The Irish Heart Foundation addressed the Joint Oireachtas Health Committee this morning, Dec 13th, on issues relating to cardiovascular health, stroke and heart attack – programmes, services and prevention.

Chris Macey, Director of Advocacy and Patient Support and Kathryn Reilly, Policy and Legislative Affairs Manager were joined by Esther O’Shea, Patient Champion with the Irish Heart Foundation.

If you would like to view the meeting, please view it here.

The opening statement by the Irish Heart Foundation included:

Thank you Cathaoirleach for the invitation to meet the Committee today. I will address three important areas of need in this presentation:

• The chronic lack of investment in community supports for heart and stroke patients and the Irish Heart Foundation’s role in supporting them.
• The lack of a national cardiovascular disease policy, the failure to publish the long-awaited National Cardiac Services Review and implementation of the National Stroke Strategy.
• The need to prioritise prevention. Given that 80% of cardiovascular disease is preventable, there’s no measure open to policymakers that will save more lives, prevent more chronic disease and help make the health service sustainable in the long-term.

I’ll begin with community services for cardiovascular patients and the solo role played by the Irish Heart Foundation in delivering national support services to heart and stroke patients. Since Covid we have built a comprehensive pathway of practical, social and emotional support services running almost literally from the hospital gates for as long as patients need our help.

These services were developed in response to a widespread sense of abandonment among stroke survivors caused by lack of access to community rehabilitation and recovery services. And to help heart failure patients who endure a revolving door syndrome highlighted by a 90 day hospital readmission rate to hospital of 30%, often for the want of basic information and support.

Although our services focus primarily on stroke and heart failure, we also deliver supports across a broad range of conditions, including heart attack, cardiomyopathies, sudden cardiac death, congenital heart disease, Long QT syndrome and people with ICDs. These services are endorsed by the HSE, but have received no statutory funding to date, apart from partial CHO support amounting to around 7% of their total cost.

Patients describe our practical, social and emotional support services as their lifeline. They revolve around non-medical services and supports delivered by phone, online and face-to-face that can be the difference between living well in the community and long-term dependency or even premature death.

They prevent hospital readmission among heart patients, reduce requirement for nursing home care among stroke survivors and remove a significant burden from frontline services. Despite psychological impact similar to PTSD that often results from a stroke or heart disease diagnosis, the Irish Heart Foundation provides the only access to counselling for many people.

This year around one third of stroke survivors returning home from hospital nationally will be referred to our services, with thousands of heart failure and other cardiac patients also benefiting.

We are more than 90% funded by public and corporate donations and therefore at the mercy of economic forces such as the cost of living crisis. We are making a difference to thousands of lives, but the continued delivery of these services can never be guaranteed in the absence of statutory funding. And our limited capacity as a small charity given the scale of cardiovascular disease means we cannot give many thousands more patients the help they need without ourselves getting help from the State.

Each year there are over 9,000 cardiovascular disease deaths in Ireland – almost 30% of all mortality. Over half a million people are living with a cardiovascular condition, with 80,000 discharged from hospital each year.

During a meeting with us in 2021, Committee members expressed alarm that there had been no national policy for the world’s biggest killer disease since 2019. Despite your subsequent representations and a continuing increase in cardiovascular disease incidence, driven by age demographics, the Department of Health still has no intention to develop a policy. Although cancer has its own unit within the Department, cardiovascular disease comes under a broad population health and non-communicable diseases unit.

Additionally, we have a National Cardiac Services Review that began almost six years ago and whose final report has been on the Minister’s desk for most of this year, without any indication of a publication date.

The review recommends an updated configuration for national adult cardiac services. Pending implementation, cardiac care will remain in a state of limbo, with unnecessary difficulties in planning and organising services that will inevitably impact patient outcomes. Specific issues include long waiting times for echocardiogram, cardiac magnetic resonance and CT scans and shortages in physiologist posts.

There’s also a pressing need for a Heart Failure Registry. Although at least 90,000 people are living with the condition with another 250,000 impending cases, there is a lack of reliable real-time data. This is crucial to give health service planners a better understanding of the causes of high readmission and mortality rates.

Meanwhile, the National Stroke Strategy 2022-27 has been published, but is not being coherently implemented. Mainly non-recurrent funding was allocated in last year’s Budget, so key staffing increases which are its cornerstone were largely unaddressed. And there’s growing concern that none of 70-75 posts required under the Strategy will be filled in 2024.