Lifesaving Cardiac Rehabilitation Service in crisis

By June Shannon Heart News   |   29th Jun 2021

New survey finds cardiac rehabilitation service in Ireland is at ‘crisis point’

 

The Cardiac Rehabilitation service in Ireland is in “absolute crisis,” Dr Angie Brown, the Medical Director of the Irish Heart Foundation has said.

Dr Brown was commenting on the findings of a new survey carried out by the Irish Heart Foundation and the Irish Association of Cardiac Rehabilitation (IACR), which found that the national waiting list for cardiac rehabilitation has now exceeded 2,800 patients – a 54 per cent increase since 2013 – while staffing levels have plummeted by 40 per cent.

Cardiac rehabilitation is a programme of exercise and education that supports and enables people who have suffered a heart attack, stroke or are living with heart failure to return to a full, active and healthy life. Studies have shown that high quality cardiac rehabilitation programmes can reduce deaths from heart disease by approximately 20 per cent.

The IHF/IACR survey also revealed that 77 per cent of cardiac rehab centres were closed during the pandemic – the vast majority for more than 12 weeks.

“This service was considered world class in 2005, but it's now in absolute crisis,”

Dr Angie Brown, Medical Director, The Irish Heart Foundation

“This service was considered world class in 2005, but it’s now in absolute crisis,” said Dr Brown, Medical Director of the Irish Heart Foundation.

“HSE recruitment embargoes and chronic under-investment have stripped it bare. Nurses are being transferred to other work, are not being replaced and even though it’s an essential service, none of our hospitals has all the expertise in place to deliver high quality cardiac rehabilitation,” Dr Brown said.

Effective cardiac rehabilitation is delivered through a number of different disciplines, from specialist nursing staff to pharmacists, physiotherapists, occupational therapists, smoking cessation specialists and cardiologists. Programmes are managed by Cardiac Rehabilitation coordinators – typically a cardiac nurse specialist – who also play a key role in the clinical management and monitoring of patients (e.g. blood pressure and cholesterol).

A core element of cardiac rehabilitation is monitored exercise training which helps patients to get physically active again. This is provided by appropriately trained cardiac nurses and physiotherapists.

Psychological support has also been proven to increase the improvements achieved by cardiac rehabilitation, but the findings revealed that only seven of the 35 cardiac rehabilitation centres surveyed, have access to a psychologist. Furthermore, 12 centres surveyed did not have access to a physiotherapist.

Since 2010, the number of medical directors in the programme has fallen from 38 to 21, cardiac rehabilitation co-ordinators from 38 to 31 and dietitians from 36 to 24.

The survey also found that 33 cardiac rehabilitation centres are missing four or more key staff and since 2013, cardiac specialist nurses from 11 centres were transferred to other duties.

In addition, 40 per cent of patients are waiting at least three months for cardiac rehabilitation, when they should be starting courses weeks after hospital discharge.

" If you don’t get cardiac rehabilitation for three months, that means you are facing the hardest time on your own,”

Dr Angie Brown, Medical Director, The Irish Heart Foundation

One patient who knows the value of cardiac rehabilitation is 52-year-old Noel Flannery who had seven stents inserted following a heart attack in March 2020.

The father-of-two from Dublin said he went to a “dark place” after his heart attack and struggled to understand why it happened given his active lifestyle as a member of Cabra Kayak Club.

However, through the cardiac rehabilitation centre at the Mater Hospital in Dublin, Noel was able to access pharmacists to advise him about medication, physiotherapists, dietitians, and a psychologist.

“It was absolutely brilliant. It was an eight-week course, two days a week and I’d be 100 per cent behind it. It helped me to move on; they were telling me ‘Noel this isn’t the end, it’s not your fault, you can get over it’.”

Dr Brown said the cardiac rehab service is a lifeline for people dealing with the physical and psychological impacts of a heart attack.

“In 2005, cardiac rehabilitation in Ireland was world class, but since then it has been chipped away at by recruitment embargoes.

“The patients going in are up 25 per cent since 2010 but staffing is down 40 per cent. Lack of investment also creates a false economy as the failure to provide a full range of care is impacting on patients who are more likely to end up back in hospital for treatment.

“Someone who has had a serious heart attack and is sent home, for example, should have access to a psychologist as well as the other support cardiac rehabilitation gives. If you don’t get cardiac rehabilitation for three months, that means you are facing the hardest time on your own,” Dr Brown stated.

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Related Topics

cardiac rehab cardiac rehabilitation heart attack heart failure Irish Association of Cardiac Rehabilitation physiotherapy stroke

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