Khalid Al Faraidy, MD, King Fahd Military Medical Complex, Dhahran, Kingdom of Saudi Arabia, shared updates from the Strategic Cardiac Hajj Intervention Program (SCHIP) in Saudi Arabia. SCHIP has demonstrated considerable success in reducing mortality due to cardiovascular disease (CVD) during Hajj season.

The Hajj is a religious pilgrimage to Mecca and represents the largest annual gathering of Muslim people. For 5 days, approximately 3 million pilgrims congregate around the city, although preparation and travel can take up to 2 weeks. According to Prof Al Faraidy, this pilgrimage is considered the most physical form of worship in Islam, often involving long-distance walks of up to 90 km. Most pilgrims are elderly and have multiple comorbidities—and, unsurprisingly, many of the deaths that occur around this time are CVD related. One study that evaluated hospital admissions during the Hajj found that cardiovascular causes—particularly myocardial infarction (MI) and left ventricular (LV) failure—were responsible for > 60% of intensive care unit (ICU) admissions [Madani TA et al. Ann Saudi Med. 2007]. Additional data showed that the death rate of pilgrims from cardiac causes increased from 51.7% to 53.2% from 2006 to 2008 [Al Faraidy K et al. J Saudi Heart Assoc. 2012].

The SCHIP was consequently developed in 2009 in an effort to reduce the number of deaths during the Hajj, and the program has produced significant results to date. From 2009 to 2013, the size of the cardiac care team increased from 20 to 120 personnel. Team members are available 24 hours a day and have access to local, 24-hour catheterization laboratories as well. They also coordinate the exchange of patients among hospitals in the area and facilitate helicopter transportation. In addition, the local hospitals are educated about the appropriate management of patients presenting with symptoms of coronary artery disease.

Following the introduction of the SCHIP, the number of cardiac procedures performed in 2009, 2010, and 2011 during the 2 weeks of Hajj significantly increased (183, 288, and 550). Coronary catheterization was the most frequently used technique (90.1%, 80.9%, and 86.7%). In-hospital mortality rates for acute coronary syndrome (ACS) were 4.7%, 4.6%, and 3.0%, and the rates of open heart surgery were 7%, 5.2%, and 4.5% [Al Faraidy K et al. J Saudi Heart Assoc. 2012]. Data from the Saudi Arabian Ministry of Health demonstrated that death rates from CVD decreased dramatically after the implementation of SCHIP; rates fell to 43.3% in 2009, 32.5% in 2010, and 19.7% in 2011, respectively.

Prof Al Faraidy emphasized that future plans for the SCHIP include establishing a catheterization laboratory in Arafat. Currently, almost half of patients with STEMI refuse to be transferred out of the region for treatment during the Hajj. Introducing a mobile catheterization laboratory may further help to reduce the rate of CVD deaths to single-digit figures.