Since May 2015 NICVD has performed 1601 primary angioplasties with 4.9% mortality

ICU beds increased to 34 with 8-bed additional Paediatric ICU,

KARACHI: National Institute of Cardiovascular Diseases (NICVD) the premier mother cardiac institution of Pakistan is setting new standards for cardiac care.  Primary angioplasty for patients with acute myocardial infarction coming to NICVD was initiated on May 18th 2015 and so far till November 4, 2015 sixteen hundred one primary angioplasties have been performed with a mortality rate of 4.9%. It also includes high risk patients coming with cardiogenic shock. Ever since Prof. Nadeem Qamar has taken over as the new Director, a positive qualitative administrative change is visible at the institution.  Authoritative centralized administration has been replaced with decentralized administrative set up with all the Heads of the Departments being empowered to take decisions in line with the policy once decided with main focus on providing highly subsidized best quality care to the patients.

Giving details of the various measures initiated to improve care and expand services Prof. Nadeem Qamar told Pulse International that all patients with acute myocardial infarction coming to the NICVD are offered primary angioplasty. The package for primary angioplasty is Rs. 75,000/- but no patient is refused treatment if he or she cannot pay. They can pay later or whatever they can afford, even they can pay in installments.  At present our recovery rate from primary angioplasty he further stated was just 33%. The administration has also decided and made it clear to the entire staff that effective July 1st 2016 no NICVD staff will work outside. They have been given enough time to make up their mind and wind up their private practice set up. We are expecting that from January 1st 2016, most of the NICVD staff will stop working outside much before the deadline of July 1st 2016.

At present we have twenty Echo machines of which fourteen are functional and the remaining will be operational soon. We have acquired some new Echo machines, a few are old refurbished and all this has been acquired through donations.  Our aim is that we will eliminate the waiting list for Echo. The patient will get the Echo report the same day. Earlier patients particularly coming from the interior of Sindh or other far flung areas of Pakistan were first given date for Echo, then they come and have their Echo and then they collect the report and seek consultation which mean three to four visits. We are aiming that the patient should get the treatment plan the same day. At present over two hundred Echoes are performed daily at the institution. Echo is performed in the OPD, in the ward as well as in the Emergency. Out Patient Services have also been streamlined. There is no chaos now. Token system has been shifted from the OPD and pharmacy is issuing two weeks drugs to the patients instead of one week which has also reduced the rush to a great extent. Daily OPD attendance is between 1800-2000 patients, he added.

NICVD also offers highly subsidized packages for cardiac surgery.  Stenting with bare metal stents at NICVD costs just Rs. 70,000/- as against Rs. 1.75, 000/- charged by the private hospitals. Similarly procedures with Drug Eluting Stents at NICVD costs just Rs. 90,000/- as against   Rs. 2.25 to three lacs charged in the private sector. Charges for valve replacement at NICVD are just rupees one lac and for special tissue valve it is Rs. 1.25 lac as against Rs. 3.25 lac charged in the private hospitals. Prof. Nadeem Qamar further emphasized that they buy all the valves and other material which is best quality FDA approved from American manufacturers and do not use the Chinese and European stuff. After directnegotiations with the manufacturers, suppliers, we have been able to get highly competitive rates and the whole benefit is being passed on to the patients. Replying to another question Prof. Nadeem Qamar said that at present they are doing about thirteen hundred surgical procedures annually but we wish to increase this number to two thousand five hundred annually. Surgery has already started in the evening shift at NICVD, he added. Currently we have eight cardiac surgeons which includes two professors and three associate professors. We are looking for more surgeons. One of the cardiac surgeon from Ireland will join shortly while cardiac surgeons working at other city hospitals have also been offered lucrative packages.

The number of beds in the Intensive Care Unit has also been increased to thirty four, more ventilators have been provided and an 8-bed Paediatric ICU has also been established to take care of the paediatric patients. In addition we have also established a 6-Bed Medical Intensive Care Unit. Laboratory has been accredited by NEQA. Patients will get the reports within one hour.  Prof. Nadeem Qamar specially thanked M/s PharmEvo who he said were helping them to make NICVD a paperless hospital with the result that it will be fully computerized which has already improved efficiency besides checking pilferage. Quality of food being served to the patients has been improved. They are now served food in proper tray and there is special emphasis on hygiene and cleanliness. Duties of the Public Relations Officer who has joined recently include looking after the hygiene, cleanliness, taking care of the problems of the patients and finding a solution after talking to the medical and nursing staff and if need be the administration is also approached. The whole objective of this exercise is to provide comfortable stay to the patient during their stay at the hospital and enhance patient satisfaction.

