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關心您的心 冠心病及其療法認知調查 SURVEY ON KNOWLEDGE OF CORONARY HEART DISEASE AND TREATMENTS

關心您的心 冠心病及其療法認知調查 SURVEY ON KNOWLEDGE OF CORONARY HEART DISEASE AND TREATMENTS. 傳媒發布會 Press Conference 19/11/2013. 發布會內容 CONTENT. 研究背景及目的 Research background & objectives 調查方法 Research methodology 調查結果 及分析 Research findings & analysis 有關冠心病及其療法簡介

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關心您的心 冠心病及其療法認知調查 SURVEY ON KNOWLEDGE OF CORONARY HEART DISEASE AND TREATMENTS

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  1. 關心您的心冠心病及其療法認知調查SURVEY ON KNOWLEDGE OF CORONARY HEART DISEASE AND TREATMENTS 傳媒發布會 Press Conference 19/11/2013

  2. 發布會內容CONTENT • 研究背景及目的 Research background & objectives • 調查方法 Research methodology • 調查結果及分析 Research findings & analysis • 有關冠心病及其療法簡介 About Coronary Heart Disease & its treatment methods • 個案分享及總結 Case Sharing & Conclusion • 「關心您的心」近期活動Care For Your Heart upcoming activities

  3. 研究背景及目的RESEARCH BACKGROUND & OBJECTIVES

  4. 「關心您的心」介紹About CARE FOR YOUR HEART • 成立於一九九五年十一月，是首個由患有各類心臟病患者及家屬組成的社區互助組織 Founded in 1995, Care For Your Heart is the first community-based cardiac patients self-help association • 得到榮譽贊助人梁唐青儀女士的鼎力支持並由各界專業人士，包括心臟專科醫生、營養師、物理治療師、社會工作者、護士及職業治療師等擔任名譽顧問 The association has been supported by Mrs. Regina Leung as Patron of the association and a board of Honorary Advisers from various specialties, including cardiologists, dietitians, pharmacists, social workers, nurses, therapists and other professionals • 本會致力為病友及市民大眾提供全面心臟健康及復康服務 The association is committed to provide comprehensive heart health and rehabilitation service to patients and public • 服務宗旨為發揮會友及家屬互助互勉精神，解開因病帶來的困惑和恐懼。攜手共進復康之路，邁向豐盛人生。To promote mutual support and self-help among cardiac patients and family members for betterment in heart health and well being of life • 本會的服務範圍包括舉辦心臟復康活動、病友互助小組及分享聚會、病友關懷服務、心臟健康推廣活動、心臟資料製作及權益爭取及倡導。 Our services include cardiac rehabilitation service, patients mutual support groups and caring service, telephone counseling, public heart health promotion, production of education materials and advocacy

  5. 研究背景及目的 Research Background & Objectives • 心臟病是香港第三號殺手。在各種心臟病當中，冠心病是引致心臟病死亡的主因，佔68.9%* Heart disease is the 3rd highest cause of death in Hong Kong and Coronary Heart Disease (CHD) makes up 68.9%* of heart diseases deaths • 現時冠心病療法當中，進行「通波仔」植入心臟支架為香港最常見的療法 PCI stenting is a common treatment for CHD • 而在「通波仔」支架選擇上，亦該因應病人不同的身體情況而作出不同的選擇 Patients should talk with their doctors to choose the most suitable stents according to the different patient conditions • 有見及此， 心臟病人互助組織「關心您的心」進行香港冠心病患者對「通波仔」療法的認知調查，旨在了解本港冠心病患者對「通波仔」療法選擇及其服藥療程的認知，亦藉此增進市民對療法選擇的了解 Care For Your Heart, the cardiac patients mutual support association, conducted a knowledge survey of PCI treatment options and associated medication among CHD patients in Hong Kong, with the objective of enhancing understanding of the treatment among the community and the general public * 香港衛生署 2011年統計數據（2011 Data, Department of Health）

