KUALA LUMPUR: In October 2020, Mohd Yurizani Che Husin, 41, suddenly woke up at 3am with a sharp pain in his chest.
Apart from difficulty breathing, the teacher also had numbness in his fingers, shoulders and neck.
That was when he realised that he was having a heart attack.
He was rushed to Sultan Ismail Hospital in Johor Baru, where he was intubated and given morphine.
Yurizani was sent home four days later after his condition stabilised.
He was told that the hospital would call him to undergo angioplasty — a minimally invasive procedure to widen narrowed or obstructed arteries or veins.
Despite having a full-blown heart attack, that call only came six months later.
Yurizani said it was the longest six months of his life.
"I was worried that I would get another heart attack. The only thing stopping me from going to a private hospital was the cost."
The long waits for medical procedures that heart patients endure is a longstanding issue in the public healthcare system.
This, however, isn't surprising as 90 per cent of heart operations and treatments nationwide are being done by only 61 cardiologists and 14 cardiothoracic surgeons in public and university hospitals.
Serdang Hospital consultant cardiologist Datuk Dr Asri Ranga Abdullah Ramaiah said up to 2021, Malaysia had 338 registered cardiologists, with only 37, or 11 per cent, of them with the Health Ministry.
About seven per cent of them are attached to eight university hospitals — Universiti Malaya, Universiti Kebangsaan Malaysia, Universiti Teknologi Mara, Universiti Sains Malaysia, Universiti Putra Malaysia and Universiti Malaysia Sarawak.
The other 82 per cent of them are in private hospitals.
"The ministry has 37 cardiologists, who make up 11 per cent of the total. Yet we are bearing the brunt of cases because most patients can't afford to seek treatment at private hospitals.
"If we take into account our 33 million population, it would be 10 cardiologists per a million people. Seven years ago, the figure was more like seven cardiologists per a million people."
Dr Asri said the main problem was uneven distribution.
"In the Klang Valley, Penang and Ipoh, we have 40 to 50 cardiologists per a million people. But in the east coast, Sabah and Sarawak, the number is fairly small," he said, adding that Singapore's cardiologist-to-population ratio was 50 per million.
The issue of long waiting times for patients is exacerbated by the fact that there are only 14 cardiothoracic surgeons at the seven public cardiac centres in Serdang, Selangor; Johor Baru, Johor; Kota Baru, Kelantan; Kuantan, Pahang, as well as Penang, Sabah and Sarawak.
Of the total, only one specialised in children, Dr Asri said.
The National Heart Institute (IJN), which now has been separated into two wings — public and private — has 12 cardiothoracic surgeons, with only three specialising in children, as well as 15 cardiology consultants.
Cardiologists treat heart attacks and perform diagnostic procedures like angiograms and angioplasty. Cardiothoracic surgeons, meanwhile, perform heart bypass and lung surgeries, repair of heart valves or any surgery related to the chest area.
Dr Asri said the seven cardiac centres conducted 10,000 to 12,000 angioplasty procedures every year. With only 10 cardiologists, Serdang Hospital, he said, performed the highest number of angiogram and angioplasty procedures in Southeast Asia in 2019.
"In 2019, we did 6,386 angiograms and 3,533 Percutaneous Coronary Intervention, or PCI (angioplasty with stenting). Our numbers reduced significantly during the Covid-19 pandemic because we were declared a Covid hospital, so patients didn't come for treatments.
"Now, our numbers are slowly catching up. We have 2,500 to 3,000 patients per year and we conduct about 250 to 300 PCI per month. We also conduct 500 to 600 angiogram procedures per month or about 40 cases per day. We're like a machine," he said, adding that the waiting time for angiogram appointments at Serdang Hospital was between nine months and a year.
Meanwhile, the waiting time for coronary artery bypass grafting (CABG) or bypass procedure at Serdang Hospital is a year and two months.
Dr Asri said: "There is no proper international standard on how long the waiting time is for CABG but I always group the patients into three categories — critical ones who need surgery within the next two weeks, those whose
cases need to be settled within six to eight weeks and the elective group, within three to six months.
"We sometimes prioritise our patients based on symptoms. If they are in pain, we will prioritise them. But if they are stable, we will ask them to wait. We provide them with medication and tell them to rush to the Emergency Department if they feel any pain.
"But patients sometimes don't understand that. They ignore their pain and wait for their appointments.
"Another issue with making patients wait is that they may change their minds and decline surgery since they have been waiting for too long and they feel okay," he said, adding that there were more than 1,500 cases awaiting CABG surgery nationwide.
Dr Asri, however, said the ministry was taking measures to address the long waits, including training more cardiologists and cardiothoracic surgeons.
"The main trainers are IJN and the Health Ministry. IJN has at least 30 cardiologists in training. Usually, it will take about four years to complete the training.
"The ministry has 50, but the pandemic hampered our training because the doctors had to help with Covid treatment.
"It takes longer to train a cardiothoracic surgeon but last year, we had nine surgeons who passed," he said, adding that the ministry was streamlining training procedures to enable trainees to obtain fellowships, thus encouraging more participation.
He said public hospitals were also outsourcing their patients to universities and private hospitals.
"Serdang Hospital, for example, was given an allocation of RM7.65 million to outsource 170 patients, but we sent only 120 in 2021. One reason was due to Covid-19. Even the hospitals where we sent patients had outbreaks.
"Secondly, as mentioned earlier, some patients waited too long so they think they are okay and refused surgery," he said, adding that they also referred their patients to IJN to offload their burden.
Dr Asri said Serdang Hospital's Cardiology Centre, which began operations on Dec 12, was expected to expedite treatment and reduce the waiting period.
It was reported that the RM546 million cardiology centre would reduce the waiting period from 18 months to just nine months for stable elective cases, while emergency cases would be treated immediately.