Lifestyle change vital after heart attack


NEED TO IMPROVE HEALTH: Patients with coronary heart disease should be aware of treatment targets so they can work with their doctors to achieve them, said Dr Tan Ngiap Chuan (above) of Pasir Ris Polyclinic.

ONLY a handful of patients with coronary heart disease (CHD) successfully change their lifestyles for the better. In fact, many revert to their old habits six to nine months after a heart attack or bypass surgery.

This was one of the findings of a study led by Dr Tan Ngiap Chuan, Senior Consultant and Director of SingHealth’s Pasir Ris Polyclinic.

The team found that many CHD patients were unaware of what they needed to do to improve their health and reduce their risk of another heart attack by achieving treatment targets for their blood pressure, LDL cholesterol  and   diabetic control.

Patients should aim for the following targets: • Blood pressure < 130/80 mmHg • LDL-C (cholesterol) < 2.6 mmol/L • Type 2 diabetes mellitus < 7% HbA1c

Some did not know what their target good cholesterol and blood pressure levels should be, or how to control their diabetes. Others continued with poor diets, a lack of exercise and unhealthy lifestyles. Several ate at hawker centres six times a week and said it was hard to change their eating habits. A small number also continued to smoke.

The study was conducted amid concerns about the deaths of CHD patients in the last few years compared to 10 years ago. An earlier study by Tan Tock Seng Hospital showed that 70 per cent of CHD patients did not meet the target cholesterol levels and ran a high risk of getting a second heart attack.

“We wanted to look at the factors that prevented our patients from reaching their targets, and develop better treat-to-target practices for both our doctors and patients,” Dr Tan said.

The study involved 44 patients and 18 primary care physicians. During focus group sessions, patients discussed their awareness of the disease and lifestyle choices, while physicians, in separate focus groups, discussed treatment protocols.

The information correlated with results from a survey of more than 300 patients on their lifestyles, expectations of care and awareness of their disease. The final results of both studies were presented at this year’s Asia Pacific Regional Conference of the World Organisation of Family Physicians (WONCA), held in the Philippines.

The team found that the problem was due to many factors, including communication lapses between physicians and patients. Dr Tan said: “Primary care physicians are often too preoccupied with the clinical assessment of the cardiac status to exclude the risk of a second heart attack. There was little discussion on mutually agreed goals or treatment targets during consultation.”

He said the checks doctors perform on CHD patients are correct and necessary. “What is missing is simply mentioning the treatment targets. We know the risk of having a heart attack again will be reduced significantly if patients manage these factors well.”

He said it is important to give patients information on their treatment targets. “Even if they are elderly and have difficulty remembering the target levels, repeating the numbers to them gives them the opportunity to seek information on measures that they can take to achieve such targets.”

The team has now rolled out new measures to close the communication gap and improve awareness. Treatment targets are printed on CHD patients’ appointment cards for easy reference and posters have been put up in high traffic areas in the polyclinic to serve as further reminders.

Nurses also draw patients’ attention to their treatment targets, and patients have their blood pressure checked before consultation to increase their consultation time with the doctor.

These efforts have paid off. The level of quality care – as more patients achieve their treatment targets – has since improved.