With cardiovascular disease being the main cause of death in Malaysia since 2007, it is more important than ever to have organisations and specialists who can treat patients safely and effectively.

National Heart Institute (better known by its Malay acronym IJN) senior consultant cardiologist Tan Sri Dr Robaayah Zambahari, one of three pioneer consultant clinician staff still working at the hospital, says teamwork remains an important core for the hospital where discussions are held on a regular basis.

The inter-department meetings, she says, include looking at incident reports and conducting root-cause analysis.

Sentinel event forums are also held.

For clinical matters, the doctors are guided by clinical practice guidelines that are evidence-based and current.

IJN clinicians are also involved in the writing committee.

“We also have learning from new publications through ‘journal club’ sessions where papers and publications on investigations and treatment are discussed,” she says.

Learning, she adds, is also done from actual cases presented through the angiogram and intervention club and echocardiogram club.

The former CEO of Institut Jantung Negara Tan Sri Dr Robaayah Zambahari continues to play an active role as a cardiologist. Photo: IJN Foundation

“This is when angiograms and intervention, and echocardiograms are presented and discussed.”

One challenge, she says, is retaining staff, but they hope that this can be addressed by having mechanisms like appropriate salary scales and promotions, bonuses, training and education.

Besides this, effective and safe treatment is further enhanced by carrying out surveys among patients so the hospital can work out any kinks its system may have.

She adds that there is also a need to balance healthcare delivery and cost efficiency because an organisation needs to be financially viable and sustainable.

“As a healthcare organisation, revenue is principally from patient care. There is a need to ensure a steady stream of patients that are a mix of government-funded, private and foreign patients,” she says.

One also needs to have state-of-the-art diagnostic and therapeutic modalities at a reasonable cost, as well as managing the expectations of different stakeholders.

Through the years

The former chief executive officer and managing director of IJN says that among the fondest memories she has of working at IJN were when it started operations in June 1992, its corporatisation in the same year, and when it was officially opened by then prime minister Tun Dr Mahathir Mohamad on June 12, 1993.

“Over the years, the workload – the number of patients, procedures and surgeries – increased steadily,” she says.

“By 2005, it was apparent that there was a need to expand and to cater to the increasing need for beds and to reduce the waiting list for procedures ad surgeries.”

This was when the idea of a new wing was mooted, and it was subsequently opened in August 2009 by Prime Minister Datuk Seri Najib Tun Razak.

As a result, the total bed capacity increased from 270 to 461, including 106 critical care beds.

“The cardiac catheterisation laboratories increased from four to seven while the number of operating theatres went from five to seven. In addition to this, there is a hybrid operating theatre,” she adds.

“The workload continued to increase, but the waiting list for procedures and surgeries is no longer a problem.”

Among the awards that IJN has garnered are the 2011 Prime Minister’s Innovation Award, The Brand Laureate Awards (2008-2009, 2015-2016), Global Leadership Award in 2014 and the Global Health and Travel Award this year.

It also has certifications from the Joint Commission International and Malaysian Society for Quality in Health.

Clinical research is the predominant type of research done at IJN. Dr Robaayah says they have been involved in numerous randomised, multinational, multicentre clinical trials and in multicentre clinical registries.

“The results of some of these trials were published in high impact journals and the results of some of the landmark trials subsequently became part of clinical practice,” she adds.

“It is my pride to be working in IJN with the many committed personnel and experts in their subspecialties, to witness new cardiac or cardiothoracic procedures, some of which were ‘firsts’ in the country or region.”

Taking care of the heart

When it comes to heart diseases, Dr Robaayah opines that prevention is better than cure.

“We have to prevent this disease. Prevention needs to be done at various levels,” she says in conjunction with World Heart Day that is held annually on Sept 29.

“Firstly, primary prevention (for those not yet afflicted), with adoption of healthy lifestyle, including cessation of smoking, healthy eating, healthy activities and healthy weight.

“The next level is the detection and management of risk factors, with healthy lifestyle as the mainstay of treatment, and medications only if the healthy lifestyle is inadequate to reach the targets.”

World Heart Day is part of an international campaign to heighten awareness about heart disease and stroke prevention.

Among the risk factors for cardiovascular disease are high cholesterol levels, high blood pressure, diabetes, smoking, overweight and obesity.

She says detection of diseases and managing it and its consequences is the next level, emphasising that a healthy lifestyle remains the mainstay of treatment, and if necessary, medications and intervention including coronary angioplasty or coronary artery bypass graft surgery.

A healthy lifestyle remains the mainstay of treatment for heart disease, and if necessary, medications and intervention including coronary angioplasty or coronary artery bypass graft surgery.

“After these procedures and surgery, there remains the need for prevention of disease progression, and hence, healthy lifestyle remains an important component of treatment,” she emphasises.

Dr Robaayah points out that the National Cardiovascular Disease (NCVD) Database has stated that the average age of those admitted with heart attack is 59 years. This is seven years younger than that listed in the Global Registry of Acute Coronary Events.

In addition to this, the NCVD Database also approximates that 49% were in the 40-to-60-years age group.

“These people are at the peak of their careers and have families to support. Imagine the impact of disability and death of these young and productive people to the affected families, communities and to the country,” she adds.

To this end, Dr Robaayah says that healthy living in the aspects of diet, weight and activities should be adopted from a young age, to prevent this relentless and progressive disease.

“To a large extent, cardiovascular disease is preventable. Prevention of atherosclerosis is by decreasing risk factors through healthy eating, healthy weight, exercise, avoidance of tobacco smoke, managing diabetes, hypercholesterolaemia and high blood pressure,” advises Dr Robaayah.

This article is brought to you by IJN.