Medical Tourism and Electrophysiology in Malaysia

Razali Omar, MD, FHRS and Robaayah Zambahari, MD, FACC National Heart Institute (IJN) Kuala Lumpur, Malaysia
Razali Omar, MD, FHRS and Robaayah Zambahari, MD, FACC National Heart Institute (IJN) Kuala Lumpur, Malaysia
Over the past decade, with the emergence of medical tourism, Asian countries have been the preferred destination for many people seeking less expensive but high-quality medical treatments coupled with highly competent and qualified specialists. The increase is partially due to high medical costs in western countries like the United States and the United Kingdom. Specialized treatments, surgeries, and therapies are being offered in Asia at a fraction of the cost, yet with bigger perks when it comes to hospitality and patient comfort. Countries like Thailand, Singapore, and Malaysia are favorites among medical tourists mainly because of the significantly cheaper health care, which can cost as little as 10 percent of comparable care in the U.S., but still provide quality treatments by medical experts who have been trained in the U.S., U.K., and other western countries. With health care cost skyrocketing, it’s no surprise to see why patients from even developed countries such as America head to Malaysia for health screenings, treatments and medical procedures. Strategically located in the bustling city of Kuala Lumpur, and strongly commanding a number of "firsts" in cardiac breakthroughs, the National Heart Institute (IJN) in Malaysia is a favored destination for patients seeking cardiac treatment, especially for those within the region. Having treated more than 1.5 million patients — including international patients — over a span of 17 years, IJN has now become a hub in the treatment and management of heart diseases, be it for infants, children or adults. The will to excel and the aspiration by the highly dedicated and committed medical team to make breakthroughs and keep abreast with technological advancements in the field of cardiac medicine and surgery, has made IJN a medical tourist destination for patients all over the world. Background Established in 1992, IJN, a government-owned company under the Ministry of Finance Inc., is Malaysia's premier cardiac health care facility that over the years has evolved into an internationally recognized institution for its outstanding achievements in the treatment and management of heart diseases. IJN offers a comprehensive range of services for cardiovascular medicine that include all types of interventions (diagnostic and therapeutic), as well as cardiac surgery in open-heart, closed-heart, thoracic and heart and lung organ transplants. We constantly challenge ourselves to keep abreast with the latest medical advancements in all aspects of patient care. From the time of our inception up until December 2008, we recorded a total patient attendance of more than 1.5 million, with more than 230,000 registered patients. Our team has performed a total of more than 41,700 heart surgeries and more than 95,500 interventional procedures. Expanded Services In August 2009, we officially launched our new building after a four-year expansion program designed to deliver improved patient and customer care. The world-class amenities, technologies and services offered within the new wing will permit IJN to cement its growing reputation as a center of excellence for cardiac care in the region and support its goal of providing first-class healthcare to a growing customer base. The new facility has been planned to provide optimum quality of care, convenience and comfort for the increasing number of patients seeking health services, as well as for their families, relatives and friends. Notably, to ensure that patients are attended to quickly, the new facility provides 24 outpatient clinics with separate registration and decentralized payment counters and a dedicated international patient center catering to foreign patients’ need. IJN devotes considerable attention to the well-being of children, and is recognized for its innovative pediatric heart services. Accordingly, the new building features a dedicated pediatric clinic to cater to children born with congenital heart disease. The expansion project also involves the refurbishment of existing buildings to make way for additional clinics, which will bring us to a total of 59 outpatient clinics to cater to about 600 outpatients that we serve daily. IJN now has a total of 438 patient beds, including 54 ICU beds, 40 CCU beds, 26 daycare beds, 6 cath labs (with capacity to increase to 10 for future extension), 7 operating rooms, 1 hybrid cath-OT (the first in the region), a dedicated rehabilitation center and a dedicated heart screening center. While innovation is the thrust behind our pursuit for excellence, it’s undoubtedly the unified team spirit that gained us many accolades over the years and in fact garnered many "firsts" in cardiovascular medicine, the latest being the first in Asia to perform a transcatheter aortic valve implantation with the Medtronic CoreValve® System to treat severe aortic stenosis in 2009. Focus on Electrophysiology Our electrophysiology services, which started in 1992, is one area we have excelled and gained tremendous recognition from our peers in the region and worldwide. The EP unit has three consultant electrophysiologists, three EP technicians and two research assistants. The unit provides specialized investigations and treatments for the whole range of cardiac arrhythmias, implantation of permanent pacemakers, implantable defibrillators, and cardiac resynchronization therapies. Over the last 17 years, IJN’s EP team has recorded a total of 4,197 cases. Last year alone, the team performed 360 radiofrequency catheter ablations; almost 74 percent of the cases were supraventricular tachycardia (SVT), the rest being ablations for more complex arrhythmias such as atrial flutter and ventricular tachycardia (VT), both for structurally normal hearts and post infarct VT. Our first atrial fibrillation (AF) ablation was performed in 1999, and since then we have done close to 200 cases. Initially the number of cases was small, but recently we have seen a surge so we envisage the number to increase in the following years. Last year alone we did 40 AF ablation cases, which is 20% of the total for the last 10 years! The majority (75%) were for paroxysmal AF, and the rest (25%) were for persistent AF. The EP unit has been using 3D non-contact mapping (EnSite, St. Jude Medical, St. Paul, MN) since 2000 to do complex arrhythmias, which include AF ablations, atypical atrial flutters and post infarct VTs. Over the last year, we have begun to use a catheter system for AF ablation by Medtronic Ablation Frontiers. This system consists of a circular multipolar catheter capable of delivering radiofrequency energy simultaneously in both bipolar and unipolar modes, resulting in pulmonary vein antrum isolation. Since adopting this new method, our procedure time has reduced considerably to an average of 90 minutes for paroxysmal AF ablation and 120 minutes for persistent AF ablation. To date, we have also implanted a total of 3,227 pacemakers. In 1996, the EP team pioneered the implantation of cardioverter defibrillators (ICDs) in the country, and has since implanted 724 ICDs. Our will to further excel in patient care drove us to initiate the cardiac resynchronization therapy device implant in 1999, and have to date done approximately 400 cases. We must highlight that IJN as a single institute has successfully achieved the highest number of ICD and CRT implantations in Asia. We have been recognized as a training center for CRT implants in Asia, and since 2006, we have trained about 100 cardiologists from Japan, China, Hong Kong, Taiwan, South Korea, the Philippines, Vietnam, Thailand, Singapore and Brunei. Summary To summarize, IJN’s team of physicians have introduced innovations in interventional cardiology, cardiac electrophysiology as well as cardiac surgery. The array of EP procedures performed at IJN includes catheter ablation for simple and complex arrhythmias, implantation of pacemakers, defibrillators and cardiac resynchronization therapies. With the history of innovations and our vision to be the center of excellence in cardiovascular and thoracic care, IJN has also placed its utmost importance in quality care and service delivery. IJN achieved ISO 9000-2001 and MSQH’s (Malaysian Society for Quality in Health) accreditation in 2004 and 2005, and recently was awarded the prestigious Joint Commission International (JCI) accreditation in December 2009, making it the first government-owned hospital in Malaysia to be internationally accredited by the JCI. For more information and enquiries, email info@ijn.com.my or visit www.ijn.com.my for more details of the services and facilities.