AFIC/NIHD in Rawalpindi stands at the forefront of cardiac care, celebrated for its groundbreaking research and cutting-edge healthcare services. With a passionate commitment to transforming patient outcomes, this pioneering institution is not just setting new standards for heart health; it’s redefining the future of cardiovascular medicine in Pakistan, offering hope and healing to countless individuals.
When Pakistan came into being, there were no cardiac facilities in the country. In 1953, a dedicated cardiothoracic center was established at Military Hospital (MH), Rawalpindi. Since then, it has become a Centre of Excellence in Cardiovascular Care. The first coronary angiography was performed in 1969, and the first open-heart surgery was conducted in 1970. In response to the exponential demand for cardiac services, the center was upgraded to the Armed Forces Institute of Cardiology (AFIC) in 1978. Just three years later, to extend services to fellow citizens, government servants, and underprivileged patients, the institute was upgraded to the National Institute of Heart Diseases (NIHD) under President of Pakistan Directive No. 216 of 1981. It was Major General Zufiqar Ali Khan who conceived and implemented the ideas of AFIC and NIHD.
In its current state, AFIC is a 400-bedded tertiary cardiac care hospital that addresses major aspects of cardiovascular medicine. The present building is the most beautiful and unique of its kind. Its foundation stone was laid by the former Chief of the Army Staff (COAS) and President of Pakistan, General Zia ul Haq, in 1983. It was later inaugurated by the former President of Pakistan, Mr. Ghulam Ishaq Khan, in 1988. Over the years, AFIC and NIHD have established themselves as major tertiary cardiac care hospitals in Pakistan, dedicated to cardiac patients from all over the country, including Armed Forces members, federal government employees, and the civilian population. The Institute is an extremely busy center with a state-of-the-art Emergency Coronary Care Unit, a Surgical Intensive Treatment Centre (ITC), a Department of Clinical Cardiac Electrophysiology (CCEP), and a Nuclear Cardiology department. Currently, there are six fully equipped catheterization laboratories and one hybrid catheterization laboratory, capable of treating complex coronary and cardiac electrophysiology interventions. It also has six surgical theatres equipped to handle all types of adult and pediatric cardiac surgeries. A new OPD complex was inaugurated by the former COAS, General Ishfaq Pervez Kayani, on November 25, 2010.
With a legacy spanning over 46 years, the institute stands as one of the nation's premier healthcare facilities, situated in the heart of Rawalpindi, adjacent to the federal capital, Islamabad. AFIC and NIHD take pride in their service to a diverse population across the country. The institute benefits from a cadre of extensively trained specialists and dynamic residency training initiatives in cardiology, interventional cardiology, cardiac surgery, and cardiac anesthesia. Through a strategic partnership with the International Children Heart Foundation (ICHF) USA, led by Prof. Dr. William Novik, a cardiac surgeon, the hospital has made remarkable strides in advancing its capabilities in surgical procedures and intensive care for complex congenital heart conditions in pediatric patients.
The institute contributes to the training of not only physicians but also nurses and a diverse array of healthcare professionals across multiple disciplines. This includes hosting international conferences on cardiology, cardiac surgery, electrophysiology, and pediatric cardiology. Through Continuing Medical Education (CME) and Continuous Professional Development (CPD) initiatives, the institution ensures the perpetuation of high-quality care for both current and future generations. AFIC encompasses departments in Adult Cardiology, Pediatric Cardiology, Adult Cardiac Surgery, Pediatric Cardiac Surgery, Cardiac Electrocardiography, Nuclear Cardiology, CT Angiography/Cardiac MRI, Research & Development, and Preventive/Rehabilitation.
Adult Cardiology. The Adult Cardiology department was established at AFIC/NIHD from the very beginning, where state-of-the-art procedures are carried out in addition to basic cardiology. The institute has attained excellence in the following complex procedures:
▪ Round-the-clock Primary Percutaneous Coronary Intervention was initiated in 2010.
▪ The first Transcatheter Aortic Valve Implantation (TAVI) was performed on March 28, 2015.
▪ The first Endovascular Aneurysm Repair (EVAR) was conducted on March 3, 2015.
▪ The first Thoracic Endovascular Aneurysm Repair (TEVAR) was carried out on May 21, 2017.
▪ Rotational Atherectomy (ROTA)
▪ Chronic Total Occlusion (CTO) procedure
▪ Intravascular Ultrasound (IVUS)
▪ Fractional Flow Reserve (FFR)
▪ Laser-Assisted PCI
▪ Percutaneous Transluminal Mitral Commissurotomies (PTMCs)
Pediatric Cardiology. The history of pediatric cardiology in Pakistan can be traced back to the early 1980s, specifically 1983-1984, when Dr. Shakeel Qureshi pioneered this specialty within the Pakistan Army. His journey began in a modest British-style cardiology unit located in MH, Rawalpindi. This humble beginning laid the groundwork for significant advancements in the field.
