Younger Bermudians are being diagnosed with heart disease and other serious ailments, placing a drain on a healthcare system struggling to cope with the demands of an ageing population.Practitioners at King Edward VII Memorial Hospital (KEMH) are treating patients who have had heart attacks at the age of 27 — a startling prospect when one considers medical advances are enabling survivors to live longer.

Of added concern is the likelihood that diseases such as diabetes and asthma will be diagnosed later, making it more difficult to treat the initial problem.

“The amounts of supports, repeat procedures, repeat hospitalisations to manage illnesses create a burden on society that our present healthcare system is struggling to provide and support,” said Myrian Balitian-Dill, a cardiac care specialist with the Cardiac Care Programme at KEMH. “Moreover, not only are patients living longer, but the onset of disease is much earlier. So instead of supporting someone at 60 years of age with heart disease, we need to provide it at the age of 40. Already, KEMH has seen a number of 27-year-olds with heart attacks.”

Her comments came in the wake of the annual Cardiology Symposium for Nurses, hosted last week by the Cardiac Care Programme and the Argus Group. Sixty five nurses met to discuss the theme Managing Heart Disease in the 21st Century.

“(Our) goal is to further educate local health professionals on the most current research and disease management tools,” the nurse continued. “This year’s theme is particularly important because more often than not, heart disease is not the only condition that health professionals have to deal with in patients. Patients are living longer and living with multiple conditions longer and that can be very challenging to both the patient and the health care providers who help care for them.

“In Bermuda, the three major disease states affecting our population are heart disease, diabetes and asthma. A large proportion of our ageing population will more likely than not have at least two, if not all of these ailments. We have to equip our front-line healthcare professionals with the knowledge and practical know-how to deal effectively with this growing trend. Nurses represent the largest body of healthcare professionals that will have to care for this population. So it is for this reason that the symposium was geared towards them and to addressing this issue.”

A team of healthcare professionals from Johns Hopkins Hospital in Baltimore presented information on the latest updates in heart disease management, new tools that are available for cardiovascular disease screening, evolving trends in diabetes management and the impact of heart disease on women. And co-ordinator of the Diabetes Centre at KEMH, Debbie Jones, gave Bermuda’s perspective on two large international diabetes studies participated in by local patients — the DREAM (Diabetes Reduction Assessment with ramipril and rosiglitazone Medication) Trial and the ORIGIN (Outcome Reduction with Initial Glargine Intervention) Trial.

“Our population is living longer due largely to improvements in technology that prevent death,” explained the cardiac care specialist. “We have the ability to open up blood vessels and prevent heart muscle damage in someone who is working his way to having a heart attack. We have the ability to implant devices in our patients who are at risk for lethal heart rhythms that may shorten their lives. Advances in CPR techniques and public access to defibrillators save people from sudden cardiac death. Additionally, medications for heart disease management have shown remarkable outcomes in terms of survival.

The end result is that people suffering from heart disease are living through their illness and living long enough to acquire more conditions. Once upon a time, people with heart ailments, or any ailments for that matter died of their single disease. That is no longer the case. The burden of heart disease is not solely measured by the numbers dying from the disease. It is also measured — and probably more so — by the numbers that are still living with the disease.”

The likelihood of successful treatment lessens where a patient with heart disease also has a condition such as diabetes, said Mrs. Balitian-Dill. And with heart disease the number one killer of women, it is critical that they understand the threat it poses to them.

“Many people do not realise that the major cause of death in diabetics is cardiovascular causes. Those with diabetes need to be aggressively treated because their risk of having a heart attack is similar to those who already have heart disease. In order to better ensure best outcomes in heart disease management, we also have to manage diabetes well.

“In terms of asthma and lung disease, many have been misdiagnosed as having these conditions when in fact their wheezing and shortness of breath was due to congestion and worsening heart failure. Not being able to appropriately diagnose heart disease as the cause of their symptoms can delay the appropriate treatment in someone who may need more diuretics as opposed to just puffers.

“Research shows that heart disease is the number one killer of women, unfortunately the studies looking at heart disease management have women under-represented. It also shows the disparity between how healthcare professionals prescribe known treatment and procedures to women versus men.

“Women are less likely than men to be referred for an angiography (a procedure which looks at blood vessels), and to be prescribed beta blockers and statins at discharge following their heart attack. It is no wonder that outcomes for women in heart disease have become worse.”