Only one in 12 people hit by attacks dying as
treatments have become better and quicker. The faster the arteries are unblocked, the better
the recovery as more heart muscle is preserved.
The number of people getting heart attacks in Singapore has shot up in recent years – but far fewer are dying because of them.
Back in 2007, heart attacks killed one in six people who suffered them. Fast forward to 2016, only one in 12 people hit by heart attacks died as treatments became better and quicker.
Restoring blood flow to the heart rapidly is “crucial” for good outcomes, said the Singapore Myocardial Infarction Registry Annual Report 2016 released last week.
That is precisely what Singapore has achieved. It has cut the median door-to-balloon (DTB) time – or the time between the patient arriving at the hospital and receiving balloon angioplasty to unblock his blood vessel – from 95 minutes to 55 minutes over that 10-year period.
The international goal is a DTB time of 90 minutes or less. The United States achieved a median DTB time of 59 minutes in 2014.
The faster the arteries are unblocked, the better the recovery as more heart muscle is preserved.
Singapore has been refining its processes to treat heart attack patients faster.
To give the hospital a head start, Singapore Civil Defence Force paramedics do an on-site electrocardiogram to establish the amount of blockage in the arteries. The results are transmitted to the hospital, so everything is ready when the patient arrives.
Death rates for heart attack patients have also fallen because the most serious cases – in which arteries are totally blocked – are being attended to far more promptly. In 2007, only nine in 20 of such patients were treated within 90 minutes.
By 2016, this proportion had risen to 19 in 20.
Over this period, the average age of a heart attack patient climbed from 67.6 years to 69.3 years. Two in three heart attack patients were men – who are known to be more susceptible to heart disease.
Half the patients were diabetic and almost half were smokers. This is disproportionately high, given that only 14 per cent of people here smoke and only 11.3 per cent of adults below the age of 69 here are diabetic.
Other risk factors flagged in the report were high blood pressure, high cholesterol level and obesity.
All the major risk factors can be controlled or, in the case of smoking, stopped.
However, cardiologists told The Straits Times that risks are higher for people with such conditions, even when the factors are well controlled. But the risks are far higher if they are poorly controlled.
Professor Tan Huay Cheem, director of the National University Heart Centre Singapore, said: “Control of risk factors, especially with cholesterol- lowering, significantly reduces the risk of cardiovascular events such as death and heart attacks, but does not eliminate it.”
Apart from more prompt treatment, he said, heart attack deaths had dropped because people were controlling risk factors better.
Professor Carolyn Lam, a senior cardiologist at the National Heart Centre Singapore, said: “A diabetic patient is still at higher risk than a non-diabetic patient, even if his or her sugars are well-controlled.
“But the risk of adverse outcomes is even higher if sugars are badly controlled. So good control of risk factors is, ultimately, still important,” she said.
The report also showed that, in relative terms, more Malays and Indians had heart attacks, compared with Chinese.
The report pointed out that, in the case of Malays, relatively more have high blood pressure, high cholesterol level and diabetes.
As for Indians, the report said they are genetically more prone to heart disease, and more of them are diabetic.