In June 1991, Major General Waqar Ahmed returned from the United Kingdom (UK) and formally commenced his work in pediatric cardiology. Under his leadership, the department achieved remarkable milestones, including the first-ever transcatheter patent ductus arteriosus (PDA) occlusion using Rashkind umbrella devices in Pakistan. Early procedures in pediatric cardiology included balloon atrial septostomy, balloon dilatation of the pulmonary and aortic valves, and interventions for native coarctation of the aorta. Over the years, the scope of procedures has expanded significantly. Today, the department handles a wide range of diagnostic and therapeutic cases with varying complexities, including transcatheter device closures for atrial septal defects (ASDs), PDAs, ventricular septal defects (VSDs), and percutaneous pulmonary valve replacements (PVRs).
Among the more complex interventions are stenting procedures for ductal patency in cyanotic patients and those with transposed great vessels. The department also performs stenting of the aorta and peripheral vessels, providing critical support to surgeons during intricate cardiac surgeries. Remarkably, these procedures are conducted on very small patients, some weighing less than 1.5 kg. Innovations in technique have led to the first successful VSD closure via a periventricular hybrid approach, as well as transcatheter closures of pulmonary valves and sinus venosus ASDs using advanced devices.
The department has successfully tackled complex surgeries, with the exception of hypoplastic left heart syndrome, and is currently exploring the feasibility of pediatric heart transplant procedures. Equipped with state-of-the-art technology, the department boasts advanced echocardiography capabilities, including 4D imaging and transesophageal probes, alongside comprehensive CT and MRI data acquisition facilities. This cutting-edge equipment enhances diagnostic accuracy and procedural outcomes, ensuring that the department remains at the forefront of pediatric cardiology in Pakistan.
Adult Cardiac Surgery. From its very beginning, AFIC and NIHD have provided state-of-the-art cardiac surgery supported by advanced cardiac anesthesia. The first closure of an atrial septal defect was performed on March 5, 1970, by Dr. Ali Masood Akram, and the first coronary artery bypass grafting was conducted in 1980 by a team of surgeons consisting of Dr. B.T. William, Dr. M.R. Kiani, and Dr. Syed Afzal Ahmed. The first bypass by an indigenous team from AFIC was carried out in 1982.
Currently, they have four state-of-the-art modular operation theaters equipped with the latest machines. In addition to routine cardiac surgeries, they perform valve replacements and repairs, congenital heart surgeries, aortic surgeries, aortic root replacements, aortic arch and descending thoracic aorta replacements, surgery on the pericardium, surgery for cardiac tumors, and minimally invasive surgery.
They also have future plans for an LVAD and heart transplant program.
Congenital Cardiac Surgery. The specialty of congenital cardiac surgery encompasses the treatment of individuals born with congenital heart defects, with an age spectrum ranging from neonates just a few days old to patients up to sixty years old. Pediatric and congenital cardiac surgery is a highly intricate specialty with a limited number of practitioners throughout the country. Foreign proctorship programs have been instrumental in the development of this specialty at AFIC, establishing it as the preeminent institute in Pakistan. Collaboration with Professor Dr. William Novick (USA) and his International Children Heart Foundation (ICHF) team included 15 visits to AFIC between 2005 and 2015 under a Memorandum of Understanding (MoU).
Periodic visits were conducted by various world-renowned surgeons, including Dr. David R. Anderson from the UK, Dr. Asif Hassan (a prominent cardiac transplant surgeon from the UK), and Dr. Zohair al Halees from Saudi Arabia. All these missions have significantly contributed to the strong reputation of pediatric and congenital cardiac services at AFIC.
Another groundbreaking development was the introduction of the Birmingham Children’s program, which commenced in 2014. This program has shortened the learning curves not only for surgeons but also for the entire team, including pediatric cardiologists, pediatric intensivists, and intensive care staff.
Clinical Cardiac Electrophysiology. Clinical Cardiac Electrophysiology (CCEP) was introduced at a very basic level during the late 1990s in Pakistan, and AFIC has been at the forefront since its inception. CCEP is a novel subspecialty of cardiology that is rapidly evolving to cater to the growing population of patients suffering from various types of rhythm disorders (arrhythmias) or advanced heart failure (HF). For arrhythmias, we have the capability to conduct procedures ranging from basic electrophysiology (EP) studies to complex high-density mapping procedures that eradicate complex arrhythmias. For HF and conduction disorders, cardiac devices are implanted, ranging from simple pacemakers to complex devices like cardiac resynchronization therapy (CRT).
