Heart disease

joined 9 months, 2 weeks ago

Pinakin. V Parekh

Senior Consultant Cardiologist

Dr. Parekh studied medicine at the National University of Singapore (NUS) and obtained his Bachelor of Medicine and Surgery (MBBS) in 2006. He placed a strong emphasis on both primary and specialist care and underwent simultaneous training in internal and family medicine. He obtained his Membership of the Royal Colleges of Physicians (MRCP, UK) in 2011 and Graduate Diploma in Family Medicine (GDFM) in 2012. He received comprehensive cardiology training at National Heart Centre Singapore (NHCS) and Changi General Hospital (CGH) and was accorded a Certificate of Specialist Accreditation in Cardiology in January 2017.

He is a member of the Singapore Cardiac Society (SCS) and a Fellow of the Academy of Medicine (FAMS) in Singapore. He is also a member of the British Cardiovascular Intervention Society (BCIS) and is a registered medical practitioner with the UK General Medical Council.

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Dr. Khurana performed his general cardiology training at several teaching hospitals in London UK, and subspecialty training in coronary intervention at Kings College Hospital, London and Vancouver General Hospital, Canada. He is an experienced interventionist routinely performing complex angioplasty. He received his UK Certificate of Completion of Training (CCT) in 2009. He became US Board Certified in Cardiac CT in 2009. Dr. Khurana was appointed consultant cardiologist at the National Heart Centre Singapore (NHCS) and visiting consultant to Changi General Hospital (CGH) in 2009. With his extensive training in the UK and Canada and contributions to research, he was accepted as a Fellow of the European Society of Cardiology (FESC) in 2010 and awarded Fellowship to the American College of Cardiology (FACC) in 2012. Dr. Khurana has mentored many cardiologists in Singapore and the surrounding region in the field of coronary intervention and conducted workshops for intravascular ultrasound and rotational atherectomy. He regularly performs and proctors interventional cases in neighboring countries. He recently pioneered renal denervation in Singapore, as an emerging procedure to treat resistant hypertension.

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Dr. Reginald Liew is a Senior Consultant Cardiologist and also Director and co-founder of the Harley Street Heart and Cancer Centre in Singapore. He specializes in the treatment of general heart conditions and heart rhythm disorders and regularly gives talks to the public and medical professionals on heart disease awareness and management. Dr. Liew studied medicine at Cambridge University and has trained and worked in leading medical institutions in the United Kingdom and Singapore. He obtained his PhD from Imperial College London and after completing all his post-graduate and specialist training, undertook the executive MBA course at Singapore Management University. He co-founded the Harley Street Heart and Cancer Centre in 2012, which is the first combined heart and cancer specialist centre in South East Asia. Dr. Liew has developed this into a well-known and respected medical specialist centre and is committed to growing the group further within Singapore and SE Asia.

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MICS Heart

MICS Heart

"The Minimally Invasive Cardiac Surgery and Robotic Heart Surgery program was started in 2008. Our early experience with the technique was at the Harvard Medical School’s BWH hospital and since its initiation it’s grown to be the largest minimally invasive cardiac surgery program and the only qualified robotic heart surgery program in the country. With an experience of over 15 years and over 3000 procedures our safety and outcomes are well established in the country as well as among our peers. ⦿ Minimally Invasive Cardiac Surgery ⦿ Robotic Heart Surgery ⦿ Minimally Invasive Valve Surgery ⦿ MICS CABG"

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joined 1 year, 8 months ago

michael macdonald

Consultant Cardiologist

Dr Mike MacDonald is a consultant cardiologist with over 20 years experience. He trained in the UK an dnow practices in Singapore. He has an interest in disease prevention, obesity and longevity.

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joined 3 years, 1 month ago

Heart Specialist MacDonald

Heart Specialist MacDonald

Dr Michael MacDonald is a Singapore based cardiologist and heart specialist. Dr MacDonald’s vast experience and extensive training, includes a fellowship at the Scottish National Advanced Heart Failure and Transplant Unit and a Fellowship in cardiovascular MRI at Royal Brompton Hospital, London. He was appointed as Consultant Cardiologist at Western Infirmary, Glasgow, UK in 2013. He was elected Member of the Royal College of Physicians (MRCP) in 2004 and Fellow of the European Society of Cardiology (FESC) in 2010.

