INTERVIEW

Dr. Chuwa Tei

Chairman of the Japanese College of Cardiology

An elderly patient usually has more than one single disease. It is important to review our health care system and policy, so that our care to the patients could work towards a comprehensive and holistic approach. For that reason, I wish to take part in shaping the policy for cross-related chronic-disease control.
The Activity of the Japanese College of Cardiology
The three main activities in the Japanese College of Cardiology include:
1) Discussion of clinical cardiology research
2) Diagnosis and treatment of heart disease
3) Training of young doctors that aim to work on both the clinical practice of heart disease and research.
The function of College of Cardiology is nevertheless to disseminate the most advanced and updated information on diagnosis and treatment of heart disease, in hope to contribute to the practical healthcare issues. Currently, there are over 7,000 members in the College of Cardiology.
Cooperation with other stakeholders such as academic societies, ministries and government offices, patient groups etc.
Emphasizing on cooperation, we had worked with the Japanese Circulation Society to promote various activities by keeping pace in the three-legged race. In addition to that, we had also constantly exchange information and ideas with the other related societies in various kinds of domestic conferences, for the intervention of ischemic heart disease, heart failure, cardiac rehabilitation, and arrhythmia. In Japan, the two major academic societies on cardiology are the Japanese Circulatory Society, and The Japanese College of Cardiology. In the States, the two major academic societies for cardiology are American Heart Association and American College of Cardiology. The College of Cardiology in Japan and America often work together in organizing International conferences. Not only that, we also work together with the overseas partners in the area of circulatory in exchanging knowledge and ideas, such as European Society of Cardiology, Korean Society of Cardiology, China, Taiwan etc.

In addition, heart disease is related to kidney and lungs disease, I want to tackle on this multidisciplinary interaction than we had never really done before. The General Assembly of the Society meets once a year to discuss on the measures for severe heart failure, such as heart transplantation, and the other challenging issues including the soaring medical expenses, which also provides an opportunity to get feedback from the standpoint of the Ministry of Health, Labour and Welfare on these issues. For example, the current problem in our area is that there is a declining trend of young doctors in considering cardiology career. It is necessary for us to think seriously about the things that we need do to foster medical personnel responsible for each specialty. While facing several pressing issues such as depopulation and the shortage of doctors in rural hospitals, cardiovascular physician shortage is a major problem. In order to resolve this problem, setting policies to ensure health care and retaining of the doctors are equally important.  We see this as an important issue that the society should spend effort to work on together with the Ministry of Health, Labour and Welfare.

I also hope to focus on educational awareness campaign in the future. I think that the most common reason to mortality in cardiovascular patients is that there was too little awareness campaign to educate the ordinary people on the disease. It is necessary and I believe that the society can act further in exchanging information with the general public and deepen the understanding of the disease. In addition, I feel that it is not enough only to present our research results in the conference, but the conference should be a place where we can discuss about the healthcare policy.
Priority of policy issues in cardiovascular specialty
In future, I think one of the major issues that require further intervention is heart failure. We may be able to save life with the development of advanced medical technology, but we cannot reverse the harm that had done on the heart. As we cannot help this situation, it is foreseen that we will have a growing number of heart failure patients even when the treatment is successful. In the United States, heart failure is one of the major causes for the rising health care costs. In the case of heart failure, the treatment of those who have been diagnosed with heart failure is not enough to just only preserve lives, but it would be important to improve the QOL and individual independency.
The future activities of the Society ~ the TIME to rethink health policy
The control of the leading causes to heart failure (e.g. lifestyle, hypertension, diabetes etc.) is a major challenge. At the early stage of heart failure, when the symptoms are mild, it is important to have appropriate medication treatment and exercise. However, when the disease becomes moderate to severe, exercise can be difficult. When severe, we depends on invasive medical treatment (non-drug therapy), which progress to further surgical treatment. So far, the emphasis of treatment in Japan has been placed on lifesaving. Japan has the world's longest life expectancy, but it is important, whether the elderly in the society really thinks that, "I am happy because my longevity." Medical technology has advanced indeed by having specialists that were trained in different fields in the medical field. However, an elderly patient usually has more than one disease. Therefore from now on, it is necessary to provide the patients with more comprehensive examination. I think this is the time to review the healthcare policy in this regard. Even when the treatment for heart disease is successful, it is not likely that the patient is able to live a life that is healthy and active after that. In an aging population with declining birthrate, it is important to decide where we can focus our intervention on. In the time where it is difficult for the elderly to receive adequate care from the family, the society has to offer its support. What is important then is that to establish a policy that aims to extend healthy living of the seniors, such as by promoting exercise and bathing, so that the seniors can be as independent as much as possible in their daily living. It is important to consider comprehensive, holistic healthcare approach (e.g. appropriate use of the hot spring, public bath, and sauna etc.) in future health policy making for the people who has difficulties in exercise because of the complications in stroke, osteoarthritis, and heart failure etc. It is very important to implement a discussion platform for the multi-stakeholders with regards to these cross-related diseases, and it is necessary to proceed from there. Although the academic societies for individual diseases today are very much divided, yet from now on, it should move towards a comprehensive and holistic healthcare approach. Therefore, I agree entirely on the need to have measures of cross-related chronic disease, and I want to help. I want to be able to live in a society that seems good and satisfying before I die. In the presentation of WHO in 2000 for healthy living, the average healthy living of the Japanese is around 75-year-old, and the average life expectancy of the Japanese is 83-year-old, that means there are 8 years where the elderly people may need to live under the care of others. What we can do with this aging society, is aiming towards a Fukuju (happy long life) longevity society. In the near future, I hope that I can contribute to the realization of a Waon (soft and warm measures) Fukuju society.

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