Saudi Arabia advances cardiovascular care through Integrated Centres of Excellence

By Dr. Russell Hales, Chief of Centers of Excellence, Johns Hopkins Aramco Healthcare

SAUDI ARABIA—Saudi Arabia’s next advances in cardiovascular care will depend not only on investments in advanced medical technology but also on how effectively healthcare professionals, clinical services, and patient pathways work together.

Although modern cardiac catheterisation laboratories can map the heart’s blood vessels with millimetre-level precision, technology alone cannot coordinate emergency teams, anticipate every complication or ensure that specialists work together when a patient’s life is at risk.

According to Dr Russell Hales, Chief of Centers of Excellence at Johns Hopkins Aramco Healthcare (JHAH), achieving better outcomes requires an integrated healthcare system that connects expertise, technology and clinical decision-making.

As Saudi Arabia advances its healthcare transformation agenda, the focus is shifting from individual centres of clinical excellence towards a connected system that provides coordinated, high-quality care across the patient journey.

Cardiovascular disease places a significant burden on Saudi Arabia

Cardiovascular disease is a major public health challenge in the Kingdom.

According to a national investment case published by the Ministry of Health, it accounts for 28% of all deaths from non-communicable diseases in Saudi Arabia and causes annual economic losses of SAR 52 billion (US$13.9 billion).

Dr Hales argues that addressing a challenge of this scale requires more than expanding hospital infrastructure.

While additional catheterisation laboratories, imaging equipment and specialist services remain essential, healthcare providers must also establish systems that prevent complications, improve coordination and identify risks before they become life-threatening.

This approach is taking shape in the Eastern Province, where JHAH has established a Cardiovascular Center of Excellence to integrate specialist expertise and clinical services within a coordinated model of care.

The underlying principle is that healthcare infrastructure delivers its greatest value when providers connect individual services into a seamless patient pathway.

Consider the typical journey of someone with heart disease. A patient may first consult a family doctor before seeing a cardiologist, undergoing echocardiography or receiving a CT or MRI scan.

Depending on the findings, the patient may then require a catheterisation procedure, cardiac surgery, hospitalisation, rehabilitation and long-term follow-up.

Each stage involves different healthcare professionals, creating opportunities for communication gaps, delayed decisions and fragmented care.

Patients may also have to repeat their medical histories at successive appointments because clinical teams do not consistently share information.

Care coordination can improve patient outcomes

Research highlights the consequences of fragmented cardiovascular care.

A study involving nearly 9,000 patients with heart valve disease found that more than half of those who required readmission returned to a different hospital.

This disruption in continuity of care was associated with a significantly higher risk of death within one year.

The volume of procedures performed at a hospital also matters. An analysis of nearly 100,000 heart valve replacements found significantly lower 30-day mortality rates at hospitals performing the highest numbers of procedures than at those performing the fewest.

These findings highlight two priorities: concentrating specialist expertise where it can be used effectively and maintaining continuity throughout treatment and recovery.

Professional organisations, including the American College of Cardiology and the American Heart Association, support multidisciplinary assessment for patients undergoing complex heart valve procedures.

A dedicated Heart Valve Team brings together the relevant specialists to evaluate each case and agree on the most appropriate treatment.

For Dr Hales, this approach defines a true Center of Excellence. Such a centre is not simply a modern building or a branding initiative.

It is an integrated system that combines specialist teams, standardised clinical pathways, measurable outcomes and coordinated relationships with community hospitals.

Under this model, local hospitals can identify patients who need advanced care and connect them to specialist centres, while maintaining communication with the wider healthcare network throughout treatment and follow-up.

Five principles underpin the JHAH model

JHAH has developed its Cardiovascular Center of Excellence around the model of the Johns Hopkins Heart and Vascular Institute.

The approach brings specialists and technology into a coordinated clinical pathway, prioritises patient safety over departmental boundaries, and integrates research and training into everyday clinical practice.

Implementing this model requires changes to how healthcare professionals collaborate, how hospitals measure performance and how they share responsibility for patient outcomes.

1. Multidisciplinary teams replace departmental silos

JHAH brings cardiologists, cardiac surgeons and rehabilitation specialists together to coordinate care rather than operate as separate departments.

