Inspiring Better Health

Saving Hearts One Beat at A Time

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Saving Hearts One Beat at A Time
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The human heartbeat tells you that life is just minutes and seconds. The heart begins beating seven months before you are even born, and with every beat the blood that gives you life is pushed through your body, carrying oxygen and nutrients to every cell. The heart is the only organ that never calms, never rests, and never ceases. And when it does cease, life ceases with it. We talked to Dr. Mohammed Al Hashemi to find out more about this complex organ and the inner workings of the department of Cardiac Rehabilitation at Hamad Medical Corporation.

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How was the Cardiac Rehabilitation Program founded?

The Cardiac Rehabilitation program was founded in 2011. Dr. Hajar was the head of the Cardiac Department in Hamad Hospital. When he offered me the position to run the program, I hesitated because the program was very specific in its field. It was also the first program dedicated only to heart patients in the Gulf region. Until today, the Cardiac Rehabilitation Program is considered the only encompassing program in the whole GCC, even with other centers and programs that are far newer.

Around the world, you can probably only find one or two centers or programs dedicated to the heart, even in university towns, so back then it was a challenge. With the help of some staff from the Rehabilitation Department at Rumaila Hospital, we started forming the program and rented an area in the Heart Hospital in 2012. It was a small space but it was good enough to start, better than not having a rehabilitation program at all. The program’s activities started before its grand opening and we progressed and worked on expanding both our knowledge and research, and our space.

Who receives treatment at the Cardiac Rehabilitation Program?

The patients that benefit the most from the Cardiac Rehabilitation Program are those who are going through or have gone through open heart surgery, patients who have suffered from a heart attack, whether mild or serious, and patients with a congestive heart muscle.

What treatment do these patients receive?

The treatment is divided in two phases: the first is to educate the patient to fully understand his health condition, whether before the operation or before a heart attack, or even when the patient is newly diagnosed with heart failure. Unfortunately, many of the patients admitted to the hospital do not have any idea what disease they are suffering from. So they get educated about the disease in detail, and are guided to the best ways to treat themselves and get treatment, whether it is with medication or changing their lifestyle. Usually patients get through this stage with the help of a nurse, and are given manuals and booklets explaining the disease in full. The booklets come in many languages including Arabic, English, Urdu, and Dutch.

Are the parents or family members educated as well, or just the patient?

The priority goes to the patient. If he is in his right mental state, it is better and more important that he knows all the advice and recommendations. However, if he is elderly, and has other health issues, like strokes, or does not have good comprehension, then the family or those who accompany him get the same education at the same time.

What is the second phase of the program?

Before the second phase, the patients are classified according to their condition, and whether they need to go through the second phase of the program. Patients who benefit from the second phase are those who are able to move, as in have some ability to move their body even if it was just sitting and moving their arms. These patients are invited to a session in the rehabilitation clinic usually on Mondays and Wednesdays. This is basically a check-up like the ones given in outpatient clinics. The patient’s vitals are checked and a blood sugar test is conducted and then the patient gets an ECG. We then make sure that the patient is safely performing the physical activities in the rehabilitation center. After monitoring the progress of the patient, he either gets directed to normal ECG treatment, or ECG with oxygen and carbon dioxide testing, where a special prescription is written up specifying how much of the rehabilitation treatment the patient can handle.

The patient also gets to see a nutritionist, to make sure that the medication prescribed to him works well with their condition, and to make sure the patient understands the dosage. The medication is adjusted if a patient misses their pick up or their condition does not allow them to get that specific treatment.

Do all patients in the program receive medications as treatment?

We are talking about patients who suffered from heart attacks or have a severe heart muscle defect, or have had open-heart surgery. Those patients often depend on medication for their heart condition and need that support.

What else does the second phase of the program include?

The patients are educated and monitored weekly to check if they are able to perform their day-to-day activities at home safely. However, for those who go back to work, therapy and check-in sessions are about 3 times a week, for a period between 6 and 12 weeks, depending on the patient’s progress. The sessions usually last about an hour or an hour and a half.

What physical therapy is given to the patients during the program?

Physical therapy is part of the rehabilitation process and includes:

  • Activating blood circulation
  • Walking slowly or jogging on a treadmill, as well as motion of hands, arms and shoulders
  • Light weightlifting and muscle strengthening
  • Breathing exercises to improve the process of inhaling and exhaling

In general, the idea behind these therapy sessions is to strengthen the heart muscle, and increase its efficiency in pumping blood to the rest of the body, while releasing toxins and bad cholesterol. Sport is not just for your physical health but also for your mental wellbeing and not getting enough is closely linked to severe setbacks in the patient’s condition in the future.

