Speech by Mr Gan Kim Yong, Minister for Health, at the 21st Asian Pacific Society of Cardiology Congress, 13 July

Dr Prasart Laothavorn, President, Asian Pacific Society of Cardiology
Dr Jack Tan, Organizing Chair, 21st Asian Pacific Society of Cardiology Congress
Distinguished Guests
Ladies and Gentlemen

Good morning.

        It is my pleasure to join all of you here at the opening of the 21st Asian Pacific Society of Cardiology Congress.

Cardiovascular Diseases Globally and Locally

2.     Cardiovascular disease is one of the world’s major killers. An estimated 17.7 million people died from cardiovascular diseases in 2015 , representing about one-third of all global deaths.

3.     Singapore has made good progress in the treatment of cardiovascular diseases. Between the years 2000 and 2015, the premature mortality rates for ischaemic heart disease and stroke were halved . However, significant challenges remain. In 2015, about 1 in 3 deaths were attributed to cardiovascular diseases. The Global Burden Disease 2015 Study reported that cardiovascular diseases contributed one-sixth of the total burden of disease in Singapore. We need to continue our efforts to address cardiovascular diseases, through preventive health as well as appropriate treatments and technologies.

Efforts on Cardiovascular Disease Prevention

4.     Cardiovascular conditions are strongly associated with diabetes. One in two heart attack patients and two in five stroke patients also suffer from diabetes . Therefore, we should also move upstream to tackle diabetes. The Ministry of Health, Singapore (MOH) took this very seriously, and last year, Singapore declared War on Diabetes. In this War, we adopted a whole-of-system approach to tackle diabetes: strengthening prevention, enabling early screening and intervention, as well as ensuring better control of diabetes and its complications.

5.     Everyone has a part to play in the fight against cardiovascular conditions and diabetes. As medical professionals, you can talk to your patients at all ages and encourage them to adopt healthy lifestyles and habits. Eating healthily, exercising regularly, not smoking and moderating alcohol consumption are all well known to lower the risk for chronic conditions such as hypertension, hyperlipidaemia and diabetes, that are themselves risk factors for heart attacks and stroke. Individuals should be encouraged to adopt these preventive health measures and take personal responsibility for their own health. They should also be encouraged to attend regular and appropriate health screening to enable early detection and timely intervention of chronic conditions and prevent cardiovascular complications.

Importance of Research and Innovation for Improved Patient Care

6.     This year’s theme of the Congress, “Advances in Cardiology – The Next Lap”, marks a significant milestone. It was in 1972 when the last Congress was held in Singapore, and back then, some 45 years ago, I understand that common cardiology treatment options available today, such as “ACE inhibitors” and “Percutaneous Coronary Angioplasty” were almost unheard of. As we look back, we have indeed come a long way and made significant progress in treatment of heart disease.

7.     As we consider the disease burdens facing us, we must continue to push the boundaries of cardiovascular research and evidence-based treatments. Let me share a few examples. In 2013, NHCS cite a project entitled “Integrated Multi-phenotype and Systems-level Analysis of Human Heart Failure” to identify genes, pathways and disease mechanisms related to heart failure. It aims to develop new diagnostics, therapeutic targets and treatments for heart failure patients. NHCS has since built up a large biobank with more than 2,000 patients recruited to date. Recently, they discovered a new gene related to tissue scarring and this discovery was associated with the award of four patents over the last two years. I am glad that the research team is securing investments to further develop and commercialise the research findings. Beyond patents, we also look forward to benefits of the research to our health system.

8.     At the National University Health System (NUHS), Prof Mark Chan is leading a project entitled “Predicting Outcomes in Acute Coronary Syndrome: A Translational Approach Integrating Population-Specific Clinical Risk Models, Platelet Reactivity and Metabolomic Biomarkers” to better understand the risk and markers for acute coronary syndrome. His team had recalibrated the Global Registry of Acute Coronary Events (or GRACE) risk score to better stratify patients by risk categories, customised to the Asian population. This was one of the first recalibration of the GRACE score for Asians. The study has also resulted in numerous scientific publications on the outcomes of patients with heart attack in Singapore.

9.     The Ministry of Health also funded the Left Ventricular Assist Device (LVAD) implantation implementation pilot, which started initially as a bridging therapy for heart transplant candidates but more recently, LVAD has been used as destination therapy for heart failure patients. As of March this year, the National Heart Centre Singapore (NHCS) has performed 20 LVAD implants as destination therapy, and this number looks set to grow. However, with such advanced procedures, we should be prudent and only administer such a treatment to appropriate patients where it is deemed clinically necessary and cost effective.

Importance of Cost-Effectiveness in Ensuring a Sustainable Healthcare System

10.     Even as we seek progress in medical technology, we should be mindful that this could results in higher costs. New drugs, therapies and screening tests may not always be more cost-effective than existing ones and improvement in health outcomes of new modalities of treatment may only be modest relative to the higher costs. We should therefore choose treatment options that are both clinically effective and cost effective to ensure good quality healthcare remains affordable for all.

11.     To this end, the work of the Agency for Care Effectiveness (ACE) at the Ministry of Health (MOH) in the area of health technology assessment is crucial in enabling us to choose innovations which not only produce better health and patient outcomes but also provide value to patients. As an example, ACE’s evaluation found that despite higher costs, the novel oral anticoagulants were clinically effective, safer and cost-effective for patients with atrial fibrillation and who were not able to take warfarin for stroke prevention. This evaluation enables MOH to effectively provide funding to support this new medication, thereby, providing better care for our patients.

Conclusion

12.     While we continue to press on with cardiovascular research and care, let me reiterate that as healthcare professionals, we have a pivotal role to play in enabling a holistic and patient-centred care for our patients: nudge them on active and healthy living, educate them on risk factors screening and management, as well as encourage and monitor them on disease management and treatment compliance.

13.     Working together, we can improve the system of care surrounding our patients not just in Singapore, but globally. I wish you all a fruitful time at the Congress.

Thank you.