CCEP is one of the few treatment modalities that is curative in more than 95 percent of cases. The latest addition to the EP armamentarium at AFIC/NIHD is the introduction of a laser lead extraction system, which is the first of its kind in Pakistan. AFIC is also a pioneer in the introduction of the College of Physicians & Surgeons (CPSP) EP Fellowship Program nationwide since 2014. Since then, the number of EP fellows has been increasing each year.
The first International EP Conference, themed “Rhythm for Life,” was held in 2001 at AFIC. It is the only conference that truly represents the education and research activities of the EP community in Pakistan. This conference is held at AFIC every year to address the educational needs of a wide spectrum of audiences, including medical students, cardiologists, and EP consultants. It provides an opportunity for the national EP community to gather and discuss common issues related to cardiac electrophysiology in Pakistan.
Nuclear Cardiology. Myocardial perfusion imaging (MPI) plays a critical role in the diagnosis and management of various cardiovascular diseases, including coronary artery disease. Traditionally, SPECT myocardial perfusion imaging has been limited in its ability to accurately assess myocardial blood flow dynamics. However, with the introduction of CZT-SPECT MPI, valuable insights into myocardial perfusion and function can now be obtained.
The successful commissioning of the country’s sole CZT-based dedicated cardiac gamma camera and the subsequent initiation of novel dynamic SPECT myocardial perfusion imaging, which measures myocardial blood flow and flow reserve, in March 2023 marked a significant accomplishment for the Nuclear Cardiology Services at the national level, on par with international best practices.
This achievement positions AFIC/NIHD as a pioneer and leader in Nuclear Cardiology Imaging, introducing this latest procedure in the country and underscoring our commitment to providing patients with the highest standards of care.
Diagnosis. The first CT angio machine was donated to AFIC/NIHD by Mr. Shaukat Aziz, the Prime Minister of Pakistan, in 2008, and the first case was performed on December 31, 2008. Currently, AFIC has three CT angio machines where CT scans, CTPA, and CRT procedures are carried out. An MRI machine was also installed in 2018, which is used for cardiac MRI diagnostics.
Research and Development. This department was established in 2014, making it a pioneer in cardiovascular research. It is dedicated to advancing cardiovascular health through innovative, evidence-based research that aligns with our mission to improve clinical outcomes. The department focuses on clinical research, including oversight from the Institutional Ethical Review Board, journal publication, and clinical trials. We also engage in academic activities, conducting ongoing workshops, lectures, and conferences.
Prevention/Rehabilitation. AFIC has a dedicated Preventive & Rehabilitation department that addresses risk factor assessment, diabetes management, nutrition, smoking cessation counseling, lipid profile testing, and blood pressure monitoring. Moreover, in cardiac rehabilitation, we provide inpatient monitoring post-cardiac surgery, supervise exercise training, and offer psychological support.
Conferences. AFIC and NIHD hold annual conferences, such as the Cardiology Update, in collaboration with the Pakistan Cardiac Society, as well as cardiothoracic and electrophysiology (EP) conferences. Moreover, AFIC/NIHD has become a hub for conducting BLS/ACLS courses accredited by the American Heart Association (AHA).
Collaboration With International Institutes. AFIC and NIHD have collaborated with University Hospital Birmingham to provide young fellow cardiologists, cardiac surgeons, and cardiac anesthetists with on-the-job training to update their professional skills and meet international standards.
NEPCARD. Currently, AFIC is actively engaged in constructing the National Institute of Heart Diseases Center of Excellence for Preventive Cardiovascular Research and Development (NEPCARD). This facility will serve as the national hub for collaborative research, data analysis, and the eventual formulation of guidelines. These guidelines will help shape public policies aimed at benefiting the masses.
The hospital is recognized for its unwavering commitment to patient welfare, steadfast pursuit of professional objectives, drive for excellence, and a deeply compassionate and cooperative ethos. The institute is celebrated for delivering compassionate care that seamlessly integrates cutting-edge technology with a human touch.
The global burden of disease is shifting from infectious diseases to non-communicable diseases, with cardiovascular diseases being the leading cause of death worldwide. Cardiac diseases are rampant and epidemic in Pakistan. AFIC/NIHD is dedicated to treating individuals suffering from cardiovascular diseases, supported by an excellent team of professionals and state-of-the-art hospital facilities.
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