Developing Cardiac Developing Cardiac Rehabilitation in VietnamRehabilitation in Vietnam

Dr Juliette HusseyDr Juliette HusseySchool of MedicineSchool of Medicine

Trinity College DublinTrinity College DublinIrelandIreland

ContentContent

Data outlining need for Cardiac Rehabilitation in Data outlining need for Cardiac Rehabilitation in VietnamVietnam

Collaboration to dateCollaboration to date

How a university can change the world- in How a university can change the world- in relation to cardiac rehabilitationrelation to cardiac rehabilitation

VIETNAMVIETNAM

Population of Vietnam: 86,206,000Population of Vietnam: 86,206,000

Population of : Ho Chi Minh City (Saigon): Population of : Ho Chi Minh City (Saigon): 7,123,340; Hanoi 6, 452,0007,123,340; Hanoi 6, 452,000

Country: 331,690 sq kmCountry: 331,690 sq km

Cardiovascular disease in LMICs and Cardiovascular disease in LMICs and VietnamVietnam

Cardiovascular diseases and their risk factors emerging as the Cardiovascular diseases and their risk factors emerging as the leading cause of morbidity and mortality in developing countries leading cause of morbidity and mortality in developing countries including Vietnamincluding Vietnam

Double burden of disease- common communicable diseases Double burden of disease- common communicable diseases and emerging non-communicable disease during early stages of and emerging non-communicable disease during early stages of health transitionhealth transition

Need for cardiac rehabilitation in LMICsNeed for cardiac rehabilitation in LMICs

Globally CVD accounts for 29.2% of deaths and 80% of these in Globally CVD accounts for 29.2% of deaths and 80% of these in LMICsLMICs

Rapid increase in cardiovascular and non-communicable Rapid increase in cardiovascular and non-communicable diseasesdiseases

Primary and secondary prevention requiredPrimary and secondary prevention required

Need for cardiac rehabilitation in Need for cardiac rehabilitation in VietnamVietnam

Ischaemic heart disease and cerebrovascular disease- 13% and Ischaemic heart disease and cerebrovascular disease- 13% and 11% of all cause mortality in Vietnam11% of all cause mortality in Vietnam

Extent of risk factors unknown- but indications they are risingExtent of risk factors unknown- but indications they are rising

Success in management of chronic diseases depends on long Success in management of chronic diseases depends on long term adherence to treatment, risk factor modification and term adherence to treatment, risk factor modification and lifestyle changes. Key to reducing deaths is to modify risk lifestyle changes. Key to reducing deaths is to modify risk through prevention strategies targeting cardiovascular risk through prevention strategies targeting cardiovascular risk factorsfactors

Tabacco related diseasesTabacco related diseases

40 000 people in Vietnam die each year due to smoking (WHO)40 000 people in Vietnam die each year due to smoking (WHO)

One of the highest male smoking rates worldwideOne of the highest male smoking rates worldwide

Over half of adult men smokeOver half of adult men smoke

Chronic disease in VietnamChronic disease in Vietnam

Country experiencing rapid transition and increased burden of Country experiencing rapid transition and increased burden of chronic diseasechronic disease

Poorer people more vulnerable to chronic diseases and their risk Poorer people more vulnerable to chronic diseases and their risk factors ( other than overweight)factors ( other than overweight)

We know the causes of cardiovascular disease but need to We know the causes of cardiovascular disease but need to understand the cause of the causesunderstand the cause of the causes

Chronic diseases shown to cause economic loss for familiesChronic diseases shown to cause economic loss for families

Health care systemHealth care system

Hospitals- overcrowded Hospitals- overcrowded

Very basic nursing- families provide majority of careVery basic nursing- families provide majority of care

In case of cardiology rapid advances in interventions and In case of cardiology rapid advances in interventions and surgerysurgery

Need to develop primary care, health promotion and Need to develop primary care, health promotion and rehabilitation servicesrehabilitation services

Definitions of Cardiac Rehabilitation Definitions of Cardiac Rehabilitation 20002000

