Interview: Update on cardiology and critical care medicine in Egypt
A leading specialist discusses recent developments in cardiology and critical care, and the need for nationwide preventive efforts. In this exclusive interview with Fabric of Africa, Professor Alia Abdel Fattah talks about establishing effective services, encouraging patients to present earlier, and promoting practical prevention efforts. Prof Abdel Fattah is professor of critical care medicine and chief of the Critical Care Medicine Department at Cairo University Hospitals, Egypt.Professor Alia Abdelfattah
TRANSCRIPT OF INTERVIEW:
Interviewer: Welcome, Professor. To begin with, can you tell us about recent developments in care at your centre?
A-The most important development is we are trying to stick to the guidelines on the management of cardiovascular disease and critically ill patients. We have a strong critical care cardiology sector in our department, where we are applying, for example, primary PCI (percutaneous coronary intervention). Interventional cardiology is an important area of overlap between critical care and cardiology, absolutely. Also, we do CRT (cardiac resynchronisation therapy) device insertion, and CRT-D (defibrillator) insertion in the patients that need it.
We have very strong IT systems, and run patient registries, and we regularly evaluate how our statistics in terms of care compare with international figures and international standards – I think that is one of the most important policies that we adopt in our department. The Stent for Life project – which in Egypt involves the Ministry of Health and hospital universities (including ours), in addition to the European Society of Cardiology – has proven to be important in helping to establish primary PCI policies all over the country. [For more information on Stent for Life see: http://www.escardio.org/communities/EAPCI/Stent-For-Life/Pages/welcome.aspx]
We have a lot of patients with complicated infarction and most of our patients are presenting late in the course of acute coronary syndrome (ACS). For these patients, the intervention sometimes needs mechanical components such as the intra-aortic balloon and ECMO (extracorporeal membrane oxygenation) – a new addition, available only in our department. ECMO needs a very specialised, fully trained team, and is one of the important additions for me.
Q- You mentioned that many patients, particularly with ACS, present late. Is that an issue to do with patient awareness or with referral, there being a limited number of places to which GPs (for example) can refer?
A- No, it is not the limited number; it is the awareness of the patient. We have a lot of patients who are not aware of the cardiac symptoms; they often feel the chest pains as epigastric pain and are taking antacids before later taking analgesics. That is why many more patients with acute coronary syndrome in our country present with STEMI (ST-elevated myocardial infarction) than with non-STEMI acute coronary syndrome. It is the opposite in the US and in Europe, where more patients present with non-STEMI because they are aware they have to seek medical advice when the treatment has failed and so on. Their presentation is early in the course of acute coronary syndrome.
Q– In terms of the organisation of cardiology services in Egypt, right from primary through to tertiary care, what would you say are the most important issues to focus on right now? What is needed and what is being done?
A– Prevention. It can help a lot when you educate the population about cardiovascular disease, its problems, and the control and assessment of risk factors. Believe me, 50% of patients presenting with acute coronary syndrome do not know that they have risk factors. They present with uncontrolled risk factors like dyslipidaemia, diabetes, hypertension, and so on. Prevention must involve thorough assessment and on-going control of risk factors in people who are more at risk of cardiovascular disease.
Q- To institute such a preventive policy presumably requires some involvement at a government level?
A– Yes, we have to go to the people, many of whom are not particularly well-educated, they are not aware of the problem. It needs a very big project to control and minimise cardiovascular disease in Egypt.
Q- Last year we spoke with Professor El-Togby in Cairo, who was telling us about also the establishment of centres of excellence in cardiology [see http://www.healthcare.philips.com/main/clinicalspecialities/womenshealthcare/foa/cardiology-education.html]. Are you involved in this sharing of knowledge?