Our initial experience shows that S-ICD is a feasible treatment for VT among an Asian population with smaller body-build. There was nonetheless a relatively high rate of wound complications.
BackgroundLimited data in our multi-ethnic South East Asian society on the feasibility of advance care planning (ACP) where different cultures have disparate beliefs with regards to death.AimA pilot study for the feasibility of basic ACP for patients with mild heart failure.MethodsPatients were recruited from a heart failure clinic over a 4 month period if they are in New York Heart Association class I/II with no readmission in preceding 6 months.ResultsOf 58 patients, 83% had formal ACP while 17% declined to participate. Mean age was 57 years with predominance of male (72%). Ethnic distribution followed the national demographic (84% Chinese, 9% Indian, 7% Malay). The participation rate among the different ethnic groups were 86% for Chinese, 100% for Indians and 25% for Malay. For the participants, 90% had more than one ACP session with a mean duration of 60 min per session, and 17% had completed the ACP forms upon enrolment of the last patient. Significant challenges faced were low awareness of ACP among patients and caregivers as well as need for coordination across multiple disciplines.DiscussionThere is a high acceptance of ACP among patients with mild heart failure. But there is a disparity in the attitudes of different ethnic groups towards ACP where Malay are less willing to discuss it compared to Chinese and Indian.ConclusionOur study highlights the feasibility of implementing ACP in South East Asian patients with heart failure, and the need for further research on the observed impact of ethnicity.
BackgroundOur institution has initiated inpatient advance care planning (ACP) programme for heart failure patients in 2013. Enrollment rate has been low.AimExpansion of ACP programme to arrhythmia and myocardial infarction (MI) patients besides heart failure (HF) with support from nurse navigators to increase enrollment.MethodsPatients hospitalised for MI were approached by ACP trained nurse navigators from 1st October 2014 to 30th November 2014, while patients with arrhythmia were approached by ACP coordinators from 1st July 2014 to 30 November 2014. Heart failure patients were approached by ACP coordinators from 1st June 2013 to 30th November 2014.Results112 (5.8%) patients were enrolled from a total screening of 1943 patients. The mean age of patients was 63.9 years and majority was male (73.2%). Ethnic distribution: Chinese 83%, Malay 8%, Indians 7%. 7 out of 61 MI patients were enrolled by the nurse navigators. 8 out of 273 arrhythmia patients and 97 out of 1609 HF patients were enrolled by ACP coordinators. Enrollment rates for MI 11.5%, arrhythmia 2.9%, HF 6.0%.DiscussionThere is a significant increase in enrollment rate of ACP programme after the engagement of nurse navigators’ support. During the patient’s hospital stay, rapport and trust have built up among the patient, caregiver and nurse navigator. This resulted in patient being more open and able to accept ACP when approached by nurse navigator.ConclusionHealthcare providers who have built up a rapport with patients play an important role in advocating ACP programme.
BackgroundNHCS Heart Failure team and Medical Social Workers (MSWs) spearheaded ACP in August 2012. The Programme now incorporates sub-clinical teams, with support from 2 Clinical Coordinators, covering: Education, Research, and Clinical.AimThe team aims to increase awareness of ACP amongst Healthcare Workers (HCWs) in a South-East Asian (SEA) acute hospital, and to facilitate the understanding amongst MSWs of the impact of ACP on patients. ACP programme strives to ensure that patients of different disease stages and cardiac sub-specialities can benefit.MethodsThe ACP programme involves educational lectures delivered by MSWs for HCWs, pre/post-test surveys with patients and collaboration with DUKE-National University of Singapore and Singapore General Hospital MSWs. NHCS specialist physicians are involved in the formulation of workflows and protocols.ResultsThe educational lectures enjoyed good participation (162 registered/enrolled nurses and physicians). 20 HCWs trained in facilitating the delivery of ACP. Collaboration with the aforementioned institutions produced a manuscript, a research paper and two ongoing studies. Subspecialty-specific workflows were developed after consultation with NHCS cardiologists, targeting wide range of cardiac patients.DiscussionPatients and HCWs often find it difficult to discuss the crucial issue of ACP in view of Asian sensitivities. A holistic approach towards ACP in terms of educational lectures, training, and formulation of workflows greatly assisted NHCS in establishing a platform for future studies, research and improvement to the provision of care to our patients.ConclusionOngoing education and advocacy of ACP to patients and healthcare stakeholders is necessary in increasing the recognition of ACP as part of standard patient care.
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