More than 220 recommendations are contained in the report intended to improve cardiac health published yesterday. Cardiovascular diseases, of the heart and blood vessels, eventually kill half of the population.
The National Cardiovascular Health Strategy said the focus should not just be on those who are in need of treatment, but also those who are at risk and those who are currently well but need to be educated about the risks.
According to the report, the strategy group came across a range of issues where there were no consistent standards of practice between and within health board regions. It has been known for several decades that of those dying from fatal coronary artery disease, at least 50 per cent will be dead within two hours of the onset of symptoms. In Ireland the average length of time from the onset of symptoms to admission to a coronary care unit is between four and six hours. The strategy group recommended a standard time of 90 minutes.
Emergency response call times for ambulances are not recorded in some health board areas. In early 1997, 87 per cent of all calls were responded to within 20 minutes. However, in the Midland, North Western and Western health board areas fewer than 60 per cent of calls were responded to within that time. The group said it was essential and feasible that there was rapid response by the emergency ambulance services. It recommended a single command and control centre for emergency ambulances in each health board area. It said the National Ambulance Advisory Council should be established on a statutory basis.
There was a need to improve the care of patients with heart failure, it said. All such patients should receive treatments which had been proven to work. Protocols should be agreed for the diagnosis and management of heart failure in different areas of the health services. Each hospital admitting patients with acute cardiac problems should have an appropriately trained doctor and a coronary care unit.
Thrombolysis, a treatment to dissolve clots and restore blood flow through the artery, is recognised as an early effective treatment. However, the report said an important proportion of people did not currently benefit from the timely administration of this therapy.
The group concluded that there were inadequate data available on numbers of patients with specific cardiac conditions treated in hospitals, resources available for treatment, the treatment supplied and the outcomes of therapy. "A substantial improvement is required in health information systems relevant to cardiovascular health services."
In the case of cardiac rehabilitation services, the report said that in the areas where they were provided there were generally not enough places, and services were "underdeveloped". While there are rehabilitation programmes, it said, the level of service permitted access by only a minority of eligible patients. Approximately 820 patients per year are being rehabilitated through the programmes surveyed, representing less than one in 10 patients who could benefit from referral.
Referring to the value of health promotion and preventing cardiovascular disease before it happened, the group said the health promotion unit of the Department of Health should be given substantial, additional powers and staff to support the strategies recommended in the report.
It criticised the fact that the medical card scheme provided only for treatment, and except where there were explicit arrangements, such as childhood immunisation, GPs were not paid to undertake any preventive care of patients, which was "neither logical nor acceptable".