Number of heart attacks in Singapore continues to rise

Key Concepts

• Rising heart attack cases in Singapore, particularly among younger individuals
• Coronary artery disease as a primary cause of heart attacks
• Risk factors: hypertension, high cholesterol, smoking, family history, underlying heart conditions (e.g., heart arrhythmia)
• Importance of CPR and AED (Automated External Defibrillator) in improving survival rates during cardiac arrest
• Knowledge gap in AED usage despite CPR training
• Cardiac rehabilitation programs for post-heart attack recovery
• Personal responsibility in maintaining heart health through lifestyle choices

Rising Heart Attack Cases in Singapore

• Heart attack cases are increasing in Singapore, with over 12,000 cases annually compared to 8,000 a decade ago (according to a national registry).
• The National University Health System projects approximately 480 heart attacks per 100,000 people in Singapore this year, potentially rising to over 1400 by 2050.
• Younger people are increasingly presenting with heart conditions.
• Recent cases, such as deaths during marathons (e.g., the Standard Chartered Marathon in 2011 and 2016), have raised concerns. Investigations revealed links to heart conditions, including cardiac arrest and heart failure.

Personal Story: Alvin Mikado

• Alvin Mikado, a 37-year-old, experienced a heart attack while accompanying his daughter to the doctor.
• Symptoms included heavy chest pain, numbness in the left hand, difficulty breathing, and cold sweats.
• He underwent an emergency stent procedure due to blocked arteries.
• Alvin had a family history of heart disease but initially dismissed warning signs (chest pain, numbness) as transient.
• He now emphasizes vigilance and correcting misconceptions about heart attacks only affecting older individuals.

Causes and Risk Factors

• Coronary artery disease is a common cause, where arteries supplying blood to the heart become blocked.
• Chronic conditions like hypertension (high blood pressure) and high cholesterol contribute to the risk.
• For young people (under 40), smoking is a significant factor, impacting around 60% of patients.
• Family history of heart disease affects approximately 20% of young heart attack patients.
• Heart arrhythmia (irregular heartbeat) is often overlooked but can lead to cardiac arrest. The Singapore Senate at Marathon runner in in 2016 died because of this.

Understanding Heart Arrhythmia

• Normal heart rhythm: regular intervals, typically 60-100 beats per minute.
• Heart arrhythmia: irregular heartbeat, potentially with a higher rate (e.g., 150-200 beats per minute or, in extreme cases, up to 400 beats per minute).
• Example 1 (normal heart sound): regular, consistent rhythm.
• Example 2 (arrhythmic heart sound): irregular, faster, and less normal rhythm.
• Impact: affects about 2% of the population (potentially 100,000 people in Singapore).
• Symptoms: breathlessness, inability to maintain activity levels, potential for stroke due to blood clots.

Vulnerable Populations and Diagnosis

• Risk factors for developing heart arrhythmia: underlying heart disorders, lung disease, hypertension, and obesity.
• Diagnosis: ECG (electrocardiogram) is the primary method.
• Challenge: arrhythmia can be transient, making it difficult to detect during a standard ECG.
• Solution: smart devices (smartwatches) can be used to monitor heart rhythm and provide data for doctors.

Prevention and Response

• Pace yourself during physical activity and stay adequately hydrated to avoid stressing the cardiovascular system.
• 70-80% of cardiac arrests occur at home or in public, highlighting the importance of community CPR and AED response.
• For every minute without resuscitation, the chance of survival decreases by 10%.
• Singapore Heart Foundation oversees lifesaving training courses (CPR and AED).
• Knowledge gap: 56% of people in Singapore know CPR, but only 36% are confident in using an AED (as of 2021).
• In 2021, nearly 6 in 10 cardiac arrest victims received CPR in public, but less than 10% had an AED used on them.

Singapore Heart Foundation Initiatives

• Increased CPR and AED training outreach, resulting in an almost 80% increase in participants (April last year to March this year).
• Promoting AED usage: emphasizing that AEDs are user-friendly and provide clear instructions.
• Advocating for more AEDs island-wide, including in private buildings and on public transport (buses and taxis).
• Providing cardiac rehabilitation programs: supervised exercise, dietary planning, and mental health support.

Stakeholder Responsibilities

• Ensure AEDs are accessible and well-maintained in public and private spaces.
• City managers and building managers should ensure people know where AEDs are located.
• Utilize mobile applications (e.g., "MyResponder" by the Singapore Civil Defence Force) to locate nearby AEDs.
• Promote CPR and AED training through free courses offered by organizations like the Singapore Heart Foundation.
• Personal responsibility: maintain a healthy lifestyle, including a balanced diet and regular exercise.

Conclusion

The rising trend of heart attack cases, particularly among younger individuals in Singapore, is a serious concern. Addressing this requires a multi-faceted approach involving prevention through healthy lifestyle choices, early detection through regular check-ups and monitoring, and effective emergency response through widespread CPR and AED training and accessibility. Stakeholders, including individuals, healthcare providers, and community organizations, must work together to improve heart health outcomes and save lives.