Assistant Professor Dr Jasper Tromp has lived and worked in the Netherlands, Germany, Japan, and Singapore over the past seven years. These experiences have given him insights into the impact of different health systems and cultural differences on health and healthcare, particularly in the area of his research expertise in cardiovascular disease.
He has been working in Singapore for the last five years, with a focus on identifying differences in quality of care or cardiovascular disease between countries and Digital Health interventions to improve care.
Why Is Cardiovascular Disease A Public Health Priority?
Cardiovascular diseases include ischaemic heart disease, heart failure and cerebrovascular disease (or stroke). Ischemic heart disease is the build-up of plaque on the inside wall of the artery restricting blood flow.
Although highly preventable, cardiovascular disease is still the leading cause of death in Asia-Pacific. Patients with cardiovascular disease in Asia are about a decade younger than those in the West.
When I first started working in Singapore, I was struck by how young many of the patients with cardiovascular disease were.
Our research has found that there are significant differences in terms of mortality from cardiovascular diseases across the region. For example, in Singapore, the average age of patients presenting with heart failure is 62, while the average age in Indonesia is 50. These are both low compared to some Western countries – in Holland the average age is 75.
The differences are likely due to variation in risk factors and access to healthcare, as well as a possible genetic component.
What Can Be Done To Prevent Cardiovascular Diseases?
The risk factors for cardiovascular disease overlap with other chronic diseases – obesity, hypertension, diabetes, smoking and alcohol use. Prevention around these risk factors is crucial to reducing the burden of disease.
Singapore’s War on Diabetes has been excellent in focusing on the common risk factors for most chronic diseases as reducing the level of diabetes will go a long way in also reducing cardiovascular diseases. I’d like us to go further and faster in approaches to reduce smoking prevalence and cholesterol, increase healthy diets and physical activity and manage blood pressure and blood sugars.
Access to care is also an important part of the puzzle; there are specific issues in the region and Singapore that need to be researched further and addressed sensitively. One is around the impact of the family on treatment of patients in need of cardiac care.
The ability to pay is linked to an assessment of the family income and thus families can play a role in determining whether a patient is treated of not. Similarly, there is a culture component around treatment versus care for those at the end stage of heart failure, and a reluctance or perhaps fear to move from curative to palliative even when treatments no longer remain a viable option for controlling the disease. These issues need more unpicking to ensure care is provided based on need and quality of life considerations.
As the population ages, it will become increasingly important to address risk factors and access to care, in order to enable people to age healthily and stay independent for longer. This will become an emerging serious issue as Singapore has one of the fastest ageing populations.
How Are Trends Analysed?
Singapore benefits from a few large disease databases – the one I work on is housed in the National Heart Centre. This is a rich source of information that can be analysed to identify trends and outliers. The Saw Swee Hock School of Public Health is working to build up a team to analyse the data further to inform policy makers on emerging trends and to advocate for strategies to address the key risks associated with cardiovascular disease.
Regionally, I am a member of the Expert Committee of American Heart Association on quality of care of heart failure in Southeast Asia. This group is undertaking the first multinational prospective study on implementing a quality improvement programme for heart failure in Southeast Asia.
How Has The Pandemic Impacted Your Work?
When the pandemic hit, I was visiting family in Holland and working in a clinical placement. Measures were imposed quite rapidly and I could not leave instantly due to clinical commitments. I ended up being stuck out of Singapore for the whole of 2020 and was finally able to return in April 2021 after I received approval after more than 15 applications.
I think I’ve probably spent about six months of the pandemic in one form of lockdown or another, either in Holland or in Singapore. Unfortunately, many of my ongoing projects are outside of Singapore and I’m currently not able to travel overseas to perform local site visits.
Online work has obviously increased during the pandemic, and the teaching I’m about to start with year two medical students will leverage on online tools.
If You Could Change One Thing About The Treatment Of Cardiovascular Disease, What Would It Be?
So many of the key areas to focus on are common knowledge, but an area that is often overlooked is centered around improving the patient perspective and sharing the decision making with the patient based on imparting clear and concise information.
Some of the treatments at the end-of-life phase can be aggressive and futile; there can be a reluctance to talk about death and dying with patients and families. But talking about options and what each would mean for quality of life can make the end of life more comfortable for patients.
Given Your Experience Of Multiple Health Systems, Are There Other Areas You Would Like To Research On?
One area I would like to further explore is around the incentives and barriers in the complex dynamic system of healthcare and impact on care and outcomes, as well as the impact on cultural expectations on health care delivery.
Each health system that I’ve worked in has pros and cons, but ones that manage the costs and quality more effectively do seem to have an awareness of incentives and the dynamics of the complex system. They focus on affordable and accessible primary care, have a gatekeeping role to specialist care based on best evidence, and promote patient empowerment and self-care.
The pandemic has illustrated this more clearly than other diseases – with some countries adopting lower thresholds for admission resulting in rapid pressure in the hospital system.
Share Something Interesting About Yourself
I’m a huge fan of cats. Whenever I can, I try to facetime with my 18-year-old cat, Sylvester, back home in the Netherlands.