1. Developing Cardiac Rehabilitation in Vietnam Dr Juliette Hussey School of Medicine Trinity College Dublin Ireland

2. Content Data outlining need for Cardiac Rehabilitation in Vietnam Collaboration to date How a university can change the world- in relation to cardiac rehabilitation

3. VIETNAM Population of Vietnam: 86,206,000 Population of : Ho Chi Minh City (Saigon): 7,123,340; Hanoi 6, 452,000 Country: 331,690 sq km

4. Cardiovascular disease in LMICs and Vietnam Cardiovascular diseases and their risk factors emerging as the leading cause of morbidity and mortality in developing countries including Vietnam Double burden of disease- common communicable diseases and emerging non-communicable disease during early stages of health transition

5. Need for cardiac rehabilitation in LMICs Globally CVD accounts for 29.2% of deaths and 80% of these in LMICs Rapid increase in cardiovascular and non-communicable diseases Primary and secondary prevention required

6. Need for cardiac rehabilitation in Vietnam Ischaemic heart disease and cerebrovascular disease- 13% and 11% of all cause mortality in Vietnam Extent of risk factors unknown- but indications they are rising Success in management of chronic diseases depends on long term adherence to treatment, risk factor modification and lifestyle changes. Key to reducing deaths is to modify risk through prevention strategies targeting cardiovascular risk factors

7. Tabacco related diseases 40 000 people in Vietnam die each year due to smoking (WHO) One of the highest male smoking rates worldwide Over half of adult men smoke

8. Chronic disease in Vietnam Country experiencing rapid transition and increased burden of chronic disease Poorer people more vulnerable to chronic diseases and their risk factors ( other than overweight) We know the causes of cardiovascular disease but need to understand the cause of the causes Chronic diseases shown to cause economic loss for families

9. Health care system Hospitals- overcrowded Very basic nursing- families provide majority of care In case of cardiology rapid advances in interventions and surgery Need to develop primary care, health promotion and rehabilitation services

13. Definitions of Cardiac Rehabilitation 2000 Scottish Intercollegiate Guidelines Network (SIGN) Guideline 57 states “Cardiac rehabilitation is the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals, are encouraged and supported to achieve and maintain optimal physical and psychosocial health” “Cardiac rehabilitation is the process by which patients with cardiac disease, in partnership with a multidisciplinary team of health professionals, are encouraged and supported to achieve and maintain optimal physical and psychosocial health” (SIGN) SIGN. Guideline 57 Cardiac Rehabilitation. Available at: www.sign.ac.uk/guidelines/fulltext/57/section1.html. www.sign.ac.uk/guidelines/fulltext/57/section1.html

14. Principles of Cardiac Rehabilitation Behaviour change SmokingExercise Weight management NutritionLipids Blood pressure Psychosocial factors

15. Developing cardiac rehabilitation in Vietnam- aims To provide initial education, training and practical assistance for the development of Cardiac Rehabilitation services which will act as reference centres for the development of services in surrounding provinces To facilitate a sustainable education and training programme for the expansion and delivery of cardiac rehabilitation services

16. Strengths from TCD Considerable experience academically and clinically in the area of exercise in prevention and treatment of disease MSc in Cardiac Rehabilitation and Prevention since 2002- approx 45 students supervised to date Now translating much of this experience into the rehabilitation of patients with other chronic diseases- pulmonary disease and cancer

17. Collaboration to date ASEAN Cardiology conference in 2008 held in Hanoi and one session on cardiac rehabilitation Two day introductory course in Ho Chi Minh in 2010 Undergraduate physiotherapy students on elective placement Have identified and agreed a number of steps necessary but need funding

18. Two day introductory course to cardiologists, cardiac nurses, rehabilitation physicians and physiotherapists

19. Participants from Ho Chi Minh

21. How can a University change the World?- case of developing cardiac rehabilitation Collective experience which can be very broad Knowledge Analytical skills In the case of Health Sciences- built on clinical and professional experience and large network of colleagues nationally and internationally Experience in interdisciplinary working

22. Acknowledgements HRB/Irish Aid – Networking grant Bachmai Hospital and Vietnam Heart Institute in Hanoi Cho ray and An Binh Hospitals in Ho Chi Minh City