The physical therapy program also includes educating the patient about factors that contribute to an increased risk of heart attacks. Some of these factors are beyond the control of science and medicine, like:

  • Blood pressure
  • Diabetes
  • Smoking
  • High cholesterol
  • Obesity
  • Lack of movement or sports
  • Genetic factors passed on in the family

What advice would you give patients to avoid the risk of heart attacks?

People should get regular check-ups at least every six months to make sure that there is no high blood pressure. Patients should be educated on how to manage blood pressure. Before the test, patients should be sitting in a calm place at least half an hour. They should not check after they have done some physical effort like climbing stairs or walking fast, and even after drinking coffee or tea or having a heavy meal or smoking.

As for checking blood sugar levels, it is better to check it in specialized clinics especially when it is genetic. Diabetic patients should check their blood sugar condition with a professional at least every 6 months in primary health care clinics. As for other diseases and conditions like cholesterol, these can also be checked at primary health care clinics. Patients should fast for 12 hours before taking the cholesterol test.

We encourage patients to lose weight if they are considered over-weight and avoid fattening foods. We encourage patients who suffer from heart conditions to exercise regularly, at least 3 times a week, even if it is just light walking for 30-50 minutes, to protect them from heart attacks and high blood pressure.

New research from the United States shows that sugar increases blood pressure more than salt and causes more damage to the body. Do you have any comments on this?

Patients who suffer from high blood pressure know without a doubt that salt increases blood pressure. However, there is a close relationship between salt and sugar in the human body. Consuming sugar on a long term basis, without a doubt, first causes obesity, and second affects the efficiency of the arteries to the heart, which automatically affects blood pressure. Surely patients who have diabetes, also have high blood pressure. Patients who are obese also usually have high blood pressure and yes, sugar is the cause behind most of this increase in blood pressure.

Are there any new developments or research for treatments? Do you face any problems in the program now?

There’s always research published in the rehabilitation department. For example, for a patient undergoing rehabilitation after a heart attack, there is a 40 percent probability that the same patient will have another heart attack in the same period of time. For patients who have a heart attack and smoke, the risk of a relapse and another heart attack is tripled in the same period of time, compared to patients who don’t smoke. There is great benefit in the Cardiac Rehabilitation Program, we discharge 90 to 120 cases every year.

Sadly, we see a lot of patients who get accepted in the program but do not commit to the sessions or treatments. Of course there are many reasons behind that. One of them for example is not wanting to exercise, because they do not have the will to do so. A lot of the locals that do not have transportation, like the workers, are also unable to commit to the program. We try to provide transportation for those who need it from Hamad Medical Corporation. We also offer vouchers for taxis and buses, so that patients can continue with the treatments. Another problem is that the program is still new and fairly small and is not accessible to those who are unable to move. This program is late with its introduction, even to the world as a whole. The World Heath Organization acknowledged the countries around the world that managed to lower the percentage of heart diseases, and Qatar was part of the top 8 countries acknowledged.

Tell us about accepting patients in the program. Do you think you will expand the program to include those on the waiting list?

The program now has 600 patients waiting to be treated here. We are at the developmental stage. We are in talks with Al Wakra hospital to open a new section there, if possible, and we can also consider the rehabilitation hospital. No doubt that the program will expand and there will be a newer and bigger section. Our priority is to open a branch in the rehab hospital. By that time, we would have a third phase for the program, which is to branch out to rehabilitation centers, either with health centers or with gyms, as they are close to the patient if he needs a quick consultation. This is a futuristic strategy planned for when the second phase is complete in all hospitals. There will be standards and criteria for the centers and the activities of course.

Any last tips for the general public and our readers?

Prevention is better than cure. If you are able to protect yourself from the risks of heart disease or attacks and take it all seriously, that determination by itself will cut your chances of suffering from those diseases and it will save you, and the country, a lot of money.

Phase I – Statistics (in-patient)

 

Qatari

Non-Qatari

 

Year

      Male

Female

Male

Female

Total

2015

        180

48

1749

72

2049

2016 (Jan-Jul)

        137

46

1193

46

1422

Phase II – Statistics (outpatient)

 

Qatari

Non-Qatari

 

Year

      Male

Female

Male

Female

Total

2015

         12

9

  126

10

157

2016 (Jan-Jul)

         11

4

   77

6

98

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