  6. 調查方法 RESEARCH METHODOLOGY

  7. 調查方法Research Methodology • 調查日期 (Interview period)： 2013年7月15日 – 2013年8月2日 July 15 – Aug 2, 2013 • 訪問對象 (Target sample)： 「關心您的心」病友 （曾進行通波仔手術的冠心病病人） Members of Care For Your Heart (Patients who had undertaken PCI) • 調查方法 (Methodology) : 由「關心您的心」訪問員對該病友組織的患者進行電話訪問 Interviewers of Care For Your Heart to conduct telephone interview with the members of the association

  8. 調查方法Research Methodology • 問卷主要研究以下部份 (The questionnaire mainly looks into the following parts)： • 對「通波仔」療法植入支架種類的認知 The knowledge about different types of stents • 對進行「通波仔」後服藥療程的認知 The knowledge about medicationafter PCI • 對常規心臟健康檢查重視程度 The awareness of the importance of regular heart health test • 冠心病患者獲取療法資訊的途徑 The information channels of CHD for patients • 樣本數目(Sample size)：215個成功個案 (215 successful cases) • 有效回應比率(Respond rate): 87.8%

  9. 樣本年齡及性別分布Distribution of Sample by Age Group and Gender • 受訪者年齡介乎36歲至89歲之間，大多數（67.4%）受訪者介乎61歲至80歲；樣本中男性佔七成五 The sample population was aged between 34-89 and the majority (67.7%) aged between 61-80. About 75% of respondents were male

  10. 研究結果及分析RESEARCH FINDINGS & ANALYSIS

  11. 對心臟健康的注意程度Awareness of Heart Health • 逾三成半受訪者在過去一個月沒有接觸有關心臟病的資訊 Over 35% of respondents had not came into contact with information about heart disease over the past month

  12. 對心臟健康的注意程度Awareness of Heart Health • 過半數受訪者十分樂意了解更多關於冠心病資訊Over 50% of respondents are interested in reading information related to PCI

  13. 心臟病療法及護理資訊來源Source of Getting Treatments Information • 超過六成受訪者表示通過健康講座或小冊子瞭解心臟病療法Over 60% of respondents indicated that health talks, leaflets and booklets were the main source of getting information about treatments of heart disease • 仍有超過一成六受訪者認為坊間有關心臟病療法的資料不足夠There is still 16% of respondents expressed that there is not enough information about heart disease treatments out there

  14. 對支架的認識Knowledge on Stent Options • 接近三成受訪者未能講出任何一種支架類型Almost 30% of respondents could not name any one type of stent • 僅一成七受訪者能答中三種以上支架Only 17.7%of respondents were able to name 3 or more types of stent • 現時香港共有五種支架可供選擇 - 裸金屬支架、藥物塗層支架、生物工程支架、全吸收式生物血管模架及最新推出的雙療法支架There are 5 types of stent available for PCI in Hong Kong – Bare Metal Stent, Drug Eluting Stent, Bio-engineered Stent, Bioresorbable Vascular Scaffold and the latest Dual Therapy Stent

  15. 植入支架類型Stent Implanted • 接近兩成受訪者不清楚自己血管內所植入的支架類型18% of respondents did not know the type of stents that has been implanted in their vessels • 超過一半受訪者植入了藥物塗層支架More than half of the respondents were implanted with Drug Eluting Stent

  16. 選擇支架準則Criteria when Selecting Stent • 接近八成受訪者聽從醫生建議選擇支架類型78% of respondents followed doctor’s recommendations when selecting stents • 僅約一成受訪者以支架療效作為選擇準則Only 10% of the respondents chose the stent because of its efficacy

  17. 了解心臟支架種類的主動性Intention to Know More about Stents • 即使接近八成受訪者聽從醫生建議選擇支架，仍有約四成認為在術前沒有得到足夠有關支架的資訊，但同時超過一半受訪者表示從未向醫生主動了解Although almost 80% of respondents depended on doctors when choosing stent, still about 40% believed that they did not receive enough information from their doctors; however, over 50% did not actively seek for stent information from their doctors • 若對支架選擇存有疑問或認知不足，我們鼓勵病人應多發問，及主動向醫生了解Patients are encouraged to asked more if they do not understand about the stent options

