Proceedings of PULSE 2020 Cardio Metabolic Health held at AKU


Proceedings of PULSE 2020 Cardio
Metabolic Health held at AKU

By Mubarak Ali

KARACHI: AKU’s Section of Cardiology and Department of Medicine organized (PULSE 2020) 1st Cardio metabolic health conference in collaboration with Association of Pakistani-descent Cardiologists of North America, Pakistan Hypertension League and Pakistan Aspirin Foundation at AKU from 10-12, January 2020. The event was attended by cardiologists, postgraduate students, nurses, nutritionists and other healthcare professionals. The theme of the event was cardio metabolic health, focusing on health issues that result in heart attacks, strokes etc.

Speaking in the inaugural session Shagufta Hassan AKUH CEO said that we have to work towards prevention, lifestyle changes, and good health. AKU Hospital system, she stated is a diversify hospital and nationwide network of two hundred ninety plus locations, present in one hundred twenty five cities of Pakistan and provide diagnostic laboratories services in 125 cities and has created a diagnostic system for Pakistan. We have now moved on to primary health care by opening up forty Primary Healthcare centers. Reason behind this is that we wants to take the quality healthcare to the people. We cannot expect everybody to come to AKU. Seventy percent of the treatments can be managed outside hospitals, and our objective is to treat these people without coming to big hospitals. It is our mission to provide high quality solutions at low cost. She lauded the services of senior cardiologists of the country and Prof. Abdus Samad in particular and said that these are very humbling moments for you and for all of us to see that next generation taking us where ever you desired them to be and even you have seen the children progressed even beyond what they expected and setting new records because they are very well raised. Prof. Samad has produced number of cardiologists in the country and we are so grateful to him she added.

Prof. Eric Jose Valazuquez, Prof. Zainab Samad, Dr. Faiez Zannad and Dr. Aamir Hameed
Khan photographed during (PULSE 2020) 1st Cardio metabolic health conference
organized by AKU’s Section of Cardiology
and Department
of Medicine at AKU from 10-12, January 2020.

Dr. Adil Haider, Dean Department of Medicine congratulated Prof. Zainab Samad and her team for hosting Pulse 2020. It is essential that we add cardiovascular in top of our conversation, it will make a difference and PULSE 2020 is a very timely and much needed initiative. Values of Impact, Quality Relevance and Access (IQRA) are the main core issues needs to be discussed. He hoped that we are going to discuss how we are going to improve the impact of this diseases, where we need to focus our efforts for prevention of cardiovascular diseases, how to improve access care for those who have not that access. Dr. Adil Haider also lauded the services of Prof. Abdus Samad who has trained number of cardiologists and we are proud of him for his services in the field of cardiology. Dr. Anjum Halai, Vice Provost AKU in her remarks said that we should work to reduce the burden of cardiovascular diseases. We should explore research in cardiovascular diseases for people who really needs to have its benefits.

Prof. Zainab Samad, Chair Department of Cardiology, addressing the participants said that Ischemic Heart Diseases are the number one cause of death in Pakistan. Over the last ten years we have a 30% increase in cardiovascular disease related deaths which has displaced maternal and new born disorders as the leading cause of deaths in the country. There are three cornerstones in our success to manage this epidemic, first is research, we must learn how to implement strategies those have been shown to be effective in other parts of the World. How we implement in low resource settings, how we innovate and when we do that besides how are these therapies different in implementation and effectiveness in our part of the world. We need to educate our health professionals and our public. Pakistan has a very young population, sixty percent of our population is under the age of forty which means, and there is a huge opportunity for us to educate them. We know that cardiovascular disease is a big problem, we have just to face the crises, we have to manage it, and this means that we have to strengthen our health system. We cardiologist have to work together to tackle this cardiovascular epidemic. Through PULSE 2020 conferences we will hopefully target all the areas, research, education and strengthening of our healthcare system. The conference will be a regular feature in the years to come, she added.