Phone Number:
+65 9430 5007

Contact Email ID:

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joined 5 years, 1 month ago

Dr. Sish Chakrabarty

Consultant Cardiologist

Consultant Cardiologist

Heart Specialist Consultancy International, Harley Street, London

Clinical Examiner King's College University Hospital Medical School, London

Director and Consultant Cardiologist, Harley Street London.and Cambridge



Heart Specialist Consultancy International

12 Harley Street

London W1


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Preventing cardiovascular disease

  • 90% of the 17m heart related deaths each year are preventable

  • Not preventing heart disease will cost US$47 trillion over the next 20 years

  • Contrasting Indian and English preventative strategies are described

  • Devi Shetty, world renowned heart surgeon describes heart disease

  • Technology shifts the management of heart disease to communities and homes

Each year cardiovascular disease (CVD) accounts for more than 17 million deaths worldwide. Despite the fact that 90% are preventable, deaths from CVD are projected to grow to some 24 million by 2030. In addition to the human costs, the economic costs for not preventing CVD are estimated to be US$47 trillion over the next 20 years.

CVD is often asymptomatic, caused by atherosclerosis, and represents a family of conditions linked by common risk factors, and includes coronary heart disease, stroke, hypertension, hypercholesterolemia, diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia. Many people who have one CVD condition commonly suffer from other related conditions. Devi Shetty, world-renowned heart surgeon, founder and chairman of Narayana Health, India, describes heart disease:



Two prevention strategies

As CVD prevention strategies evolve, we describe two; both developed by cardiologists:

Billion Hearts Beating

Billion Hearts Beating is an open, and easy-to-use website launched in 2010 by Dr Prathap Reddy, and Indian entrepreneur and cardiologist who founded the Apollo Group; the first corporate chain of hospitals in India: Reddy is mindful that there are some 65 million people in India with CVD, but each year only about 100,000 of these receive specialist treatment. Unsurprisingly, 2.4 million people die each year in India from CVD. The Billion Hearts Beating website identifies five simple solutions for lowering the risk of CVD: (i) a healthy diet, (ii) cessation of smoking, (iii) increased physical activity, (iv) reduced stress, and (v) regular heart checks. The website invites visitors to regularly check their heart disease risk with its easy-to-use embedded risk calculators, and sign a pledge to follow recommended solutions to reduce their overall CVD risk.

JBS3 Risk Calculator

The Joint British Societies Risk Calculator, the JBS3, was launched in 2014 after a long iteration between experts from 11 British cardiovascular societies chaired by Professor John Deanfield, the British Heart Foundation Vandervell Professor of Cardiology at the University of London. The Calculator embodies the UK’s national guidelines for CVD prevention. Although available as an app, it’s recommended for doctors rather than patients because it requires data that are not readily available. The JBS3 is managed by the British Cardiovascular Society, supported by the British Heart Foundation, and allows doctors to assess and communicate a person’s true heart age, and lifetime risks of CVD. These communications are expected to motivate individuals to adopt healthier diets and lifestyles, which would lower their risk of CVD:

According to Shetty such risk calculators are symptomatic of rapidly growing technologies that are shifting the management of CVD away from hospitals, and into communities and peoples’ homes:



Cycle of care

The cycle of care for CVD includes, (i) prevention and control of risk factors, which need sustained and effective communications, (ii) surgical and medical interventions, which require screening and early interventions, and (iii) the maintenance of a healthy state, which requires effective communications for disease management, and the modification of diets and lifestyles. The communications of all three care-strategies are underserved because overwhelmingly doctors operate “hands-on” care to diagnose and treat symptoms, and are reluctant to embrace modern technologies to improve doctor-patient communications. Shetty explains:




Preventing CVD involves changing peoples’ behavior, which requires effective communications between health providers and the general public. Developing risk calculators is no guarantee of preventing CVD, but it’s a significant contribution to preventative strategies. It’s too early to assess the effectiveness of the JBS3 Risk Calculator, but it appears to have underestimated the challenge associated with getting overstretched and demoralised UK primary healthcare professionals to adopt it. The Billion Hearts Beating campaign fares better, not least because it engages individuals directly. To-date, over 355,000 visitors to the website have used its embedded risk calculators, and pledged to improve their diets and lifestyles in order to reduce their risk of CVD.  

