In Singapore, cardiovascular diseases are accounting for
20%
of deaths with as many as
4.5%
of Singaporeans living with heart failure
Among all cardiovascular-related admissions, up to
17%
are attributed by heart failure
Issue 51
Aug 2024
AFFAIRS OF THE HEART
By CLAIRE TEO, PHD CANDIDATE, ALICE LEE CENTRE FOR NURSING STUDIES (NUS NURSING), NUS YONG LOO LIN SCHOOL OF MEDICINE, AND WANG WENRU, PROFESSOR, NUS NURSING AND CARDIOVASCULAR METABOLIC DISEASE TRANSLATIONAL RESEARCH PROGRAMME, NUS MEDICINE.
In the contemporary landscape of healthcare, the synergy between human expertise and digital innovation has emerged as a powerful force in the prevention and management of chronic illnesses.
Amidst this convergence, heart failure self-management and cardiac tele-rehabilitation are examples of how technology can augment the human touch to enhance patient outcomes. However, amidst the digital revolution, it is essential to underscore the irreplaceable role of human interaction in fostering empathy, trust, and holistic care delivery.
The rising tide of chronic illness: A call to action
The prevalence of chronic illnesses, especially heart failure, continues to rise unabated, fuelled by factors such as ageing populations, sedentary lifestyles, and escalating healthcare costs.
The global prevalence of cardiovascular diseases has nearly doubled from 285 million in 1990 to 523 million in 20191. The prevalence of heart failure alone has reached an estimated 64 million in 2017, rising 32.6% from 2007 and with expectations of further surges with the development of life-saving treatment and longer life-expectancies2. Heart failure, a complex syndrome characterised by the heart’s inability to pump blood effectively, exacts a heavy toll on individuals and societies, leading to reduced quality of life, increased hospitalisations, and heightened mortality rates.
In Singapore, cardiovascular diseases remain the leading cause of morbidity and mortality, accounting for 20% of deaths with as many as 4.5% of Singaporeans living with heart failure3. Among all cardiovascular-related admissions, up to 17% are attributed by heart failure with readmission rates within 30 days after hospitalisation as high as 20-25%4. Despite advancements in medical treatments, managing heart failure remains a daunting challenge, underscoring the imperative for innovative approaches that extend beyond conventional clinical interventions. Harnessing the expertise of clinicians, nurses, and software engineers, Professor Wang Wenru led a team in conducting two clinical trials at the National University Hospital (NUH). These trials were designed to assess nurse-led digital health interventions tailored for patients grappling with heart failure and post-acute myocardial infarction. The first trial, a nurse-led home-based heart failure self-management programme (HOM-HEMP) completed in August 2019 proved effective, results can be read in the following publication5. The second trial, a home-based cardiac rehabilitation programme, is ongoing and reporting positive results as well. These trials not only demonstrated the efficacy of digital health innovations in facilitating patients’ self-care but also underscored the indispensable role that the human touch plays in delivering comprehensive patient care.
Human-digital lifestyle partnerships: Empowering patients to take charge
Central to effective chronic illness management is patient empowerment, wherein individuals are equipped with the knowledge, skills, and resources to actively participate in their care journey. Heart failure self-management epitomises this ethos, empowering patients to monitor their symptoms, adhere to prescribed medications, adopt healthy lifestyle behaviours, and recognise warning signs of deterioration. Digital technologies play a pivotal role in facilitating self-management initiatives, offering an array of tools such as mobile applications, wearable devices, and remote monitoring platforms. Through these digital solutions, patients gain real-time access to vital health data, enabling them to track their progress, communicate with healthcare providers, and make informed decisions about their care. However, amidst the technological advancements, it is essential to acknowledge the essential role that the human touch plays in cultivating trust, empathy, and personalised support. Healthcare professionals serve as guides and mentors, offering clinical expertise, emotional support, and compassionate care that transcends algorithms and data points.