  18. 支架及所配合藥物療程的認知Knowledge of Stents and Its Medical Treatment • 逾半受訪者知道植入不同類型支架，醫生所建議的服藥時期會有所不同。 但仍有四成七受訪者表示不知道More than half of the respondents realized that the medication treatment period varies between stents, but still there is 47% of them did not know about this • 一般來說， 不帶藥及有抗體塗層的支架服藥期較短， 植入藥物塗層支架則需長期 (不少於12 個月) 服用雙重抗血小板藥物。而植入雙療法支架，根據研究指引需服藥6個月In general, medication treatment after implanting stents without drug or with antibody-coating would be shorter. With Drug Eluting Stents, patients would be required to take longer period (not less than 12 months) of dual antiplatelet therapy. And for Dual Therapy Stent, according to study’s protocol, 6 months medication is recommended

  19. 服藥時間Period of Medication • 超過九成受訪者於術後需服用雙重抗血小板藥物12個月或以上，逾半更需要永久服用Over 90% of respondents has been instructed to take DAPT for 12 months or more, more than 50% need to take DAPT for life • 雙重抗血小板藥物的作用為減低血塊形成的機會，降低血管栓塞的風險The use of DAPT is for preventing the formation of blood clots in order to reduce the risk of thrombosis • 長期服用雙重抗血小板藥物有機會增加出血風險， 服藥期間要動其它手術而需要停藥的病人，血管栓塞的風險亦會增加Long-term DAPT might increase the risk of bleeding. For patients who need to stop the medication due to near-term surgery, risk of thrombosis will also increase

  20. 服藥依從性Medication Compliance • 有近三成受訪者表示曾經忘記服用雙重抗血小板藥物29% of respondents have experienced forgetting to take prescribed medicine DAPT on time after undergoing PCI

  21. 需要停藥的情況Termination of Medication • 約半成受訪者表示曾經因要進行手術以停藥，兩成三則根據醫生指示暫停或停止服用About 5% of the respondents indicated that they had to terminate the medication due to surgery. 23% was instructed to suspend or terminate the medication by their doctors • 而逾七成半受訪者於未有醫生指示下自行停藥，當中原因以忘記服用為最多 (66%)，亦有人表示因不知道是否需要，或認為不需要而決定暫停或停止服用雙重抗血小板藥物More than 75% of the respondents had stopped taking DAPT without doctor’s instruction, most of them (66%) said they have forgotten to. Some of them expressed that they suspendedor terminateddue to the uncertainty of the need for the medication or felt that there was no need to take the medication

  22. 醫生所提供有關藥物的資訊DAPT Information from Doctors • 超過六成受訪者表示醫生於手術後有告訴他們於服藥期間如需進行其它手術或有出血情況出現應該怎麼做More than 60% of respondents said that doctors had told them what they should do if they need to undertake other surgery or bleeding occurred during the medication period • 建議市民如有需要進行「通波仔」，應主動瞭解多一點有關服藥的資訊， 以及自己的身體狀況是否適合長期服用抗血小板藥物。It is suggested that patients should take the initiative to acquiremore information about the medication, and to learnif their own condition is suitable for long-term DAPT

  23. 服藥依從性Medication Compliance • 大部份受訪者均表示即示身體狀況好轉(87%)或感到不適(83%)亦不會自行停藥Most of the respondents indicated that they would not stop taking DAPT even if they feel better (87%) or experience side effect symptoms (83%) • 但仍有逾一成表示即使醫生沒有許可， 仍會自行停藥However, there was still more than 10% of the respondents expressed that they would stop taking DAPT without doctor’s permission

  24. 不依時服藥風險的認知Knowledge of Associated Risks of Medication Non-compliance • 逾半數受訪者均能講出植入心臟支架後沒有按時服藥的最大風險 - 血塊形成及血栓More than half of the respondents were able to identify the largest risk of not taking DAPT on time - Blood Clot Formation and Thrombosis • 僅4 人 (1.9%) 意識到擅自停藥或會導致死亡Only 4 respondents (1.9%) mentioned that it may lead to death • 仍有逾三成半受訪者未能講出任何有可能出現的風險There were still 37% could not identify any one of the possible risks

