x Abu Dhabi, UAEFriday 19 January 2018

Only two specialists for 4,000 heart cases

The number of adult Emiratis with congenital heart disease is expected to double in the next 10 years.

DUBAI // The number of cases of congenital heart disease among adult Emiratis is expected to double in the next decade and, as a result, doctors are pushing for more specialised facilities.

Estimates from Rashid Hospital show there are more than 4,000 UAE nationals over the age of 16 with congenital heart disease.

That number is expected to double in the next 10 years, said Dr Haitham Al Hashim, the head of the hospital's adult congenital heart disease clinic and one of only two cardiologists in the country who specialise in adult care.

He attributed the forecast increase to the growing population and increased success in treating children born with congenital heart disease, putting the survival rate at 85 per cent. Main risk factors for the disease include genetic predispositions, diabetic mothers, late pregnancies, and intermarriage of first degree cousins, which is slowly declining due to increased awareness, Dr Al Hashim said.

"Advances in medication, surgery, and overall treatment techniques have played a role in this," he said. "So now you have adults living longer, but those who survive are not cured and require specialised care."

Despite advances made in the field, more progress is needed, said Dr Wael Almahmeed, board member of the Emirates Cardiac Society, and deputy chief medical officer and head of cardiology at the Sheikh Khalifa Medical City (SKMC). The medical facility houses the country's other congenital heart disease clinic.

"Those who are being treated are growing up and living well into later stages of their lives. The question is, who's going to follow up with all these adult patients?" Dr Almahmeed said. "Two people in the country trained in this sub-speciality are not enough."

Adults with congenital heart disease can develop serious complications, including weakness of the heart muscle, problems with heart rhythm and infections, Dr Al Hashim said.

"Another important consideration is women with the disease who want to get pregnant," he said. "They are at high risk and need continuous follow-up. Previously, a patient would have to visit doctors individually, and sometimes those doctors don't know the implications the disease would have on other aspects of the patient's health. At a specialised clinic they can receive the treatment they need in one place."

Worldwide, the probability of having a child with congenital heart disease is 1 per cent, Dr Al Hashim said. However, if the mother has the disease the chances increase to 3 to 5 per cent, and if the father has the disease they increase 2 to 3 per cent with every birth.

Since its launch in October the clinic at Rashid Hospital has registered 80 patients, and the number continues to increase, Dr Al Hashim said.

The disease is divided into three complexity categories: simple, moderate and severe. It is caused by genetic and chromosomal mutations, and can be triggered if the mother abuses drugs or alcohol. It can be present in many forms, including as a hole in the heart's lining, an inversion of the main blood vessels and an asymmetry of the heart chambers.

Abu Dhabi recently introduced a test that measures blood oxygen into its newborn screening programme, where doctors use it in combination with a physical examination.

Dubai continues to use physical examinations as a benchmark. However, Dr Haitham said that in cases where a child clearly falls into the high-risk category, doctors request an echocardiogram, an ultrasound of the heart that looks at its structure and function.

It is not only the adult cases that need to be reviewed, Dr Almahmeed said, adding that there is a "serious lack of paediatric cardiologists in the country".

"This is a problem because it means many children may go undiagnosed because the doctors assessing them do not have the necessary qualifications," he said.

In addition, SKMC is the country's only facility to provide paediatric cardiac surgery, performing nearly 350 operations a year on children born with congenital heart disease.

"Sometimes we are so fully loaded that we can only accept extremely high-risk cases, while other patients have to be transferred abroad," Dr Almahmeed said.