When a patient presents with a complex condition, the specialists discuss the case collectively and determine the appropriate treatment.

An integrated clinic allows patients to undergo an initial assessment within this coordinated system, reducing the need for repeated referrals and fragmented communication between clinicians.

2. Shared clinical standards promote consistent care

Clinical pathways and quality measures must meet internationally recognised standards. JHAH benchmarks its protocols against those of Johns Hopkins Medicine to support consistent clinical practice.

The objective is to ensure that patients receive the same standard of care regardless of when they arrive at the hospital or whether they receive treatment in Saudi Arabia or the United States.

3. Transparent measurement supports continuous improvement

A Center of Excellence must demonstrate its performance through measurable clinical outcomes.

JHAH reports clinical data against international benchmarks to evaluate its results, identify areas for improvement and assess how its services compare with those of leading healthcare institutions.

This approach allows providers to use evidence rather than assumptions when evaluating the quality and effectiveness of care.

4. Knowledge-sharing builds lasting clinical capacity

High-quality care should not depend on a small number of highly experienced physicians. Instead, healthcare organisations must embed expertise in clinical protocols, staff training and institutional knowledge.

Through collaboration with Johns Hopkins Medicine, JHAH facilitates the exchange of expertise and opportunities for specialists to work and train together.

This helps maintain clinical standards and develop institutional capabilities beyond the tenure of individual practitioners.

5. Rehabilitation and follow-up complete the care pathway

Treatment does not end when a patient leaves the hospital. Cardiac rehabilitation and long-term follow-up play important roles in recovery and in reducing the risk of further complications.

Evidence involving tens of thousands of patients indicates that cardiac rehabilitation can reduce hospital readmissions by nearly one-third. However, many eligible patients do not receive these services.

JHAH has therefore incorporated rehabilitation into its cardiovascular care pathway from the outset, making recovery and long-term monitoring integral parts of treatment.

Shared accountability strengthens the system

Implementing these principles requires healthcare organisations to move beyond measuring the performance of individual departments.

Instead, teams must take collective responsibility for the patient’s experience and outcomes across the entire care pathway.

This shift aligns with Saudi Arabia’s broader healthcare transformation agenda under Vision 2030.

Through the Health Sector Transformation Program and the Saudi Model of Care, the Kingdom aims to move away from fragmented services towards integrated, value-based healthcare that coordinates care around patients’ needs.

JHAH’s Cardiovascular Center of Excellence applies these principles in clinical practice in the Eastern Province, linking specialist services and establishing coordinated pathways for patients with complex cardiovascular conditions.

For patients and their families, the approach can improve access to advanced treatment closer to home.

Embedding international clinical standards, specialist expertise and continuous training within Saudi hospitals also helps develop sustainable local capabilities.

Prevention remains central to cardiovascular health

Alongside improvements in hospital-based care, prevention offers substantial opportunities to reduce the burden of cardiovascular disease.

Saudi Arabia’s national investment case projects that comprehensive prevention measures could save more than 200,000 lives and generate over SAR 112 billion (US$29.9 billion) in economic benefits over 15 years.

Prevention and specialist hospital care therefore serve complementary purposes.

While preventive interventions can reduce the number of people who develop cardiovascular disease, integrated specialist services can improve the management and outcomes of patients who require advanced treatment.

For healthcare leaders deciding where to direct future cardiovascular investments, Dr Hales identifies three considerations.

First, does the investment connect services and shorten the journey from the onset of symptoms to recovery, rather than create another isolated point of care?

Second, does it measure performance against recognised international standards? Comparing outcomes with those of leading centres helps providers identify gaps and demonstrate the quality of their services.

Third, will the investment strengthen the capabilities of the wider healthcare system? Sustainable improvements should leave behind better-trained clinicians, established clinical pathways and stronger coordination, rather than relying solely on new equipment or individual specialists.

Medical equipment depreciates over time, but a well-designed healthcare system can build on its experience. Each patient treated, outcome measured and clinician trained can contribute to better care for future patients.

For Saudi Arabia, the next phase of cardiovascular development will depend on how effectively healthcare providers connect the different components of the patient journey, ensuring that clinical expertise, technology and coordinated care work together to deliver consistent outcomes.

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