps to manage their health in order to prevent the onset of chronic diseases.

“When we talk about lifespan, we often forget to talk about health span — years of life spent living healthily, without ailments. We need to shift the focus from treating to preventing conditions, and preventive cardiology plays a big role in this,” said Dr Koh.

Read more: Regular exercise is just one of the factors for good heart health. Don't neglect these other factors that help prevent heart disease!

NHCS cardiologists like Dr Koh work closely with primary care physicians so that patient management can be optimised. For instance, in early screening and detection of underlying silent heart disease such as obstructive coronary disease or abnormal heart rhythms, Dr Koh recommends to primary care physicians the kind of cardiac tests patients need, and whether certain medications should be started early. “At times, primary care providers do not have access to certain cardiac tests. And that’s where we come in. We can advise them on tests to be done and the actions they can take based on the results,” he said.

Dr Koh is also the Director of the Singapore Armed Forces (SAF) Cardiac Fitness Centre (SCFC) at NHCS. Operational since 2012, SCFC ensures National Service pre-enlistees have no underlying cardiac conditions and are fit for physical activities and combat training. It also screens the SAF active regulars for cardiac risk factors and monitors those who fall in the higher risk categories with tests such as stress exercise electrocardiogram. Since early 2022, SCFC has made progressive leaps in the digitalisation of healthcare communications, electronic medical records, and clinical workflow, ensuring that the entire process for SAF servicemen and pre-enlistees are seamless, convenient and readily accessible.

The SCFC team also worked with MINDEF SAF to sharpen referral criteria and clinical protocols for selected clinical conditions. “The referral patterns from the SAF medical centres have gotten more robust as a result, and we were able to reduce unnecessary tests and consultations, and improve patient turnaround time,” said Dr Koh.

In addition to these roles, Dr Koh specialises in echocardiography, the imaging of a moving heart. The modality assesses the structure and function of the heart. “We can tell if the heart is weak or strong, has stiffness or is ageing, and whether there are structural abnormalities like holes, valve issues, musclerelated issues, artery blockages, masses, growths or blood clots within the heart.”

About 1,000 patients have an echocardiogram done each week at NHCS. Most of them are referred for suspected cardiac conditions due to symptoms of chest pain or breathlessness. Other than the general population, a unique group of people who undergo echocardiograms are the elite footballers, who may require specific cardiac clearance for competitions, such as the ASEAN Club Championships.

“Previously, clinicians could only depend on bedside physical examinations or the basic ECG to pick up heart conditions, which may result in missed cases as some structural heart problems are subtle. With the echocardiogram, we now have much improved diagnostic sensitivity. It’s also a safe and cost-effective test for various clinical indications, such as in patients undergoing potentially cardiotoxic chemotherapy, or to monitor patients with known heart valve issues,” said Dr Koh.

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