  25. 有關冠心病及其療法簡介ABOUT CORONARY HEART DISEASE & ITS TREATMENT METHODS

  26. 冠心病簡介About Coronary Heart Disease 冠狀動脈心臟病」簡稱冠心病，是指環繞心臟的冠狀動脈因脂肪及膽固醇積聚而變得狹窄或閉塞。病人會因此血液流動不良，導致心肌缺氧，嚴重的甚至會引致心肌壞死，令患者心跳停頓而突然猝死 Coronary Heart Disease (CHD) refers to the narrowing and obstruction of arteries supplying blood to the heart through progressive accumulation of fat and cholesterol which leads to poor blood circulation, myocardial anoxia and even causes myocardial necrosis. In the worst case scenario, patients may die due to sudden cardiac arrest, or more commonly known as heart attack

  27. 冠心病簡介About Coronary Heart Disease 冠心病主要成因 The causes of CHD include • 膽固醇過高 (Excess cholesterol level) • 吸煙 (Smoking) • 過胖 (Excess fat) • 糖尿病 (Diabetes) • 高血壓 (Hypertension) • 生活緊張，壓力過大 (Stressful lifestyle under high pressure) • 缺乏運動 (Lack of exercise) • 家族遺傳 (Family history)

  28. 冠心病簡介About Coronary Heart Disease 冠心病目前的治療方法 Current treatments for CHD include • 藥物治療 Drug Treatment • 冠狀動脈介入手術, 俗稱「通波仔」 Percutaneous Coronary Intervention (PCI) • 冠狀動脈搭橋手術 Coronary Artery Bypass Graft Surgery

  29. 有關冠心病及其療法簡介About Coronary Heart Disease & Its Treatment Methods 冠狀動脈介入手術, 俗稱「通波仔」過程 簡介 The simple steps of PCI stenting 1. 一個帶球囊的導管穿過血管狹窄處 Balloon catheter is advanced through the site of arterial stenosis 2. 導管前端的球囊擴張，擴開血管狹窄處 Balloon catheter is dilated at lesion site to open up channel for blood circulation 3. 球囊回縮變小並撤出 The balloon catheter is deflated and withdrawn 4. 帶有支架的導管再次進入狹窄處，球囊導管擴張，支架同時被撐開釋放Stent pre-mounted on balloon catheter is then delivered to lesion site and deployed 5. 球囊回縮變小撤出，支架將永久置入血管內 Balloon catheter is withdrawn and the stent remains in the artery permanently

  30. 認識冠狀動脈支架 Coronary Stents • 一般情況下， 如冠狀動脈狹窄的情況不太嚴重，可以使用藥物控制病情。不過， 當血管收窄60%-70%以上， 便要考慮進行冠狀動脈介入治療術， 將冠狀動脈支架植入， 支撐著血管。同一樣的支架並非完全適用於每位病人，醫生需視乎病人的情況而選擇使用哪一類型支架。如血管病變程度、禁忌症和經濟狀況等In general, if coronary stenosis is not severe (<50%), medication treatment might be advised to control the disease. However, with arterial blockage in excess of 60% to 70%, Percutaneous Coronary Intervention (PCI) would probably be recommended and the procedure often involves the implantation of coronary stent(s) to provide scaffolding to keep the coronary artery open permanently. In general, stent selection depends primarily on patients’ baseline characteristics; lesion type, contra-indications and patients’ financial situation may also be factors for consideration

  31. 認識冠狀動脈支架 Coronary Stents • 金屬網格管狀支架用於通波仔手術後用以永久支撐血管A metal mesh tube used to provide permanent scaffolding to keep coronary arteries open, usually following a balloon angioplasty • 不同類型支架都具有其獨特的屬性、優點和缺點Various stent types with each having its distinctive properties as well as advantages and disadvantages 現時支架大致可分五類： There are currently 5 types of stents available in the market: • 裸金屬支架 (Bare Metal Stent) • 單療法支架 (Mono-therapy Stent) • 藥物塗層支架 (Drug Eluting Stent) • 生物工程支架 (Bio-engineered Stent) • 全吸收式生物血管模架 (Bioresorbable Vascular Scaffold) • 雙療法支架 (Dual Therapy Stent)

