Lebanon Report



AUBMC initiates preventive cardiology programme
 

The American University of Beirut Medical Center recently launched a new heart attack prevention initiative. Callan Emery spoke to Dr Wael Al Jaroudi, the Director of the Cardiac Rehabilitation Program, and Assistant Professor of Medicine in the Division of Cardiology in the Department of Internal Medicine at AUBMC, about the initiative.

Callan Emery: Why has AUBMC set up this programme? n Dr Wael Al Jaroudi: Part of AUBMC’s mission is to provide not only state-of-theart health care and therapy, but also to prevent diseases and contribute to a healthy and productive society. Cardiac preventive programmes are associated with significant decrease in morbidity and mortality from cardiovascular diseases. Therefore, we opted to launch a comprehensive preventive cardiology programme that includes screening for diseases, and diet and smoking cessation counselling. Given that lack of exercise is notoriously common in our society and is a major contributor to obesity and other cardiovascular risk factors, we also decided to start a cardiac rehabilitation programme to promote healthy lifestyle, exercise philosophy, and modify risk factors.

CE: What are the latest stats for cardiovascular disease (CVD) in Lebanon? n WAJ: 84% of deaths in Lebanon are due to non-communicable diseases. Of those, 45% are due to cardiovascular disease. 36% of the total population smoke; 47% are inactive; 39% have high blood pressure; 12% are diabetic; 62% are overweight; and 27% are obese.

CE: Can you explain how the programme will work? n WAJ: Patients are referred to the physical therapy department by their physician. They are screened by a cardiologist who, in collaboration with the referring physician, will determine each patient’s goals, such as weight loss, improving cholesterol panels, improving fitness and endurance levels, etc. The patient then starts working with a physical therapist with expertise in cardiac rehabilitation for one hour sessions up to three times a week. In the first session, an assessment of baseline functional capacity is performed, and it is repeated at the end of the programme to check for improvement. During the sessions, the physical therapist trains the patient gradually and provides him/her with a tailored exercise programme to meet the set goal. At the end of the programme, the patient should be able to pursue such exercise regimens on his/her own.

CE: Who are you targeting? n WAJ: Currently, phase one of the programme targets patients without known heart disease, but have one or more risk factors. They will therefore benefit from the programme to modify their risk factors and prevent the occurrence of heart disease and complications. Such patients include the morbidly obese who need or have recently underwent bariatric surgery to reduce weight. In such cases, adding exercise is essential to maintain weight loss, build muscle and improve functional capacity.

Phase two of the programme (which will be launched soon) targets patients with known heart disease, particularly those who had a recent heart attack, coronary artery stenting, or open heart surgery. These patients are at risk of developing future events. Many of them are afraid to exercise or cannot because they are deconditioned. The aim of the programme is to rehabilitate them and re-integrate them into a fitness and endurance levels, etc. The patient then starts working with a physical therapist with expertise in cardiac rehabilitation for one hour sessions up to three times a week. In the first session, an assessment of baseline functional capacity is performed, and it is repeated at the end of the programme to check for improvement. During the sessions, the physical therapist trains the patient gradually and provides him/her with a tailored exercise programme to meet the set goal. At the end of the programme, the patient should be able to pursue such exercise regimens on his/her own.

CE: How many people do you expect to see doing the programme? n WAJ: Each session consists of up to four patients. This allows more one-onone time with the therapist. We expect gradual increase in numbers, and we are currently expanding the programme to allow for more machines and increased capacity. We expect to recruit 10 new patients each month.

CE: How long will patients participate in the programme? n WAJ: For those enrolling in phase one of the programme, we recommend a 12-session package (3 one-hour sessions a week). We also have a 6-session package. For those enrolling in phase two of the programme, we recommend 20 sessions with the possibility of renewal depending on a patient’s needs.

CE: How will people pay for the programme? n WAJ: The current packages are competitively priced taking into account all the benefits to the patient. We have approached insurance companies and third party payers to cover this service which is known to be cost-effective, and which will save the public money in the long-term as well as result in an overall healthier population. We are currently still waiting for their feedback.

