National Review of Specialist Cardiac Services – Irish Heart Foundation submission

Some seriously ill patients are waiting for up to 15 months for urgent heart surgery, while others are waiting up to two years for the treatment of potentially disabling conditions such as atrial fibrillation (AF), the Irish Heart Foundation has said.

In its submission to the National Review of Specialist Cardiac Services, the Irish Heart Foundation said there were “considerable deficiencies in existing cardiac infrastructure to allow timely provision of equitable access to diagnostic testing and cardiovascular care in the face of ever increasing demands.”

However, it also noted that where services are available and have been resourced, they were of good quality, with “a high level of expertise within the system.”

Established by the Minister for Health, Minister Simon Harris, the National Review of Specialist Cardiac Services aims to achieve optimal patient outcomes at population level with particular emphasis on the safety, quality and sustainability of the services that patients receive by establishing the need for an optimal configuration of a national adult cardiac service.

The Irish Heart Foundation’s submission, which was informed by expert cardiologists working in Ireland, noted that patients with atrial fibrillation (AF) or an abnormal heart beat, were waiting for up to two years for treatment known as AF Ablation. This nonsurgical procedure is used to correct or control some types of rapid heart rhythm problems including AF.

Left untreated AF can lead to heart failure or stroke. Patients with atrial fibrillation are five to seven times more likely to have a stroke than someone without the condition. Patients with atrial fibrillation are also more likely to have a more disabling stroke and to die from their stroke than those without the condition.

There are more than 1,400 new cases of AF every year in Ireland and the large numbers waiting for ablation treatment for AF means that patients with other arrhythmias, although in the minority, are “not being adequately catered for due to the large AF caseload,” the submission added.

The submission also stated that a significant proportion of the national caseload in acute cardiology care was accessed through Model 3 or general hospitals, where consultant staffing was low and there were not enough trainees to meet projected retirements.

While patients treated in general hospitals had similar outcomes to those treated in level 4 or specialist referral hospitals, there was “evidence of unmet need, with a significant proportion of the cardiology caseload delivered by non-cardiologists.”

While patients treated in general hospitals had similar outcomes to those treated in level 4 or specialist referral hospitals, there was “evidence of unmet need, with a significant proportion of the cardiology caseload delivered by non-cardiologists.”

The Irish Heart Foundation’s submission also revealed that not all patients with heart failure were receiving the same level of specialist care due to the lack of specialist heart failure units in some parts of the county.

According to the submission, some 24 per cent of all heart failure patients are readmitted to hospital within 12 weeks of discharge, with the figure rising to 44 per cent after a year.

The introduction of HF units, which provide structured, coordinated and multidisciplinary care, is reducing these figures. However, the submission pointed out that of the 12 HF units in Ireland there is just one in Munster located in Limerick, compared to six serving Dublin.

Therefore, the submission called for priority to be given to overcoming geographical gaps in services, a review of the model of HF care, an audit of existing service levels and the “speedy delivery of the promised service gap analysis.”

Another major issue raised by the submission was the absence or poor quality of data in relation to cardiac care in Ireland.  It also pointed to a lack of a cardiovascular disease register and dearth of reliable epidemiological data, analysis and reporting on care needs and resource utilisation, as well as validation of waiting times.

Additional issues highlighted by the IHF submission included the need for HSE-funded clinics for inherited cardiac conditions and the lack of follow up care for adults living with grown-up congenital heart disease (GUCH).

Commenting Dr Angie Brown, Consultant Cardiologist and Medical Director of the Irish Heart Foundation said, “an accurate assessment of current and future demands and the unmet needs of patients with cardiological issues is needed to provide an accurate efficient, high quality and equitable service throughout the country. We welcome the opportunity this review provides and hope it will be produced and its recommendations implemented in a timely fashion.”