  32. 裸金屬支架Bare Metal Stent

  33. 裸金屬支架 (BMS) 性質 Properties • 純金屬支架，植入心血管後能將血管阻塞的地方張開，令血液能再次暢通運行A plain metallic scaffolding without any coating that can immediately widen the blockage area (lesion) within the blood vessel after implantation to facilitate regular blood flow 強項 Advantages • 費用較其他種類的支架便宜；而手術後一般只需服用一個月雙重抗血小板藥物（如: 柏域斯及阿士匹靈）Costs are relatively cheap. After implantation, patient will need to take one to twelve months dual anti-platelet therapy (i.e. Plavix and aspirin) 弱項 Disadvantages • 因血管內壁的細胞過度增生而導致心血管再次收窄的機率相對較高A relatively higher chance of vessel re-narrowing or restenosis as a result of hyperplasia caused by vessel trauma during stent implantation

  34. 單療法支架Mono-therapy Stent

  35. 藥物塗層支架 (DES) 性質 Properties • 備有藥物塗層的金屬支架，藥物會慢慢滲透入血管壁，減少細胞增生，防止血管再度收窄An anti-proliferative drug is embedded in a polymer coated on the stent’s surface and is gradually released and absorbed through the vessel, reducing cell proliferation or hyperplasia, preventing re- narrowing of the vessel 強項 Advantages • 減低心血管再次收窄機會Effectively reduce the chances of In- Stent Restenosis (Re- narrowing) 弱項 Disadvantages • 手術後因抑制了內皮祖細胞的增長，有礙血管癒合，增加支架位置形成血栓的機會，故需長期（不少於12個月）服用雙重抗血小板藥物Anti-proliferative drug inhibits the growth of endothelial progenitor cells, delaying the natural healing process and increasing the chance of stent thrombosis. Recommended dual anti-platelet therapy (DAPT) is a minimum of 12 months

  36. 全吸收式生物血管模架 (BVS) 性質 Properties • 塗有藥物的可溶性模架會隨著時間分解然後被人體自然吸收A new type of drug coated stent platform which could naturally be absorbed and metabolized by the body in time, leaving no permanent implant in blood vessels 強項 Advantages • 能抑制血管壁細胞增生的藥物塗在可分解性塑膠物料而製的模架上，減低血管再次收窄機會，而模架則在植入血管兩年後消失 Coated with an anti-proliferative drug to minimize re-narrowing and the biodegradable scaffold will be dissolved after two years 弱項 Disadvantages • 由於這種模架的獨特物料結構的關係，如患有血管嚴重鈣化，迂曲或分叉病變等之病人可能不適用Due to scaffold material, may not be suitable in patients with calcified, tortuous and bifurcation lesions

  37. 據歐洲心臟病醫學會/歐洲心胸外科學會指引不適宜使用藥物塗層支架的病人ESC/EACTS Guidelines on Contraindications to DES

  38. 生物工程支架 性質 Properties • 支架內壁塗有抗體，吸附血液中的內皮祖細胞成為內皮層覆蓋支架表面，加快血管自然修復過程，降低血栓及血管再收窄的機會Stent is coated with antibodies that rapidly capture circulating endothelial progenitor cells in the blood stream, accelerating the natural healing process (endothelization) and reducing the chance of stent thrombosis and vessel re-narrowing 強項 Advantages • 加快血管壁自然修復過程，因此能減低晚期血栓及心血管再收窄的機率。醫生一般建議手術後只需服用雙重抗血小板藥物一個月Accelerated natural healing process reduces chance of late stent thrombosis and vessel re-narrowing. Recommend DAPT of one month after stent implantation 弱項 Disadvantages • 生物工程支架是一個自然癒合過程，它沒有殺死細胞的藥物塗層，因此第一年再收窄的機會略高於藥物塗層支架Absence of an anti-proliferative drug to suppress cell proliferation, resulting in a higher chance of vessel re- narrowing within the first year

  39. 再狹窄v.s. 血栓 Restenosis vs.Thrombosis （有效性與安全性）(Efficacy vs. Safety) 血栓Thrombosis 在血管成植入支架範圍出現或形成血塊 Presence or formation of blood clots in a vessel or on stented area 再狹窄Restenosis 先前經通波仔治療過的血管再狹窄或再出現阻塞 Re-narrowing or blockage of a previously-treated artery by coronary angioplasty 一般血栓形成導致的死亡機率比再狹窄相對較高的（45％）， 患者通常需要再接受治療 Thrombosis in general leads to a relatively higher chance of death (45%) compared with restenosis which usually results in need of re-treatment * Iakovou, I. et al. JAMA 2005;293:2126-2130

