With our aging population, the prevalence of heart diseases has been rising in the last 10 years. The SingHealth Cardiovascular GPEP seeks to proactively prevent, manage and control the increasing burden and cost of heart disease. Heart disease can be managed effectively by delivering quality and cost effective care through comprehensive and integrated clinical practice from the general practitioner (GP) to the specialist. The SingHealth Cardiovascular GPEP aims to bring about closer cooperation between GPs and SingHealth institutions.

Approach
The key elements in our GPEP are
 - A shared care model of cardiac care in the long-term,
 - Priority access to specialist heart care,
 - Access to our specialists for discussion of cases and
 - Practical GP focused CME

Given the nature of his/her condition, each patient will receive the most appropriate and timely care. To translate this into practice, SingHealth has adopted a set of guidelines for evaluation (Chart 1 – Coronary Artery Evaluation Algorithm), treatment (Chart 2 - Coronary Artery Medical Algorithm) and referral (Table 1 – Referral Criteria to Primary Health Care) for coronary artery disease (CAD).

Shared care model
Acute episodes are treated at cardiology specialist units while private or polyclinic family physicians provide chronic care. Patients with known CAD but who are stable can be jointly managed under the Shared Care Programme (Table 1). In the long term, we forsee greater levels of collaboration between the GP and SHS doctors in the care of patients, with much of the management and follow-up being appropriately handled at a primary care level for less complex cases with the opportunity for consultation and rapid access as needed.

Table 1

Chart 2 refers to the management algorithm for the CAD patient which can be done at cardiology units and also by family physicians with the appropriate facilities and training.
 

GPEP also organises practical and GP-focused CME programmes on a regular basis. Patients are educated through regular public talks and dissemination of patients education materials on how to recognise symptoms, when to seek medical help, the importance of healthy lifestyle and risk factor control and medication.

Cardiology services at SingHealth institutes

National Heart Centre
The clinical services at NHC include cardiology, cardiothoracic surgery, cardiac anaesthesia and cardiac radiology. The clinical support services include clinical dietetics, medical social services and pharmacy.

The NHC provides state of the art 24 hour acute angioplasty services, coronary bypass surgery, valvular surgery and the latest advances such as the LV assist device. Inpatient facilities are located at Singapore General Hospital. These included a coronary care unit and cardiology wards, a cardiothoracic intensive care unit, cardiothoracic surgery wards, a cardiovascular laboratory, cardiac operating theatres, cardiac radiology, an inpatient cardiac investigation laboratory and a vascular laboratory. Outpatient facilities are located at the Mistri Wing. These included outpatient clinics, clinical laboratory, diagnostic radiological and nuclear cardiology services, cardiovascular rehabilitation and preventive cardiology unit, pharmacy and medical social services. The NHC cardiac investigation laboratory at the Mistri Wing provide tests such as echocardiography, tilt testing, 24 hour ECG monitoring, ambulatory blood pressure and other tests.

Changi General Hospital
The cardiology clinics at CGH provide general cardiology and coronary care, as well as conditions such as hypertension, anticoagulation assessment and treatment. Non-invasive cardiac diagnostic services included ambulatory blood pressure monitoring, ambulatory electrocardiography, exercise stress test, head-up tilt test, stress echocardiography, transesophageal echocardiography and tranthoracic echocardiography. Invasive cardiac
diagnostic services included pacemaker therapy, right and left heart cardiac catherisation and selective coronary angiography treadmill test. A Cardiac Rehabilitation Programme is also available.