CRP IN SAUDI ARABIA ; OBSTACLES & STRATEGIC SOLUTION By Dr.Najeeb jaha,MD. Interventional & Preventive Cardiologist. SBCC Head of SGCVPR
•Definition
and background. •Is CRP ESSENTIAL IN Saudi Arabia. • Obstacles & Strategic Solution.
DEFINITION •CR
: is an integral component in management of CVD Patients ( WHO 1993 ). •Multifaceted , multidisciplinary and comprehensive intervention ;designed to optimize cardiac patients physical, psychological, social and vocational function. •Aiming at stabilizing ,slowing and reversing the atherosclerotic CVD , hence reducing morbidity & mortality.
•Phase
I: Inpatient rehabilitation , limited to early mobilization and brief counseling (short hospital stay ). •Phase II: Ambulatory outpatient supervised CRP , during convalescence period , 2-3 months. •Phase III: Maintenance ( community-based ) .
EVOLUTION OF CRP ď Ž
ď Ž
Beyond 1950: Prolonged bed rest ( 2-3 m hospitalization), early retirement. 1stwork evaluation unit in New York ( AHA /1941) evaluate cardiac Patient capacity to return to work. In 1950`s: Hellerstein and his associate in Cleveland made a considerable progress in evaluation of many cardiac patient to return to work.( established the past and current concept of CRP).
EVOLUTION OF CRP Between1960`s-1970`s: Early mobilization post MI became widely accepted . Many inpatient & outpatient CRP was started. 1993, WHO recommendation.
EVOLUTION OF CRP
AUSTRALIA: 1961 Inpatient CRP ….1970`s Preventive rehabilitation program and ambulatory OP CRP widely evolved. Several Asian country followed the WHO recommendation and simulate the Australian program.
1994 AHA Declaration.
AHA RECOMMENDATION 2007
QUOTE
الحركة بركة خير من العلج
في الوقاية
Activities had a lot of benefits Prevention is better than the treatment.
TOP TEN CAUSES OF DEATH IN KSA
30% 30%
SAUDI ARABIA TOTAL DEATHS BY CAUSE PERCENT TOP 50 CAUSES
Deaths
%
1 Coronary Heart Disease 2 Hypertension
20,877 10,656
23.98 12.24
3 Diabetes Mellitus
5,870
6.74
4 Road Traffic Accidents 5 Stroke 6 Other Injuries 7 Influenza & Pneumonia 8 Low Birth Weight 9 Congenital Anomalies 10 Kidney Disease 11 Suicide 12 Drownings 13 Endocrine Disorders 14 Falls 15 Lung Disease 16 Colon-Rectum Cancers 17 Lymphomas 18 Diarrhoeal diseases 19 Liver Disease 20 Birth Trauma 21 Violence 22 Breast Cancer 23 Lung Cancers 24 Skin Disease 25 Leukemia
5,233 4,798 4,648 4,166 3,882 2,545 2,540 1,512 1,471 1,404 1,391 1,197 1,126 950 812 743 730 709 706 607 600 545
6.01 5.51 5.34 4.79 4.46 2.92 2.92 1.74 1.69 1.61 1.60 1.37 1.29 1.09 0.93 0.85 0.84 0.81 0.81 0.70 0.69 0.63
26 Tuberculosis 27 Pancreas Cancer 28 Inflammatory/Heart 29 Liver Cancer 30 Epilepsy 31 Other Neoplasms 32 Asthma 33 Stomach Cancer 34 Hepatitis B
35 Prostate Cancer 36 Poisonings
37 Oral Cancer 38 Schistosomiasis 39 Peptic Ulcer Disease 40 Parkinson Disease 41 Anaemia 42 Dengue 43 Oesophagus Cancer 44 Ovary Cancer 45 Rheumatic Heart Disease 46 Bladder Cancer 47 Maternal Conditions 48 Meningitis 49 Fires 50 Hepatitis C
Deaths 537 443 42 5 425 412 406 389 383 311
% 0.62 0.51 0.49 0.49 0.47 0.47 0.45 0.44 0.36
263 250 244 209 200 190 175 155 150 145 142 141 124 104
0.30 0.29 0.28 0.24 0.23 0.22 0.20 0.18 0.17 0.17 0.16 0.16 0.14 0.12
30 0 299
0.34 0.34
•Cardiovascular diseases (CVD) are the main cause of morbidity and mortality among the Saudi population1 •A significant proportion of hospital admissions is due to CVD, whether acute or chronic or to cardiac procedures including angiograms 2
1-Al Balla SR,. J Trop Med Hyg 1993;96:157-62 2-Bamgboye EA, Saudi Med J 1993;13(1):8-13. ] .
