The Breathlessness Ecosystem: Transforming Healthcare for Chronic Heart and Lung Patients
The prevalence of chronic lung and heart diseases among Singaporeans is currently significant, with up to 5.9% and 4.5% affected, respectively. These diseases include ischemic heart condition, chronic obstructive pulmonary disease, bronchiectasis, and interstitial lung disease.
Patients with chronic heart and lung conditions encounter a multitude of problems, including impaired physical and social function, and a heavy symptom load comparable to that of cancer patients.
During our clinical work, we often see how debilitating it is for patients with chronic heart or lung conditions. Among these patients, 60% to 90% of them experience breathlessness, along with physical symptoms such as constipation, gastroesophageal reflux disease, and urinary incontinence issues due to benign prostate hyperplasia.
Living with chronic breathlessness often leads our patients to experience a sense of helplessness and hopelessness. This deters them from exercising, resulting in diminished muscle strength, poorer mobility, and self-isolation. Unsurprisingly, almost a third of these patients suffer from depression and/or anxiety. As these patients’ moods and usual routines become disrupted, their caregivers also experience significant stress.
When patients with chronic heart or lung conditions avoid functional rehabilitation for fear of worsening their breathlessness, a vicious cycle of decline begins. This progressive decline in condition occurs over several years, with most patients becoming increasingly breathless and some become oxygen dependent.
Without adequate knowledge in symptoms and chronic disease management, patients experiencing breathlessness can be overwhelmed by panic and seek help at the emergency department frequently and repeatedly, adding to their healthcare cost. After being discharged, nearly one in four patients with chronic lung conditions are readmitted within 30 days, placing a high burden of care on hospitals and caregivers.
So how can we ensure that such patients stay physically and socially active to maintain a good quality of life?
Our Solution: The Breathlessness Ecosystem
Early palliative care and cardiopulmonary rehabilitation have been shown to improve these patients’ symptoms, quality of life, and disease self-mastery, but few community partners are equipped to manage these patients who are severely underserved. Financial difficulties and challenging transport arrangements also act as additional barriers for patients seeking rehabilitation.
Recognising these care needs and urgency for change, Tan Tock Seng Hospital developed the Breathlessness Ecosystem to serve the needs of patients with progressive heart and lung diseases. It comprises a network of palliative and rehabilitative services that integrates tertiary care, intermediate care, and community and hospice care.
The Breathlessness Ecosystem aims to:
This five-year initiative, which started in 2023, is led by our hospital’s palliative team in collaboration with rehabilitation medicine, cardiology, respiratory medicine, and allied health teams.
Integrated and Holistic Care
We designed the Breathlessness Ecosystem using a tiered framework, which assesses patients based on disease severity, symptoms intensity, and functional impairment before referring them to the appropriate healthcare providers to receive the proper care needed at every stage of their journey:
The comprehensive programmes provided under the Breathlessness Ecosystem will give patients in the community better access to early palliative care as well as cardiopulmonary rehabilitation. They will also get to learn more about their underlying conditions and self-management strategies.
When fully expanded over the next five years, the current Breathlessness Ecosystem will benefit patients across the National Healthcare Group, including those identified by Tan Tock Seng Hospital, Khoo Teck Puat Hospital, Woodlands Health, polyclinics, and a growing primary care network of general practitioners, thus ensuring timely, appropriate, and seamless care.
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Expanding Capabilities in the Community
By targeting care beyond hospital walls, the Breathlessness Ecosystem reaches out to support patients’ physical, mental, and social well-being at all stages of their illness rather than only at the terminal stage.
Key partners Ren Ci Hospital and Dover Park Hospice Day Care, for example, offer essential services such as individualised therapy and social support.
Given the positive patient outcomes, the Breathlessness Ecosystem plans to train community-based healthcare professionals at various Day Rehabilitation Centres on cardiac and pulmonary rehabilitation for patients with heart failure or chronic lung conditions, thereby enhancing service capacity and accessibility. ?
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Collaborative Support and Funding
To date, community care partners including AWWA, St Luke’s Eldercare, and Ren Ci Hospital are part of the Ecosystem. We are privileged to have them onboard, which has facilitated the exchange of expertise and knowledge to build palliative rehabilitation capabilities at Day Rehabilitation Centres, to meet the different needs of patients in the community. We are also grateful to partner with Lien Foundation and for its S$5.4 million funding support to help with development of the Breathlessness Ecosystem. We also extend thanks to Tan Tock Seng Hospital for their in-kind contribution of S$400,000.
With sufficient patient volume and time, we hope to demonstrate the effectiveness of bringing rehabilitation and focus on symptoms management upstream into the community for patients especially in early stages of heart and lung conditions, as well as the strength of strategic collaboration among community partners.
Breathing Easy in the Breathlessness Ecosystem
Over time, the Breathlessness Ecosystem plans to further leverage on the Active Ageing Centres to promote overall disease education, social engagement, and regular exercise among residents, especially the elderly. By advocating preventive health aligned to Healthier SG, our seniors will be more empowered to actively manage their conditions, slow functional decline, and minimise unplanned hospitalisations.
Furthermore, patients within the Breathlessness Ecosystem will receive caregiver support and opportunities to meet other patients with similar conditions and challenges, allowing them to build a community of care for one another.
As an initiative that integrates and expands palliative and rehabilitative services well into the community, the Breathlessness Ecosystem is transforming the way NHG work together with its partners to care for patients, enabling them to lead healthier and happier lives.
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