Scottish Intercollegiate Guidelines Network (SIGN) Guideline Scottish Intercollegiate Guidelines Network (SIGN) Guideline 57 states57 states

““Cardiac rehabilitation is the process by which patients with Cardiac rehabilitation is the process by which patients with cardiac disease, in partnership with a multidisciplinary team cardiac disease, in partnership with a multidisciplinary team of health professionals, are encouraged and supported to of health professionals, are encouraged and supported to achieve and maintain optimal physical and psychosocial achieve and maintain optimal physical and psychosocial health”health”

(SIGN) SIGN. Guideline 57 Cardiac Rehabilitation. Available at: (SIGN) SIGN. Guideline 57 Cardiac Rehabilitation. Available at: www.sign.ac.uk/guidelines/fulltext/57/section1.html ..

Principles of Cardiac RehabilitationPrinciples of Cardiac Rehabilitation

Behaviour changeBehaviour change

SmokingSmokingExerciseExerciseWeight managementWeight managementNutritionNutritionLipidsLipidsBlood pressureBlood pressurePsychosocial factorsPsychosocial factors

Developing cardiac rehabilitation in Developing cardiac rehabilitation in Vietnam- aimsVietnam- aims

To provide initial education, training and practical assistance To provide initial education, training and practical assistance for the development of Cardiac Rehabilitation services which for the development of Cardiac Rehabilitation services which will act as reference centres for the development of services in will act as reference centres for the development of services in surrounding provinces surrounding provinces

To facilitate a sustainable education and training programme To facilitate a sustainable education and training programme for the expansion and delivery of cardiac rehabilitation for the expansion and delivery of cardiac rehabilitation services services

Strengths from TCDStrengths from TCD

Considerable experience academically and clinically in the area Considerable experience academically and clinically in the area of exercise in prevention and treatment of diseaseof exercise in prevention and treatment of disease

MSc in Cardiac Rehabilitation and Prevention since 2002- MSc in Cardiac Rehabilitation and Prevention since 2002- approx 45 students supervised to dateapprox 45 students supervised to date

Now translating much of this experience into the rehabilitation of Now translating much of this experience into the rehabilitation of patients with other chronic diseases- pulmonary disease and patients with other chronic diseases- pulmonary disease and cancercancer

Collaboration to dateCollaboration to date

ASEAN Cardiology conference in 2008 held in Hanoi and one ASEAN Cardiology conference in 2008 held in Hanoi and one session on cardiac rehabilitationsession on cardiac rehabilitation

Two day introductory course in Ho Chi Minh in 2010Two day introductory course in Ho Chi Minh in 2010

Undergraduate physiotherapy students on elective placementUndergraduate physiotherapy students on elective placement

Have identified and agreed a number of steps necessary but Have identified and agreed a number of steps necessary but need fundingneed funding

Two day introductory course to cardiologists, cardiac Two day introductory course to cardiologists, cardiac nurses, rehabilitation physicians and physiotherapistsnurses, rehabilitation physicians and physiotherapists

Participants from Ho Chi MinhParticipants from Ho Chi Minh

How can a University change the World?- How can a University change the World?- case of developing cardiac rehabilitationcase of developing cardiac rehabilitation

Collective experience which can be very broadCollective experience which can be very broad

KnowledgeKnowledge

Analytical skillsAnalytical skills

In the case of Health Sciences- built on clinical and professional In the case of Health Sciences- built on clinical and professional experience and large network of colleagues nationally and experience and large network of colleagues nationally and internationallyinternationally

Experience in interdisciplinary workingExperience in interdisciplinary working

AcknowledgementsAcknowledgements

HRB/Irish Aid – Networking grantHRB/Irish Aid – Networking grant

Bachmai Hospital and Vietnam Heart Institute in HanoiBachmai Hospital and Vietnam Heart Institute in Hanoi

Cho ray and An Binh Hospitals in Ho Chi Minh CityCho ray and An Binh Hospitals in Ho Chi Minh City