In Singapore, palliative care is often given only at the very end of a person’s journey, with the average duration of care for non-cancer patients clocking in at just around nine days. But the Heartlanders initiative, jointly launched by the National Heart Centre Singapore (NHCS) and the non-profit Lien Foundation, is looking to change that.
With the new programme, heart failure patients will now automatically receive palliative care when their symptoms are first discovered, with the goal of providing stronger medical, financial and emotional support to patients further upstream from end of life.
An estimated 9,000 heart failure patients will benefit from the programme over the next five years. There are already 38 people enrolled in the programme since its soft launch last April.
Heart failure, also known as congestive heart failure, is a syndrome caused by an impairment to the heart’s ability to pump blood around the body and meet our blood and oxygen needs.
As heart failure is often discovered when the condition has advanced to a severe stage with more obvious symptoms, the prognosis usually hovers between five to 10 years – though they could potentially live far longer with consistent medical care, said associate professor David Sim, director of NHCS’ heart failure programme.
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The care provided as part of Heartlanders, therefore, extends beyond what people typically associate with palliative care – that is, providing relief from the symptoms of life-limiting illnesses.
Community-based approach to heart failure care
Instead, heart failure patients will now work with a cardio-palliative care coordinator to construct treatment plans that align with their goals of care.
They will also communicate with NHCS specialists, community nurses and participating general practitioners to ensure that patients receive sufficient and consistent attention from medical professionals.
Under Heartlanders, home visits to check on patients’ well-being and medication compliance will be conducted by community nurses, while general practitioners will also be empowered to seek advice from NHCS cardiologist and tweak medication dosages where necessary.
The golden number to aim for is four visits within two months after a heart failure patient is discharged, says Dr Kenneth Chew, consultant cardiologist at NHCS, as it will significantly reduce the incidence of adverse events that required rehospitalisation.
Apart from medical aid, care coordinators will also connect heart failure patients to wellness and social programmes within the community in order to further support their physical and social needs.
Heartlanders to kickstart care ecosystem
The Heartlanders programme is funded by the Lien Foundation to the tune of $6.5 million, with the bulk of that money going toward staff training and manpower. For example, NHCS and the Lien Centre for Palliative Care are now running a cardio-palliative care course for their staff and other medical professionals.
The hope is that the programme will, over the course of five years, prove effective both in terms of care and cost-savings by significantly reducing hospital readmissions for heart failure patients.
It is an especially pressing issue in Singapore, where around 4 to 5% of people live with heart failure, compared to just around 1 to 2% globally.
But more than that, the launch also serves as a way of kickstarting a wider ecosystem for integrated palliative care. The Lien Foundation, for example, has already laid out plans for working early palliative care into other specialist services, including chronic breathlessness.
