Th e HEALTH Plus | JANUARY, 2019
10
p10 i TRUST IJN
The heart
goes on
“We have been striving to be the center
of excellence for cardiovascular care in
the region and globally, and I think we are
now on the dot to achieve that.”
– Dato Seri Dr Azhari
IJN, with CEO Dato Seri Dr Azhari
Yakub at helm, continues forward to
be the best
A
S the leading center for cardiovascular
and thoracic care in Malaysia, Institut
Jantung Negara (IJN) has achieved so
much since its inception back in the
90’s.
IJN fi rst opened its doors in 1992,
with the intention in becoming the
country’s premier heart treatment center. IJN had also
established IJN Foundation in 1995 with the sole mis-
sion to raise philanthropic support for the work carried
out at the center. Th e foundation raises and manages
private funds for cutting edge research, scholarship,
education and training, patients’ welfare.
Th en in 2005, IJN was offi cially incorporated and
placed under IJN Holdings Sdn Bhd. Th e heart center is
now wholly owned by the Malaysian government, under
the Ministry of Finance. It is one of only two private
medical centers to be owned by the government.
From the various medical achievements and being
the fi rst on a lot of things, to becoming an international
referral center for heart disease – there is no stopping the
climb for IJN. As CEO Dato Seri Dr Azhari Yakub said,
“We have been striving to be the center of excellence for
Cutting down
emergency
treatment
time for heart
attacks
Th e Emergency Department at IJN
have managed to cut down the time
to treat heart attacks through an
inter-hospital collaboration program
A
S the leading cardiology and cardiothoracic
center in the country, Institut Jantung Negara
(IJN) manages a great number of patients with
various heart conditions. One of the main
emergency services provided is the early treatment of
heart attacks.
A heart attack occurs when one of the major blood
vessels supplying the heart becomes acutely blocked.
Th e mechanism of a blocked heart vessel usually occurs
over time from progressive narrowing of blood vessels
due to chronic diseases such as high blood pressure,
diabetes, high cholesterol and smoking. Th e narrowed
vessels can further progress to a sudden occlusion by
blood clots which leads to what is commonly known
as a heart attack. Th e gold standard of treatment for a
heart attack is to re-open the blocked blood vessel with
medication to dissolve the blood clot or a procedure called
Primary Percutaneous Coronary Intervention (Primary
PCI) which basically means to re-open the blood vessels
with a balloon (angioplasty) and deploying a stent so the
blood vessel remains open. For this particular treatment,
time is of the essence as the longer the heart does not
receive blood supply, the more damage occurs to the heart
muscle. Not all hospitals off er Primary PCI and IJN is one
of the few that provides this procedure with 24-hour on
call Cardiologists at hand.
Th e Emergency Department of IJN strives to deliver
this treatment as effi ciently as possible. According to
the American College of Cardiology / American heart
cardiovascular care in the region and globally, and I think
we are now on the dot to achieve that.”
With the recent launch of support group for heart
failure patients and the new Positron Emission
Tomography-Computed Tomography (PET-CT) machine
supported by Permodalan Nasional Berhad (PNB), IJN
continued to widen the gap in imaging technology
among medical centers in Malaysia.
Th e quality of patient care they are accredited for is
no small feat either, as they are on their 6th edition for
the Joint Commision International (JCI) certifi cation.
Which means they have upgraded and updated the qual-
ity of services to an international standard.
Th eir role in clinical trials and training center has
also brought them into the level few have been in. IJN’s
audacity to pursue the utmost excellence by putting
patient care before anything else is exemplary, and their
continuous milestones proves their ability to be the best
among the best. — Th e Health Plus
Th e only government hospital that off ers Primary PCI is
Hospital Serdang which was about 30 minutes away and it
did not make sense for them to send heart attack patients
there as IJN is just next door.” Dr Farina explains.
Due to this glaring fact and with the intention to
give patients the best quality treatment, both hospitals
decided to collaborate in a pilot heart attack-network
project called HISNET (Hospital Kuala Lumpur-IJN
STEMI Network).
“The collaboration
has made us
very effi cient
in the overall
process. Even a
simple process
improvement
have made a big
diff erence in time.”
– Dr Farina Salleh
Association, the recommended time to Primary PCI from
the time of patient arrival to the Emergency Department
or ‘Door-to-Balloon’ time is less than 90 minutes. Over
the last few years, IJN have excelled tremendously in their
emergency treatment through an integration program
with Hospital Kuala Lumpur (HKL) where they managed
to reduce their ‘Door-to-Balloon’ time from an average of
84 minutes to 45 minutes despite an increasing number
of heart attack cases.
Dr Farina Mohd Salleh, the Emergency Physician and
Manager at IJN’s Emergency Department tells us about
the changes made to provide the best service for patients
suff ering from a heart attack.
Identifying Problems
Standard operating procedures can be a debilitating
factor at times, as the case with ambulances transporting
patients specifi cally with a heart-related emergency.
“Heart attack patients that were brought to HKL
received initial treatment and were then referred to IJN
for Primary PCI when required. Th is follows a series of
processes and procedures that were lengthy and redun-
dant before the patient is brought to IJN and eventually
sent to the catheterization laboratory for the procedure.
Collaboration Program
Started in October 2014, the HISNET program essentially
had HKL sending patients with heart-attacks straight
to IJN with a single phone call activation system to the
IJN Emergency Department. Th e process however was
still a lot more complicated than just sending patients
by ambulance.
“When a person complains of chest pain and are taken
to HKL, they will have to do an ECG (electrocardiogram)
in their Emergency Department to make sure that he
or she is in fact having a heart attack. Only after the
diagnosis will they start the process to send the patient
to IJN for treatment.”
“HKL has improved processes on their side to diag-
nose the heart attack, give early treatment and send the
patient within 30 minutes. Th ey have to be very effi cient,”
she adds.
“We have a hotline for HKL to call, and they can call us
directly with a diagnosis and let us know they are sending
the patient to us. When we receive the call, the Cardiolo-
gist and catheterization laboratory and staff are activated
to prepare even before the patient arrives. Early prepara-
tion cuts down the time to treatment drastically. When
the patient arrives in IJN Emergency Department, he or
she is quickly prepared for the procedure and rushed to
the catheterization laboratory, ready to receive Primary
PCI.”
“Th e collaboration has made us very effi cient in our
processes including for patients who arrive at our own
doorstep. Even simple process improvements made a
big diff erence in time. Every minute counts as loss of
time equals death of more heart muscle. I am happy to
say that we have succeeded in providing safe and quality
treatment for our patients. My only hope is for patients
to come earlier to the hospital rather than wait at home
when they have chest pain.”
Th e success of the collaboration has been the catalyst
for other hospitals in Klang Valley to implement various
heart attack-networks, now called the MySTEMI Net-
work. — Th e Health Plus