Cardiac tele-rehabilitation: Bridging gaps with human touch
In parallel with self-management initiatives, cardiac tele-rehabilitation has become a cornerstone of human-digital lifestyle partnerships in chronic illness management. Traditionally, cardiac rehabilitation programmes are confined to physical settings, imposing logistical barriers and accessibility challenges for many patients. However, leveraging telehealth technologies, cardiac rehabilitation can be seamlessly integrated into patients’ daily lives, transcending geographical constraints, and enhancing engagement and adherence. Cardiac tele-rehabilitation encompasses a holistic approach, incorporating exercise training, lifestyle modification, risk factor management, and psychosocial support, all delivered remotely through digital platforms. While these technologies offer unprecedented convenience and accessibility, they must be complemented by contact with healthcare professionals. Their interaction with patients addresses the latter’s emotional needs, fosters a sense of connection, promotes accountability and ensures safety. Healthcare professionals play a pivotal role in providing personalised guidance, encouragement, and reassurance, thereby ensuring patients feel supported and motivated throughout their rehabilitation journey.
Amidst the technological advancements, it is imperative to recognise the enduring value of human touch in fostering trust, empathy, and holistic healing. By embracing a synergistic approach that combines the strengths of technology with the vitality of human interaction, healthcare systems can deliver truly patient-centred care that addresses the physical, emotional, and psychological needs of individuals living with chronic illnesses.”
The vitality of human touch in the digital age
In the era of digital transformation, it is easy to become enamoured with the capabilities of technology while overlooking the timeless importance of human interaction. While digital tools offer unparalleled convenience and efficiency, they must be integrated thoughtfully with human contact to deliver truly patient-centred care. The human touch encompasses not only physical contact but also emotional support, empathy, and genuine connection, all of which are indispensable in fostering healing and well-being. Healthcare professionals must strike a delicate balance between leveraging digital technologies to enhance efficiency and accessibility while preserving the essential elements of person-to-person interaction. This involves actively listening to patients, understanding their unique needs and preferences, and tailoring corresponding care plans. Moreover, it requires cultivating a culture of compassion, collaboration, and continuous learning within healthcare teams to ensure patients receive holistic and empathetic care.
In the pursuit of effective chronic illness prevention and management, human-digital partnerships represent a potent force for change. Through initiatives such as heart failure self-management and cardiac tele-rehabilitation, patients are empowered to take an active role in their care journey, leveraging digital tools to monitor their health and engage with healthcare providers.
However, amidst the technological advancements, it is imperative to recognise the enduring value of human touch in fostering trust, empathy, and holistic healing. By embracing a synergistic approach that combines the strengths of technology with the vitality of human interaction, healthcare systems can deliver truly patient-centred care that addresses the physical, emotional, and psychological needs of individuals living with chronic illnesses. In doing so, we can usher in a new era of healthcare characterised by compassion, empowerment, and genuine connection, thereby improving outcomes and enhancing the quality of life for millions worldwide.
Roth, G, Mensah, G, Johnson, C. et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020 Dec, 76 (25) 2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010.
Gianluigi Savarese, Peter Moritz Becher, Lars H Lund, Petar Seferovic, Giuseppe M C Rosano, Andrew J S Coats, Global burden of heart failure: a comprehensive and updated review of epidemiology, Cardiovascular Research, Volume 118, Issue 17, December 2022, Pages 3272–3287, https://doi.org/10.1093/cvr/cvac013
Huang, W., Lee, S. G. S., & How, C. H. (2020). Management of the heart failure patient in the primary care setting. Singapore medical journal, 61(5), 225–229. https://doi.org/10.11622/smedj.2020073.
https://www.nhcs.com.sg/news/patient-care/nhcs-comprehensive-suite-of-heart-failure-services-brings-new-life-to-child-of-generational-heart-disease#:~:text=Heart%20failure%20(HF)%20is%20a,30%20days%20after%20hospitalisation3.
Jiang, Y., Koh, K. W. L., Ramachandran, H. J., Nguyen, H. D., Lim, S., Tay, Y. K., Shorey, S., & Wang, W. (2021). The effectiveness of a nurse-led home-based heart failure self-management programme (the HOM-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial. International journal of nursing studies, 122, 104026. https://doi.org/10.1016/j.ijnurstu.2021.104026.
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