Malta has one of the highest incidences of heart disease in the world but the success rate of treatment at St Luke's Hospital's Cardiac Unit is one of the best in Europe, cardiology services chairman Albert Fenech said yesterday.

In fact, the mortality for open heart surgery is 0.8 per cent and that for scheduled angioplasty over the past three years was zero per cent.

Statistics of procedures undertaken at the unit show that Malta has come a long way in the past 10 years. Before 1995, there was no dedicated full-time unit in Malta.

"Four visiting teams used to come to Malta twice a year for a week at a time. So patients either had to wait for the teams or be flown to the United Kingdom," he said in an interview marking the 10th year of the unit's operation.

But despite urgently needing an intervention, some people were too unwell to be flown abroad. Moreover, it was traumatic for a person to have to travel for a procedure, mainly because of the lack of family's support.

Then, 10 years ago, in May 1995, the Cardiac Unit was opened in Malta, offering both cardiology services and cardiac surgery.

"Since then, not one patient has had to go abroad for any operation. We have a range of cardiac services, more than some European countries," he said, sitting in a small room on the hospital's third floor, which houses the unit. The room was buzzing with activity, with medical staff in dark blue scrubs darting in and out, a heart printed on the left side of their chests.

As he spoke, members of the medical team performed angiograms - an x-ray procedure which shows the heart and the arteries - in an adjacent room which can be seen through a big glass window.

Prof. Fenech's eyes darted frequently to the screens inside the other room, to assure himself that everything was going smoothly. The patient was awake throughout a procedure that was taking place.

"Many times we have music playing, so that the patient is relaxed," he said with a smile.

"It is very satisfying to see death from heart disease decline substantially over the past 10 years. Since we set up the local cardiac unit, there have been far fewer cardiac deaths."

In the past 10 years, a total of 4,134 open heart operations, 3,390 of which were bypass operations, and 10 heart transplants, were performed at the hospital.

Moreover, the Cardiac Unit performed 4,233 angioplasties - the opening of a narrowed artery without the need for open heart surgery - and 18,140 angiograms, apart from installing 1,738 pacemakers.

An average of 520 open heart operations, 550 angioplasties, 200 pacemakers and 2,100 angiograms are conducted at the unit every year.

One of the biggest plus points of local cardiac services is that they are available 24 hours a day.

"Malta is one of the few countries that has round-the-clock cardiac services, which means that people who come to hospital suffering from a heart attack are seen to straight away," he said, adding that in the whole of the UK there was only one hospital which offered a 24-hour service, and this has only been the case for the past six months.

Asked about the prevention of cardiac problems, Prof. Fenech said it was sad to note that smoking was being taken up by a number of teenagers and girls.

"It is on the increase. I find it incredible because people know the repercussions of smoking. We need more education, on different lines from the one which we have been using so far, since this has clearly not been successful," he said.

Prof. Fenech said moderate exercise, like brisk walking for around four hours a week, coupled with an intelligent diet were also important.

Asked about the first indications of cardiac problems, he said inability to do the same extent of exercise as before was one, which again pointed to the importance of exercise.

Prof. Fenech stressed that the older one gets, the higher the risk of heart problems. He said pre-menopausal women seemed to be protected, but once they reached menopause the incidence of heart disease actually surpassed that of males.

"The problem with heart disease is that it is not something that develops in old age. When post-mortems were done on teenage soldiers who died in the Vietnam war, they found that the vein narrowing process had already started."

The youngest patient to use the Cardiac Unit's services was 12 years old, but Prof. Fenech explained that even newborns sometimes need help. However, the unit mainly deals with adults; children are usually sent to Great Ormond Street Hospital, in London.

He said people who do not have an exceedingly strong family history of heart problems should start checking blood sugar, blood pressure and cholesterol levels in their 20s, but in those families where there are problems, tests should be done from childhood.

He stressed how important it is for people who think they are suffering from a heart attack to go straight to hospital. They would either be treated - or reassured.

Prof. Fenech also lashed out at a report drawn up by the British Heart Foundation, which said Malta had the lowest rate of spending on heart disease among all EU countries, while the UK spent the most.

"We do twice as many procedures per capita as the UK. Where we still have a way to go is in coronary prevention and rehabilitation," he said.