  40. 隨訪期間（％） 植入支架後內血栓形成的死亡率 Mortality During Follow up (%) Post-Stent Thrombosis 支架血栓的死亡率Death Following ST HR 13.1 (9.8–17.5) P<0.0001 患者 % N=210 N=12634 Wiviott SD, et al. Lancet. 2008.

  41. 最新型支架 Latest Stent Available

  42. 雙療法支架 Dual Therapy Stent

  43. 雙療法支架 (DTS) 性質 Properties • 全球第一隻擁有雙重療效的支架。結合了生物工程支架和藥物塗層支架的特性和優點，能同時修復血管内皮層並控制血管壁內膜增生A first-of-its-kind stent combining an anti-proliferative drug (on the abluminal surface) to control neointimal proliferation and an antibody (on the luminal surface) to accelerate endothelial coverage 強項 Advantages • 支架外壁上塗有藥物，能抑制血管壁細胞增生而降低再狹窄的機會。支架内壁則附有抗體，加快血管內皮層自然修復，從減低早期及晚期血栓之形成Anti-proliferative drug reduces vessel re-narrowing whist antibody promotes endothelialization or stent coverage, reducing the risk of stent thrombosis. 弱項 Disadvantages • 術後服用雙重抗血小板藥物的時間較裸支架及生物工程支架為長DAPT duration is longer than the period of Bare Metal Stent and Bio-engineered Stent

  44. 雙療法支架 (DTS)

  45. 雙療法支架 (DTS) 光學相干斷層掃描(OCT)影像顯示植入 單療法藥物塗層支架9個月後的支架 內膜覆蓋情況 OCT images of a monotherapy DES at 9 months with heterogeneous coverage 光學相干斷層掃描(OCT)影像顯示植入雙療法支架9個月後的支架 內膜覆蓋情況 OCT images of Dual Therapy Stent at 9 months showing homogeneous coverage

  46. 支架列表Stent Choices

  47. 手術後的藥物治療Post Surgery Medication Treatment • 雙重抗血小板藥物是指阿士匹靈及氯格雷兩種抗血小板藥物，作用是減低裝有支架的血管部位血塊形成的機會，從而減低血栓的風險Dual-antiplatelet therapy (DAPT) with aspirin and a thienopyridine ( clopidogrel or ticlopidine) reduces blog clotting/ thrombotic events • 五種支架由於其原理不同，所需服食雙重抗血小板藥物的時間長度亦不同The period of DAPT varies among patients implanted with the five different type of stents • 醫生一般建議植入裸金屬支架及生物工程抗體支架的病人服藥1個月，而植入藥物塗層支架及全吸收式生物血管模架的病人則須服用12個月或以上 。植入雙療法支架的病人，根據研究指引，建議服藥6個月Normally doctor would recommend patients who implanted BMS or Bio-engineered Stents to undergo 1-month DAPT, while patients who implanted DES or BVS need to undergo more than 12 months or above DAPT. For those with DTS, according to study’s protocol, 6 months is recommended

  48. 調查總結CONCLUSION 對支架選擇認知不足 Low Awareness about Stent Selection • 現時香港共有五種支架可供選擇 - 裸金屬支架、藥物塗層支架、生物工程支架、全吸收式生物血管模架及最新推出的雙療法支架。接近三成受訪者未能講出市面任何一種的名稱，僅一成七認識三種或以上支架There are 5 types of stent available for PCI – Bare Metal Stent, Drug Eluting Stent, Bio-engineered Stent, Bioresorbable Vascular Scaffold and the latest Dual Therapy Stent. About 30% of respondents could not name any types of stent available in the market; Less than 18% of the respondents were able to give the name of 3 or more types of stent in the market • 接近兩成受訪者不清楚自己血管內所植入的支架類型18% of respondents did not know the type of stents that has been implanted in their vessels

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