Dr Omar Hallak talks about the journey towards establishing a cardiovascular center of excellence at King's College Hospital in the UAE and discusses advancements made in the field of cardiology in the country, particularly in terms of access to care, research, and technology.

 

When we last met in 2019, you were working to establish a cardiovascular center of excellence within the Kings College Hospital. Could you tell us more about this journey and your achievements in this regard?

The last few years have been an exciting journey. Back then, the hospital had just opened its doors, and I was trying to assemble a team of experts. We now count more cardiologists within our ranks, as well as a vascular surgeon and cardiac surgeons and are able to take care of a wide range of cardiovascular problems, including all acute myocardial infarctions coming into the emergency room 24/7. We also started an open-heart surgery program – we have recently performed our first open-heart valve surgery – and I’m happy to say that it was very successful.

Moreover, the CathLab is equipped with state-of-the-art imaging and interventional technology. Include intracoronary imaging and intravascular lithotripsy to help patients with calcifications in their arteries. When arteries are extremely calcified, it becomes very hard to introduce a stent inside. This new device makes it possible to « distract » calcium deposits and makes it easier to put a stent in. This technology has allowed us to handle much more complicated cases.

Regarding non-invasive cardiology treatments, we have a one-stop service cardiac as well as full vascular service for venous and arterial management.

We’re proud and excited that the cardiology service has advanced to cover almost all cardiovascular needs.

 

What are your priorities for the coming years for the hospital?

We want to continue implementing the newest technologies, especially ones for managing valvular heart disease using a percutaneous catheter, such as mitral valve clip, Transcatheter Aortic Valve Implantation (TAVI), and tricuspid valve clip.

We also want to do more research studying heart disease in the Gulf area, and possible differences with other regions. We are accepting medical students and involve them in these research projects. We already have several Case reports published in collaboration with these students, who are very excited to have their names featured in international journals. we’d like to conduct more research, with some projects already underway.

 

Cardiovascular disease is now one of the leading causes of death in the UAE. What has been done to tackle this challenge at the country level?

This topic could take us hours to unravel because there have been many changes and improvements.

For instance, the general public is now much more conscious of the prevalence, seriousness and risk factors of cardiovascular disease thanks to repeated awareness campaigns launched by the government and medical institutions and societies.

As a result, individuals are much more diligent when it comes to monitoring their cholesterol, blood sugar, and weight. Moreover, compared to a decade ago, people are engaging in more physical activity. For instance, you see a lot of people cycling as there are more than 50 kilometres of cycling lanes in Dubai.

At my level, I’ve been trying to help this public awareness effort. Every year, I organise an event called 4TS (Top to toe transcatheter solutions), welcoming more than a hundred renowned speakers from all around the world with partnerships with more than ten international societies including the American College of Cardiology. Before the pandemic, we organized an edition, called Heart Matters, where we invited the public to attend the event and had the opportunity to hear from local and international experts. We received great feedback from it and plan to open the next event to the public again.

There are large international meetings taking place almost on a weekly basis organized by various societies, among which the most prominent is the Annual Emirates Cardiac Society Conference. These events play a vital role in enhancing the standard of care by equipping physicians with up-to-date knowledge of the latest guidelines, recommendations, and technologies in the field.

Apart from education, access to healthcare services has also seen significant improvements over the last 15 years, owing to a substantial increase in the number of hospitals across the country. Dubai, for instance, has recently witnessed the opening of five major hospitals, in addition to other medical centers, that are well-equipped with advanced technology, staffed with highly-trained professionals. Several of these hospitals offer open-heart surgery and full interventional cardiology programs. Moreover, heart transplant services are available in Abu Dhabi.

With all these advancements, we can now cater to a significantly larger number of patients while providing high-quality care and addressing more complex cases without having to send patients to other countries. Actually, the country is now well-positioned to emerge as a leading hub for medical tourism.

Overall, I’m very happy with the improvement in the quantity and quality of care in the country.

 

How would you assess the research capabilities of the UAE?

With the advancements in technology and knowledge, there are now greater opportunities for conducting research in cardiology. Extensive research has already been carried out on various topics, including risk factors, such as the incidence of dyslipidemia, hypertension, diabetes, and obesity, as well as the treatment of atrial fibrillation and acute coronary syndrome. On this last topic, a study was conducted to investigate whether doctors in the Gulf region have achieved the treatment targets recommended by guidelines, and it was executed with great proficiency.

Furthermore, the Emirates have been actively participating in significant international research aimed at examining how genetic and lifestyle factors influence disease behaviour. As an illustration, studies have revealed that the average age of heart attack patients in the country is ten years younger than that of Europe and the US. This suggests that there may be genetic or lifestyle factors, or a combination of both, contributing to the higher prevalence of heart attacks in younger patients. By leveraging this data, we can develop a more targeted strategy for patients in this region.

Our approach is increasingly geared towards early detection and management of risk factors. To achieve this, country-wide screening campaigns are organized for employees of government institutions or large private companies to detect problems such as high cholesterol levels, high blood pressure, or diabetes. All of these risk factors act as silent killers as they do not exhibit any symptoms, making early screening all the more crucial.

 

You mentioned the 4TS conference you organize every year. Could you tell us more about this event?

4TS stands for Top to Toe Transcatheter Solutions, which means we cover solutions using catheters (minimally invasive procedure) instead of surgery such as open-heart surgery or vascular surgery for all diseases related to the cardiovascular system, from head to toe. This conference has been a great success with about 2000 attendee with about 100 speakers

The conference featured several prominent speakers, including Dr Edward T. Fry, President of the American College of Cardiology, Dr Ourania Preventza, President of the International Society of Endovascular Specialists, Dr Juwairia Alali, President of the Emirates Cardiac Society, Dr Ali AbuRahmah, former President of the American Society of Vascular Surgery, Dr Herbert D. Aronow, president of the American Vascular society, and Dr Victor Costache, former Romanian Heath Minister, among several others.

It served as a great platform to learn about the latest technologies in the field of cardiovascular health. I was particularly intrigued by the new generation of artificial heart support technologies as well as an injectable medication used for lowering cholesterol which is especially convenient for patients as it requires only two injections per year.

 

What do you see as the main areas of improvement for cardiovascular care in the country?

In my opinion, there is scope to enhance access to care in underserved communities and ensure that healthcare is available to everyone, regardless of their ability to pay. While the UAE does require insurance coverage, there are limitations to the extent of the coverage. It is important that every individual has full coverage for their healthcare needs.

To improve the overall health of the population, we should increase the screening programs to reach more people. This would aid in identifying silent diseases and taking prompt action to manage them. Collaboration between the government and the private sector is crucial in achieving these goals.