Health x Wellness
Revolutionising Heart Failure Care: The Launch of Heartlanders
Heart failure care is undergoing a transformative shift in Singapore, thanks to the launch of the Heartlanders programme by Lien Foundation and National Heart Centre Singapore (NHCS).
This groundbreaking initiative integrates palliative care into standard cardiovascular care, aiming to improve patients’ quality of life from the hospital to the community. Backed by a SGD 6.5 million funding from Lien Foundation, the Heartlanders programme sets a new benchmark for patient-centred, value-driven care.
Heartlanders represents a significant rethinking of heart failure management. By incorporating generalist palliative care delivered by cardiologists and other healthcare professionals, patients receive comprehensive care much earlier in their disease journey. This approach is aligned with Healthier SG and aims to enhance quality of life while reducing unplanned hospital admissions. Over the next five years, more than 9,000 heart failure patients are expected to benefit from this programme.
Heart Failure Inflicts Years of Suffering
Cardiovascular disease is Singapore’s top killer, accounting for nearly a third of fatalities. An estimated 4 to 5 percent of Singaporeans live with heart failure—a significantly higher percentage compared to the global average of 1 to 2 percent. These patients often face years of productivity loss and additional emotional and financial strains on their families. Early-stage heart failure can have minimal symptoms, leading to late diagnoses and a grim prognosis of just 5 to 10 years. Misunderstanding the nature of the disease, many patients mistakenly view medication as a cure. The unpredictable course of heart failure, combined with infrequent monitoring and poor medication compliance, frequently results in multiple hospitalisations.
A Patient-Centred Approach to Transform Heart Failure Care
Under the Heartlanders programme, all patients are screened for clinical and psychosocial needs during hospitalisation. Dedicated cardio-palliative care coordinators work to understand each patient’s goals of care and coach them on managing cardiac symptoms. Basic palliative care needs are met by cardiologists and heart failure nurses, while those with more complex needs are referred to palliative care specialists or medical social workers. This multidisciplinary team transcends traditional boundaries to provide holistic, individualised care.
By shifting palliative care delivery upstream, patients benefit earlier in their disease journey as part of routine cardiac care. This proactive approach contrasts with conventional practices where palliative care is often an afterthought, reserved for end-of-life scenarios. These benefits of early palliative care apply to all serious cardiac illnesses, with plans to expand to other heart conditions.
After discharge, coordinators continue to monitor patients, providing ongoing coaching and connecting them to community wellness and social programmes. This continuous engagement helps patients maintain stability and avoid unplanned hospitalisations.
Collaborating with Primary Care and Community Partners
NHCS and its partners are building a robust support ecosystem for heart failure patients. Key partnerships include:
- General Practitioners (GPs) and Primary Care Services: Empowering primary care providers to manage post-discharge patients. SingHealth’s Delivering On Target (DOT) Primary Care Network (PCN) of 194 GPs oversees medication needs and liaises with NHCS cardiologists through established protocols. Fast track services are available for patients at risk of deterioration.
- Community Nurses: Crucial for providing continuous care, these nurses monitor symptoms, offer health coaching, consolidate medications, and coordinate care. They are stationed at Community Health Posts, Active Ageing Centres (AACs), Community Centres, and faith-based places for convenient access.
- Rehabilitation and Other Partners: Regular rehabilitation is essential for improving patients’ quality of life. NHCS provides inpatient rehabilitation services and transitions patients to community services like the Singapore Heart Foundation. Coordinators ensure appropriate placement to keep patients socially engaged and motivated.
Education and Research
To equip healthcare professionals with the skills needed to deliver generalist palliative care, NHCS and Lien Centre for Palliative Care (LCPC) at Duke-NUS Medical School developed a cardio-palliative care course. This course prepares professionals to initiate care conversations, understand cardiac and palliative care complexities, and manage end-of-life decisions. Palliative care education will also be incorporated into cardiology residents’ training, ensuring future cardiologists are well-versed in this crucial aspect of patient care.
Using a value-driven evaluation approach, NHCS will collaborate with LCPC to study patient outcomes and potential cost savings from reducing unplanned admissions.
Pictures credit to Lien Foundation and National Heart Centre Singapore.
