A research project at the National Heart Centre Singapore (NHCS) shows how a student-clinician researcher partnership can produce powerful results.

Coronary artery disease (CAD) is the narrowing or blockage of blood vessels to the heart which can lead to heart attack. It is one of the leading causes of death in many parts of the world. According to MOH, it accounts for 16 per cent of all deaths in 2014 here. 

Several third-year Duke-NUS students in their research year investigated how they can help detect CAD more efficiently. The project began when Duke-NUS alumna, Dr Tay Yu Ling (MD 2014), who was then attached to NHCS, explored how the accuracy of calcium scoring in assessing risk of CAD was affected by patients with different risk-profiles. Calcium scoring checks the amount of calcium in arteries of the heart, which may indicate CAD.

After much hard work under the guidance of her mentors, Yu Ling discovered that a calcium score of zero could effectively and accurately rule out the risk of CAD in specific patient profiles, eliminating the need for further testing.

“It was very exciting to embark on a research project I could call my own,” Yu Ling said. “And what is even more pleasing is having NHCS go on to pilot an algorithm based on my work.”

The algorithm that Yu Ling referred to was created by fellow alumna, Dr Olivia Tan (MD 2015), in another study. Together with Prof Terrance Chua, Group Chairman Medical Board at SingHealth and Medical Director at NHCS, Olivia developed a hypothesis based on Yu Ling’s findings:

What if, before their first appointment with NHCS, diagnostic tests were performed on polyclinic-referral patients with chest pain? Would this speed up the diagnosis and discharge times, and reduce visits to the hospital?

Olivia then created an algorithm that decides which tests to run on the patient so as to prescribe a cost-effective and accurate diagnosis.

“This allows us to perform relevant tests based on patients’ medical history,” said Prof Chua. “By re-engineering this process, Olivia has made it possible for a diagnosis to be ready in time for the patient’s first appointment with an NHCS specialist.”

This algorithm was tested and yielded very encouraging results. The 50 patients who tested the new algorithm-based process experienced a shorter waiting time for a diagnosis, and with fewer visits too. In addition, the rate of discharge after the first visit increased from 18 to 50 per cent, proving the success of this new process.

This process has since been implemented in NHCS to the benefit of 1,000 patients. “It has been turned into clinical reality,” Prof Chua said. “And there is scope to expand this to even more polyclinics.”

Reflecting on the impact of this student-clinician-researcher partnership, Prof Chua said, “This is clear evidence of how research can improve clinical care in a very practical way, thanks to the efforts of our student-researchers. It also shows the influence medical students can have on a system. When the science touches the lives of patients, everyone truly benefits.”

This article was first published on 'Vital Science' from Duke-NUS Medical School.