CE: How can you ensure that people will continue with their new healthy lifestyle after they have completed the programme? n WAJ: After seeing improvement in their fitness, endurance, weight loss, decrease in their cholesterol levels, blood pressure or glucose readings, most patients are encouraged to maintain this healthy lifestyle. Part of the physical therapist’s work is to provide a tailored exercise programme that is suitable for each patient, and that they can manage to maintain despite their time restrictions. We strive to promote the philosophy of exercise and a healthy lifestyle. Throughout the sessions, patients are counselled on the benefit of exercise and healthy choices.

We can’t force patients to continue with this brand new lifestyle; however, for those motivated enough to enrol, we meet them halfway. CE: The programme is largely a preventive measure to help reduce the risk of CVD. Lifestyle modification to help prevent CVD is notoriously difficult. Generally people are extremely reluctant to alter their lifestyle unless they have suffered a significant cardiac event. What are your comments on this?

WAJ: This is sadly true. People are very reluctant to see a doctor when they are asymptomatic. However, screening for breast, cervical, prostate and colon cancer are now routinely done by patients and covered by insurance companies. Patients do ask to be screened and are motivated enough to present for check-up for these diseases. Still, cardiovascular disease remains the leading cause of death, moreso than breast or colon cancer. As such, we have been promoting the preventive cardiology clinic and programme, asking patients to come in and get screened for heart disease, similar to breast or colon cancer, even if they are asymptomatic. We have a Saturday clinic for those busy at work on the weekdays, and provide significant discount rates for the visit and all the required tests. It will help if insurance companies and third party payers cover some of the expenses (mainly coronary artery calcium score, smoking cessation counselling, and cardiac rehab programme) similar to what they do for other preventive screening tests; the message has been relayed to them and we await their response.

CE: To show that this programme works, how will you measure the success of tit? n WAJ: We plan on measuring patients’ functional capacity through a standard 6-minute walk test at the first session and at the end of the programme to check for percentage improvement. We will also look for weight loss, improvement in blood pressure, oxygen level, and the metabolic profile (cholesterol and glucose). We also plan to have a small questionnaire to assess whether there is improvement in mood (pre and post), and to assess patients’ overall experience and feedback.


Clemenceau Medical Center wins award for Best Facilities Management Service Strategy at Middle East Hospital Build & Infrastructure Exhibition & Congress 2014



Clemenceau Medical Center (CMC) in Beirut has won the “Best Facilities Management Service Strategy” award at the awards ceremony during Hospital Build & Infrastructure Exhibition & Congress, held in Dubai on June 2, 2014. The award recognises outstanding healthcare facilities in the Middle East. The hospital was also been highly commended for “Best Hospital Design”, “Best Physical Environment”, “Best Laboratory Design” and “Best Healing Environment” awards.

Clemenceau Medical Center (CMC), established in 2006 and affiliated with Johns Hopkins Medicine International, is a state-of-the-art medical center in the heart of Beirut. CMC has been JCI accredited and is capable of delivering high-quality health care services in a timely, cost-efficient and pleasant environment to patients from Lebanon and the Middle East. Its mission being “Caring, Safety, Excellence”, Clemenceau Medical Center has established centers of excellence in several specialties, including cardiology, ophthalmology, hematology and oncology, digestive and liver diseases, cardiothoracic surgery, and minimally invasive and colorectal surgery. CMC houses all specialty branches and is fully equipped with the most advanced medical technology.

‘Best Facilities Management Service Strategy Award’ is a new category granted for outstanding healthcare service providers who have demonstrated excellence in the provision of a facilities management strategy that embraces the widest possible scope of services, meeting the needs of the clinical teams and improving patient safety. Commenting on the award , Dr. Mounes Kalaawi, CEO of Clemenceau Medical Center, said: “What an honor to be recognized this year again by regional and international leaders in the healthcare sector.”

Speaking to the team at the hospital, he wrote: “Once again this year, your commitment to quality and service excellence is recognised beyond our organization, at the hospital build Dubai. I am proud, as you all should be. Thanks to your hard work, commitment and loyalty.”

 Date of upload: 14th July 2014

 

                                  
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