Prof. Nadeem Qamar was full of praise for his colleagues and specially mentioned Prof. Nadeem Rizvi, Prof. Zahid Jamal, Dr. AndesMemo and others for their devotion and dedication.  All members of the medical and nursing staff including senior faculty members, he said, were doing a commendable job. Some have been of great help in generating funds through donations which has enabled us to provide the facility of primary angioplasty in particular on which the hospital is spending cores of rupees and thus saving many precious lives.Almost 20% of patients are getting free surgery and 50% of patients who cannot afford were getting pace makers free of cost. The administration has chalked out an ambitious expansion plan and if all goes well the bed strength of NICVD will increase from 650 to 1200 adult beds and one hundred fifty beds in the paediatric cardiology unit. We hope to accomplish it in two years’ time. We also plan to offer free bypass surgery to the patients in the days to come, he remarked.

At present we have over ninety people with FCPS including Trainee Resident Medical Officers in addition to those who have Diploma in cardiology. This year eleven postgraduates from NICVD passed their FCPS examination and we are all proud of these professionals.  We hold the mortality conference daily between 2-3 PM. Each and every death is discussed and someone is held accountable. Everyone is answerable and all this is being done to ensure quality assurance. Our prime objective remains to enhance patient satisfaction. All our efforts are directed to make NICVD as one of the best institutions in the world. We are prepared to work and collaborate with anybody and everybody Prof. Nadeem Qamar concluded.

Prof. S. Nadeem Hassan Rizvi giving further details of the primary angioplasty project told Pulse International that previously thrombolysis was recommended for patients with AMI and within six hours, it gave good results. Then the patients used to undergo angiography once he or she was stabilized and then it was decided whether to go for angioplasty, stenting or bypass surgery. However, since 2005 primary angioplasty is the standard treatment for these patients all over the world which gives excellent results and also saves lot of time. Now there is no need to have a surgical team stand by though surgical options should be there. But even then we at NICVD do have arrangements for surgical help if need be. Currently we are doing about eight to ten primary angioplasties every day.

Though by now we have performed  1601 angioplasties but  analysis of  1489 cases done from May 18th 2014  to October 30, 2015 showed that  1181 patients were male (79%) while  308 patients were female (21%) Further analysis showed that patients less than forty years of age were 8%, between 40-50 years were 31% and between 50-60 years were 30%.  It means almost 70% of the patients were under sixty years of age whereas overseas over 70% of patients are over sixty years of age. About 4% of ourpatients were of cardiogenic shock and our overall mortality was 4.9% which is equivalent to any good cardiac care center in the world. If the patient comes with shock, after thrombolysis nine out of ten are likely to die and only one can be saved but four out of ten can be saved with primary angioplasty. These are the high risk cases and if the patients come early the mortality figures will reduce further, he added.

Giving further details Prof. Nadeem Hassan Rizvi said that in these patients our Door to Balloon time was 64.4 minutes, CP-ER time was 215 minutes, Total ischemic time was 262 minutes and overall mortality was 4.9%. Patients with cardiogenic shock accounted for 3.6%.  On the administrative side, there is total delegation of powers to the Heads of the Departments. Once a policy is decided, then no one can change that and patient’s interests are safeguarded. He further disclosed that so far they have performed nine TAVI/TAVR procedures. First such procedure was performed two months ago. It costs between thirty to thirty five lac rupees. It enables valve replacement without surgery. It gives a new life to those patients who are at a very high surgical risk. Hopefully NICVD, Prof. S. Nadeem Hassan Rizvi remarked will be the first center in Pakistan to be accredited for TAVI procedures.

Continuing Prof. Nadeem Hassan Rizvi said that we are doing lot of work and now we are planning to publish our data and share it with other colleagues. To facilitate that Institutional Review Board/Ethics Committee has been established at the NICVD which will approve all the research projects and the principal investigator will be responsible for conduction of study and its publication. M/s PharmEvo has helped us establish a Clinical Research Center for this purpose. So far we were facing some problems and difficulties particularly as regards statistical analysis. We are collaborating with Prof. Abdul Basit from Baqai Institute of Diabetes and Endocrinology (BIDE) and are hopeful to publish our authentic data. Our aim is to make sure that all the facilities are available at the NICVD which should be for everyone. Later Dr. Tahir Saghir Director Clinical Research Center briefed about the proposed working of the CRC for which necessary formalities are being completed.