Bandar Seri Begawan - Treatment in Brunei for heart failure problems is comparable to international standards.

This is according to Doctor Chong from Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, speaking to the Borneo Bulletin during the Heart Failure Symposium, which took place yesterday at the Rizqun Hotel.

The Minister of Health, Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Haji Suyoi bin Haji Osman, was present at the symposium as the guest of honour.

In an interview, Doctor Chong said: "Today is the Heart Failure Symposium and the Patients' Forum where we introduced the new service, which is the Heart Failure Service that we started in RIPAS in July 2008."

Speaking about the aim of the patients' forum, he said: "In this patients' forum we are increasing the awareness among the patients and our community in regards to the availability of treatment for heart failure and the programme we have set up, so that we can deliver better care to the patients."

He explained that heart failure was "a condition whereby a person's heart is failing. The function of the heart is to pump blood to the rest of the body so that the patient is able to carry out his/ her normal everyday activities, but when going through heart failure, the heart is unable to pump blood to the rest of the body, hence, the patient will feel some symptoms such as breathlessness due to exertion, tiredness and they can also develop neck swelling."

He explained that some of the most common causes of heart failure in Brunei are coronary artery disease, high blood pressure and diabetes.

"With the introduction of this heart failure programme, we have a dedicated nurse, and a cardiology team comprising technicians, doctors and, when necessary, pharmacists, dieticians and social workers are included to help in the management of this group of patients."

According to the doctor, international studies have shown that this type of programme results in a reduction of hospital admissions involving patients experiencing heart failure as well as improving their chances of survival.

"The patients tend to come in frequently to hospitals with symptoms, as mentioned earlier. Each time they come in, their prognosis is actually worse off whenever they get discharged from the hospital, so there's a gradual deterioration of their condition despite having treated them during that acute episode," he said.

"At certain stages of the heart failure condition, they will gradually die from it, whether the specific cause is from pump failure or from the heart having a dangerous heart rhythm, which can actually stop the heart.

"This programme also introduces other treatments. For example we need to optimise the medical treatment of this group of patients, which has been shown to improve the survival and quality of life of the patients.

"After optimal medical treatment, we then select which group of patients would benefit from a particular device therapy, which is either a Permanent Pacemaker (PPM), an Implantable Cardioverter Defribellator (ICD) or Cardiac Resynchronisation therapy (CRT)."

Asked how the treatment available at RIPAS Hospital compares to other countries, he said: "With regards to the type of treatment, I can break it down into three points.

"First is the optimising of medical treatment, this is then followed by device treatment, and finally, being involved in a heart failure programme, as we have set up. "So based on the fact that we are meeting all these criteria, coupled with our having sent nurses to Australia for heart failure .specialty training, it is safe to say that treatment available here is comparable to international standards."

One of the patients at the symposium, a grandfather named Haji Saidi, along with his wife Hajah Ramni, said, "I had a heart attack in November 2007. I was taken to RIPAS, where I underwent an operation. After about a month in hospital, the doctors found that I was weak, and I couldn't work or do anything physical.

"After an operation where the doctors put a device inside my body, I felt much stronger. It really helps. I can now physically do things, like gardening and I can walk anywhere now without a problem. There are still a few problems from time to time, but I feel much better since getting the device.
"I had a lot of help from RIPAS and JPMC (Jerudong Park Medical Centre). I would like to say thank you to His Majesty and the Bruneian people for helping us and providing us with healthcare."

Asked how he felt, he said: "I am very happy. Even my grandchildren can see that I'm better, and they worry a lot less now." Another patient present yesterday was Yahya bin Masron who said, "I have been on a pacemaker for two years, and have had heart problems for 22 years."
He also suffers from high blood pressure and diabetes.

"I am not a disciplined patient when it comes to taking medication. Sometimes I miss taking it, sometimes I just don't take it at all." He advised that people who have heart failure should manage their stamina, get support from their parents and take their medication. "I am currently on 30 pills and two injections everyday, but it depends on my condition. Sometimes I need more than two injections."

Speaking about the pacemaker, he said, "The device was implanted two and a half years ago. In 1992 I had bypass surgery. I hade the bad habit of having too much salt in my food." -- Courtesy of Borneo Bulletin

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