Professor Terrance Chua, Board Member of the Singapore Heart Foundation
Clinical Assistant Professor Huang Zijuan, Chairperson, Organising Committee, Singapore Prevention and Cardiac Rehabilitation Symposium
Dr Jeanne Ong, Co-Chairman of Organising Committee
Distinguished guests, ladies, and gentlemen
Good morning and a warm welcome to everyone here today. I am delighted to join you at Singapore Heart Foundation’s (SHF) fifth edition of the Singapore Prevention and Cardiac Rehabilitation Symposium. The theme for this year’s event is “A New Era of Preventive Cardiology and Personalisation in Cardiac Rehabilitation”, and this is indeed important to talk about and to understand how we can better take care of our cardiovascular health.
Preventive care efforts against cardiovascular disease
2. Cardiovascular disease (CVD) accounted for 31.4% of all deaths in Singapore in 2022. Between 2011 and 2021, over 10 years, the age-standardised incidence rate of Acute Myocardial Infarctions (AMIs) increased slightly from 204.7 to 217.2 per 100,000 population.
3. It is therefore worrying that cardiovascular risk factors such as obesity, high blood pressure, high cholesterol levels, and diabetes are pervasive in our community. Obesity prevalence has increased from 8.6% in 2013, to 11.6% in 2022. Similarly, hypertension or high blood pressure has increased from 19.8% in 2010, to 37.0% in 2022. It is crucial that we prioritise preventive care and modify our lifestyles as our first line of defence against cardiovascular disease.
4. We have been encouraging Singaporeans to adopt more active lifestyles through programmes by the Health Promotion Board (HPB). For example, HPB introduced the National Steps Challenge in 2015 to nudge residents to incorporate physical activity into their daily routines. The programme has drawn more than 1.8 million participants since its launch. This complements HPB’s Move It! physical activity programmes that are accessible across the island for Singaporeans of all ages to be more active. With the roll-out of the Singapore Physical Activity Guidelines that were released by both HPB and Sport Singapore (SportSG) last year, residents can also equip themselves with knowledge on the levels and types of physical activity that they are recommended to achieve for better health outcomes.
5. We are also enabling residents to adopt healthier diets, through the Healthier Choice Symbol and Healthier Dining Programme which makes identifying healthier choices, easier. The Ministry of Health (MOH) and HPB further introduced the Nutri-Grade labelling and advertisement prohibition measures for pre-packaged beverages last year. This was to help consumers identify beverage options which are lower in sugar and saturated fat. This has spurred industry reformulation of pre-packaged beverages. The median sugar level of these pre-packaged beverages has indeed reduced from 7.1% in 2017 to 4.6% in 2021.These measures will be extended to freshly prepared beverages by the end of this year to further reduce and encourage lower sugar intake in the population.
6. Sodium consumption is also a pressing concern as high sodium intake is a significant risk factor for high blood pressure. Daily sodium intake has increased from 3,500mg (3.5g) in 2019 to 3,600mg (3.6g) in 2022, with nine in 10 Singapore residents exceeding the daily recommended sodium intake of less than 2,000mg, which is equivalent to one teaspoon of salt.
7. To this end, we embarked on a sodium reduction strategy last year with the aim to reduce the population’s sodium intake by 15 per cent over the next five years. HPB has worked with major manufacturers and suppliers to increase the variety of lower-sodium salt, sauces and condiments in both the retail and food services sectors. Public education campaigns were also launched to raise awareness of the effects of high sodium intake and to educate the public on ways to reduce their sodium intake without compromising on taste. More recently, we also announced that HPB has garnered the commitment of market leaders in the food service sector to reduce sodium in dishes by switching to use lower-sodium ingredients or revising recipes.
8. Another major risk factor for CVD is smoking. HPB continues its efforts on preventive education, to emphasise on the importance and benefits of leading a nicotine-free lifestyle. There are also smoking cessation services available, such as HPB’s I Quit programme, to provide support to smokers in their cessation journey.
Healthier SG to strengthen preventive health
9. At the national level, we need to tackle the rising chronic disease burden. MOH has embarked on Healthier SG, a multi-year strategy to transform our healthcare system. We recognise the uniqueness of everyone’s health needs, preferences, and circumstances. Healthier SG will therefore provide enrolled individuals with the opportunity to develop a tailored health plan with their enrolled doctor that includes lifestyle adjustments, fully subsidised screenings, and regular follow-ups, to maintain good health and prevent chronic conditions or complications.
Cardiac rehabilitation
10. Cardiac rehabilitation, which is a personalised programme of lifestyle change, diet, and exercise, is important to manage cardiovascular disease and reduce the risk of hospitalisation, morbidity, and mortality.
11. One such cardiac rehabilitation effort is the AMI-HOPE pilot (Acute Myocardial Infarction – allied Health-Oriented, Patient-centered, and digitally-Enabled care) programme. This is jointly piloted by the MOH Office for Healthcare Transformation (MOHT), Synapxe (which is MOH’s healthcare IT arm), HPB and the three public healthcare clusters. The pilot, which started in October 2022, aims to improve post-discharge care for patients with AMI. In addition to the routine care provided by cardiologists, patients will be supported by pharmacists through tele-monitoring and tele-consultations. The AMI-HOPE pilot uses the national vital signs platform, Health Discovery+ (HD+) which enables hospital and polyclinic pharmacists to remotely monitor blood pressure levels and heart rate readings uploaded by their patients. These guide the titration of medications and identify patients who require further clinical assistance. In addition, patients are guided to make necessary lifestyle changes, such as greater physical activity, healthier diet, and smoking cessation, through automated personalised nudges in HD+.
12. SHF has also played an important role in making cardiac rehabilitation more accessible. SHF provides community-based cardiac rehabilitation services at $5 per session, which includes tailored exercise regimes and dietary guidance. I am glad that they have served close to 3,000 cardiac patients and at-risk individuals at their three centres since June 2004.
Closing
13. We must all continually advance our knowledge, practice and research in preventive cardiology and cardiac rehabilitation. Concerted effort is required from all stakeholders to drive significant advancements in CVD prevention and management, to enhance the quality of life for Singaporeans and inspire progress in the global fight against CVD. This year’s Symposium is a good platform for all of us to delve into the latest research and peer sharing of best practices.
14. I would like to finally end off to thank SHF for bringing together the best of minds in preventive cardiology at this symposium and I wish you all a fruitful and enriching time here. Thank you very much.