The National Heart Centre Singapore (NHCS) has introduced a new therapy known as Aquapheresis, a form of ultrafiltration to help heart failure patients with fluid overload removes excess salt and water from the body safely and effectively.
- Fluid overload accounts for over 90 per cent of heart failure hospitalisations
- New treatment known as Aquapheresis, helps to remove salt and water from the body faster and results in greater weight loss compared to diuretics therapy
- Reduce readmissions by 50 per cent, length of hospital stay by 63 per cent and unscheduled clinic/emergency room visits by 52 per cent
The National Heart Centre Singapore (NHCS) has introduced a new therapy known as Aquapheresis, a form of ultrafiltration to help heart failure patients with fluid overload removes excess salt and water from the body safely and effectively. The new therapy is targeted at those who do not respond well to diuretics (medications to help the body get rid of unneeded water and salt through the urine). Aquapheresis helps to relieve symptoms such as weight gain, swelling in the legs, arms and abdomen, difficulty in breathing and fatigue. This will help heart failure patients reduce their readmissions, length of hospital stay, unscheduled clinics and emergency room visits. NHCS is the first in Asia to introduce Aquapheresis in October 2011.
The safety and efficacy of the new therapy is shown in a major US clinical trial (UNLOAD trial) involving 200 patients at 28 US centres. The trial compared ultrafiltration with standard intravenous diuretic therapy. The results showed that at 48 hours, the ultrafiltration group had 38 per cent greater weight loss and 28 per cent greater net fluid loss than the diuretics group. At 90 days, the ultrafiltration group saw 50 per cent reduction in re-hospitalisation episodes, 63 per cent reduction in total re-hospitalised days and 52 per cent reduction in unscheduled clinic/emergency room visits.
Elaborating on the significance of the Aquapheresis therapy, Dr David Sim, Consultant, Department of Cardiology and Co-Director, Heart Failure Programme, NHCS said, “With our ageing population and better outcomes from heart attack treatment, the number of heart failure cases will increase. Fluid overload accounts for over 90 per cent of hospitalisations for heart failure patients. The introduction of Aquapheresis therapy can be used as a more efficient method of fluid removal. This helps to improve the quality of life for the patients with a shorter length of hospital stay.”
Fluid overload is a condition where the person has excess fluid (comprising mainly of salt and water) in the body. For most patients, they are treated with diuretics, commonly known as "water pills," to help the body get rid of unneeded water and salt through the urine. However about 20 to 30 per cent of these patients suffer from diuretic resistance. This means that their kidneys are not responding to the diuretic drugs. This happens more
commonly in patients with moderate to severe heart failure.
During Aquapheresis, trained medical personnel will insert catheters in selected veins in the patient’s body. Once in place, the catheters are connected to the blood filter circuit. The filter removes the excess fluid (salt and water) from the blood and re-circulates the blood back to the body. The duration of the treatment depends on the severity of the patient’s condition. Mr Soh Teow Cheng, 59, is among the six patients who have successfully received the Aquapheresis therapy. Mr Soh has chemotherapy induced cardiomyopathy (heart muscle disease) in 2003. He started to have fluid overload in September 2011 and was hospitalised. At his follow-up visit on 4 November 2011, he still had fluid in his abdomen despite oral diuretic and was referred for Aquapheresis. Mr Soh was started on the new therapy on 8 November 2011. After the treatment, his net weight loss was 8.8kg and fluid loss was 12 litres over 48 hours. His symptoms were relieved and he was discharged well after five days.
Sharing his experience, Mr Soh said, “Formerly I couldn’t walk and will get breathless with less than 10 metres. The swelling in my abdomen was so bad like I’m 10 months pregnant. Now, I can walk so much better and can continue to work as a taxi driver.”
In Singapore, heart failure is a top cause for cardiac admissions at about 5,000 cases yearly. NHCS sees about 1,000 cases each year. The centre estimates about 50 patients will benefit from the Aquapheresis therapy.
About the National Heart Centre Singapore
The National Heart Centre Singapore (新加坡国家心脏中心) is a 185-bed national and regional referral centre for cardiovascular diseases. It provides one-stop comprehensive preventive, diagnostic, therapeutic and rehabilitative cardiac services for heart patients.
Each year, NHCS handles over 100,000 outpatient consultations, 7,000 interventional and surgical procedures and 10,000 inpatients. Its outcomes for heart attack treatment, balloon angioplasty with stenting and coronary bypass surgery have been shown to be equivalent to international standards.
NHCS is the first heart centre outside USA and in Asia to receive the prestigious Joint Commission International (JCI) since 2005, which is an assurance for safe and quality patient care for the patients.