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Devi Shetty’s hospital of the future
London heart attack sufferers taken to a specialist cardiac centre have a 60% chance of survival, whereas those taken to a standard A&E unit only have, at best, a 26% chance of survival: according to unpublished information from the London Ambulance Service.

Experts say that the current provision of cardiac services in north and east London have, "relatively poor patient outcomes in comparison to the rest of England", and suggest that St Bartholomew's Hospital in central London should be transformed into a huge cardiovascular surgery unit, and a hub for a comprehensive network of care, which would embrace GPs and local hospitals.

For years, Devi Shetty, world-renowned heart surgeon, philanthropist, Founder, Chairman and Executive Director of Narayana Health, one of Indian’s leading private hospital groups, has argued that, "One hundred or 200 bed hospitals are not the solution". Narayana Health has Asia's largest cardiac centre providing affordable world-class cardiac care. "Large specialist cardiac centres, treating high volumes of patients, staffed by specialists and equipped with the latest technology, save lives, reduce complications, lower costs, and are the hospitals of the future," says Shetty.

The Bart's heart centre
The proposed new Bart's Heart Centre is similar in concept to Shetty's 1,000-bed cardiac hospital in Bengaluru, which attracts patients from more than 70 countries, and each year, performs some 7,000 surgeries; 50% on children and new-borns. It also serves as a centre of excellence for cardiac services in regional communities.
The importance of culture
Besides size, Shetty also appreciates the significance of culture in developing the hospital of the future.
In Narayana's 24 hospitals in 23 cities, Shetty has developed a culture of improving clinical outcomes while reducing costs. All Narayana's 14,000 employees are committed to providing affordable world-class integrated healthcare services for people with complex medical needs.
No matter how large the new London cardiac centre, without an outcomes-orientated culture supported by every employee, the quality of patient care is likely to be inferior to that of Narayana Health.
Outcomes obsessed
Narayana's outcomes data are systematically collected, organised, widely shared and used to improve clinical guidelines and decision aids. Data sharing in Narayana creates peer completion and self-regulation, which improves clinical outcomes, without incurring the costs of heavy regulation and unwieldy bureaucracy.
Narayana's surgical outcomes compare well against the world's best. Its mortality rate within 30 days of the high-volume coronary artery bypass surgery is 1.4%, compared with an average of 1.8% for England and 1.9% for the US. Were these figures adjusted for risk, Narayana's outcomes would be even better. Narayana's hospital-acquired infection rate is 2.8% per 1,000 ICU days, which is comparable with the best hospitals in the world.

Challenging professional assumptions 
Like their UK NHS counterparts, Narayana's senior surgeons provide consultations for patients, lead operations, train surgeons and discharge patients. Unlike their UK counterparts, they're incentivised to spend more time in the operating room concentrating on what they do best - complex surgeries – while junior surgeons open and close surgical procedures and other health professionals attend patients in ICUs.
Typically, Narayana's surgeons work 60 to 70 hours a week, perform up to five operations a day and a third of their compensation is profit related. By contrast, UK's NHS consultant surgeons undertake between three to four procedures a week and their pay is based on 10 4-hour programmed activities a week and anything more is paid overtime. Unlike the NHS, Narayana has no rifts between clinicians and administrators; both are responsible for financial management. Every day, every doctor and every administrator receives a text message with the previous day's profit and loss statement.

Narayana's heart centre in Bangalore is a MECCA for western policy makers. All come away inspired but suggest that Narayana is an “Indian phenomenon”.

Perceiving Narayana Health as “Indian” fails to see the elephant in the room. In February 2014, Shetty opened a 140-bed hospital in the Cayman Islands as the first phase of a 2,000-bed Narayana Health City designed to capture share from the American healthcare market. "Our intention is not just to build a super specialty hospital; our intention is to build a hospital of the future," says Shetty.
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