Report on cardiac services recommends concentration of services in four centres

Four principal cardiology centres in Dublin, Cork and Galway, supported by a network of satellite hospitals, are to be recommended by the National Review of Specialist Cardiac Services.

A confidential report by the review team to Minister for Health Stephen Donnelly names Cork University Hospital (CUH); University Hospital Galway (UHG), the Mater Misericordiae University Hospital (MMUH) and St James’s Hospital as the sites for the main centres.

Services would be strengthened at five other hospitals, including in Waterford where a long-running campaign has agitated for an upgrade in cardiac care.

The document, seen by The Irish Times, proposes the establishment of four regional cardiac networks to be aligned with six proposed regional health areas.

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Chaired by Prof Philip Nolan, the review team began its work at the beginning of 2018, tasked with examining the “optimal configuration of a national adult cardiac service”.

It covers scheduled and unscheduled hospital-based services for the diagnosis and treatment of cardiac disease in adults.

Each regional network would be linked to one of the “comprehensive interventional cardiology centres” as a hub to provide a full range of surgical and other services in “Model 4″ acute hospitals.

A network of designated cardiac centres would provide “layered, differentiated and complementary capabilities”, supported by an ambulance service, it recommends.

The team will also recommend that interventional cardiology services at Beaumont Hospital in Dublin; University Hospital Limerick, University Hospital Waterford, Dublin’s St Vincent’s University Hospital and Tallaght University Hospital be sustained and strengthened.

“These centres should have formal and structured links to one of the comprehensive interventional centres to ensure sustainability and continuity of care,” the document notes.

It points to international evidence that supports the concentration of interventional cardiology services in a limited number of centres.

“The review has a vision for the future of specialist cardiology services to promote the health of the population, where the needs of the community and patients are the central consideration,” it says, “and which offers patients the best possible standard of care in a timely manner, insofar as possible in their own community.”

Full-time emergency care for patients who suffer heart attacks (myocardial infarction) should continue to be concentrated at MMUH, SJH, GUH and CUH.

Serious cases

These four hospitals already provide 75 per cent of coronary angioplasty with stenting, otherwise known as percutaneous coronary intervention, for the most serious heart attack cases.

“However, the review also acknowledges there are circumstances under which primary PCI can be provided to patients more quickly and equally safely outside the four comprehensive interventional centres,” the document notes.

For such potential alternatives, decisions on the extent of their ability to provide care would be made by the National Heart Programme, based on a range of factors.

These would include expertise; adequacy of facilities, and the level of demand that could not be met by other centres.

“The review will recommend that the use of cardiac catheterisation laboratories in the regional network should be planned to optimise the urgent care of patients ... and minimise conflict between such urgent care and scheduled diagnostic and interventional work,” the report adds.