SPACE REGISTRY
Al-Habib etal
EPIDEMIOLOGICAL STUDIES OF PREVALENCE OF DM IN SAUDI ARABIA( 1982-2009)
ANN SAUDI MED 2011;31(1) 19-23
2000 Saudi diabetics ( Initial ) Cardiac arrest 5.9%
Cancer 5.9%
Cancer Others CVA IHD MI Cardiac arrest
Others 5.9%
MI 17.6% CVA 17.6%
IHD 47.1%
METABOLIC SYNDROME PREVALENCE IN SAUDI ARABIA AS DEFINED BY ATP IIICRITERIA 2001
•
Saudi Med J 2005; Alnozha etal
Prevalence of Metabolic Syndrome in Saudi Adults
Overall prevalence rate of metabolic syndrome as defined by the Adult Treatment Panel (ATP) III in 2001 was
39.3%.
Prevalence of obesity in Saudi Adults 50
Male (Rural) Male (Urban) Female (Rural) Female (Urban)
40 30 20 10
15-20
21-30
31-40
41-50
51-60
>61
Prevalence of dyslipidemia in Saudi Adults •The overall prevalence of hypercholesterolemia TC > 200 mg/ dL: 35.4% . •The overall prevalence of hypertriglyceridemia TG > 150 mg/ dL) : 49.6%. •HDL Values in men and women Men <40mg/dL: 74.8 % Women <50mg/dL: 81.8
Al-Nozha MM.et al. Metabolic syndrome in Saudi Arabia. Saudi Med J 2005; 26 (12): 19181925
Prevalence of Hypertension in Saudi Arabia
AL-Nozha et al in a cross-sectional cluster sampling & house hold survey on 13700 Saudis of both sexes Kingdomwide 27 Ann Saudi Med, Vol 17, No2.1997
The prevalence of regular smokers in each country
Journal of Hypertension 2005, Vol 23 No 6
28
Proposed Function of Cardiac rehabilitation and prevention Units
Exercise Based Program and Comprehensive Multidisciplinary Secondary Prevention Concentrate : 1)Post PCI 2) Post CABG 3) Post MI. 4) HF 5) PVD 6) Post ICD
Community based Exercise program
Early risk
factors
detection and modification clinic
CR and prevention unit/ Department
DM
Metabolic syndrome Clinic/program
Home Visit program
Primary Care center
Diabetic Centers
IDENTIFY OBSTACLES AND LOOK FOR A SOLUTION
لوقايةللتأهيللل لو للودية لل ل لعل للس موعةال ل ل ال مج ي اللللصح لب القل ل
MULTIPLE HEALTH AUTHORITY OR SECTOR. LACK OF AWARENESS OF HEALTH PROFESSIONAL AND HEALTH ADMINSTRATION. LACK OF AWARENESS OF THE PUBLIC AND PATIENTS. LACK OF SPECIALIZED HEALTH PERSONEL IN THE FIELD. OTHERS.
ENVIROMENTAL OBSTACLES
CULTURAL OBSTACLES
STRATEGIC SOLUTION
CRP = SECONDARY PREVENTION + TERTIARY PREVENTION AND MAY BE PRIMARY PREVENTION ( MS…ETC). MOH SHOULD DOMINATE WITH CREATION OF COMMITTEE COMPOSED OF REPRESENTATIVE FROM EACH HEALTH AUTHORITY / SECTOR. THE SGCVPR WORK ON :
IMPRORVE THE AWARENESS OF THE HEALTH ADMINSTARATIVE AND PROFESSIONAL ( SCINTIFIC CONFERENCE , INTERNATIONAL COLLABORTIVE PARTNERSHIP , FACILITATE AN INTERNATIONAL SCHOLARSHIP FOR CERTIFICATION IN THE FEILD ) . IMPROVE THE AWARENESS OF PUBLIC THROUGH CAMPAIGN , JOURNALS, MEDIA , AWRENESS DAY DURING THE WORLD HEART DAY…ETC. ,INVOLVE OTHER NON-HEALTH AUTHORITY IN THE COMMUNITY ( MINISTRY OF EDUCATION AND SWIMMING FEDERATION) AND MAKE PARTNERSHIP , ( ORGANIZE SUMMER CAMP , USE SPORT TOURNEMENT FOR ADVERTIZING HEALTHY LIFE STYLE…ETC). PROPOSE TO CIVILIAN ENGINEER TO INCREASE THE WALKING AREA FOR PUBLIC AND MAKE SPECIAL TRAIN FOR BIKES. CREATE COMMUNITY CENTER IN EACH DISTRICT, USE THE SPORT CITY AS PART OF COMMUNITY PROGRAM. USE HOME VISIT AND COMMUNITY BASED PROGRAM AS AN ADJUNCTIVE FACILITIES TO ACCOMADTAE MORE NUMBER OF PATIENTS ( MINIMAL OPD SUPERVISION).
Thank you