Group photograph during (PULSE 2020) 1st Cardio metabolic health conference organized
by AKU’s Section of Cardiology and Department of Medicine shows, Dr. Osman Faheem,
Prof. Zainab Samad, Prof. Abdus 
Samad, Prof. Khalida Somroo, Dr. Bashir Hanif,
Prof. Hasanat Sharif and others.

Dr. Osman Faheem, Chairman Organizing Committee, welcomed the guests and highlighted the different facilities being provided at AKU and future plans. Theme of the conference he pointed out was chosen to highlight the critical relevance of this global epidemic for a low middle income country like Pakistan where over one third of Pakistan’s annual deaths are attributed to cardiovascular disease and it is imperative to develop innovative strategies to face this growing challenge.

Eric Jose Valazuquez from Yale University, School of Medicine who is a global authority on Heart Failure, Cardiovascular clinical trials and cardiac imaging was the first Key Note Speaker. Life, he stated is short, make a difference, build relationship to expand capacity, it is all about mentorship, technical development, intellectual transfers. Always be innovative- challenge dogma. Economic implications are staggering. Use of Sacubitril- Valsartan in hospital could save eligible US HFrEF patients over 50,000 subsequent hospitalizations for heart failures each year. This would result in saving of one billion dollar per year in hospitalization cost per year or nearly $100 million a year net of medication cost. Observe carefully, visualize the goal, perservance, relationship are what matter most, avoid transactional encounters and focus on team building, he added.

Dr. Faiez Zannad, a cardiologist and clinical pharmacologist at University de Lorraine in France was the 2nd Key Note Speaker. Topic of his talk was are we doing good job by treating our heart failure patients? Global progress in treating heart failure, he stated has been spectacular in the last 25 years with mortality declining three fold in dedicated clinical trials. He said that evidence from global clinical trials show income inequality as a factor determining clinical outcomes in heart failure.

Talking about different modalities to treat Heart failure he said that an ACEI is recommended, in addition to a beta blocker for symptomatic patients with HFrEF in class-1, a beta blocker is recommended in addition an ACEIs, for patients with stable, symptomatic HFrEF to reduce the risk of heart failure hospitalization and death. An MRA is recommended for patients with HFrEF, who remains symptomatic despite treatment with a ACEIs, and a beta blocker to reduce the risk of HF hospitalization and death. Sacubitril/Valsartan is recommended as a replacement for a ACEIs, to further reduce the risk of HF hospitalization and death in ambulatory patients with HFrEF who remain symptomatic despite optimal treatment with an ACEIs, a beta blocker and MRA. Patients with highest risk of poor outcome (elderly, poor renal function, with diabetes,) are those who are at highest risk of worsening renal function and hyperkalemia and are those who are deprived from therapy.

Most recent trials Dr. Faiez Zannad said show patients with mild symptoms are not mild, and are not stable, they progress rapidly even on optimal treatment. Over one third experience deterioration in symptoms, quality of life, in the first year. One out of six die or are hospitalized for HF in the first year. In one third of patients, the first manifestation of progression/worsening is cardiovascular death and mainly sudden death. In multidisciplinary management programme it is recommended that patients with HF are enrolled in a multidisciplinary care management programme to reduce the risk of HF hospitalization and mortality. We have strong evidence based lifesaving treatments, have done the hard job generating this evidence and need to do the hard job to implement this evidence and get our patients on the best optimal HF therapy, because , if we do not implement it , our patients will suffer he concluded.

Prof. Joseph Kisslo, from Duke University, Medical Center was another Key Note Speaker. He pioneered development of echocardiographic method and was the first person to conduct both two-dimensional as well as three dimensional echocardiographic examination using real time, phased array systems. He established the first echocardiography laboratories at both Yale and Duke. Addressing the participants he said that never be the smartest person in the room, there is nothing like first time, someone has at least done some work before us, you are surrounded by very intelligent people, teaching is remarkable try to use them. Parallel workshops on imaging, electrophysiology, Interventions, Cardio-metabolic Health, Nursing Education besides Scientific sessions and plenary sessions were part of the three day conference.

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