MEDICAL MATTERS:Despite its obvious success, Heartwatch is under threat of cancellation, writes MUIRIS HOUSTON
ALTHOUGH STILL a major cause of mortality and morbidity in the Republic and other European countries, the management of heart disease in the western world has improved beyond all recognition. This can be credited to a number of factors; but a key development has been the success of both primary and secondary prevention programmes.
Properly managed, heart disease is now a chronic illness for many people. Patients with established ischaemic heart disease, who work with healthcare professionals in managing their risk factors, do very well.
A paper published online this month in the British Medical Journal reinforced this message. An all-Ireland study of more than 900 patients from general practices in the North and the Republic found patients with established heart disease who were intensively targeted to improve their cholesterol and blood pressure levels had a much lower number of hospital admissions.
Lead author Dr Andrew Murphy, professor of general practice at the National University of Ireland Galway, says: “It is the first study to definitively show that such programmes reduce both total and cardiovascular-related hospital admissions. This is of crucial importance today where hospitals are under such pressure regarding which patients to admit.”
An interesting nugget to emerge from the research was the finding that baseline measures for blood pressure and cholesterol in all practices were much lower (more normal) than that found in previous studies.
But the intervention was clearly helping in some way – otherwise the number of hospital admissions would not have dropped by 44 per cent.
Unfortunately, a similar prevention programme, Heartwatch, has been only partially implemented in the Republic. Set up in 2003 by the Irish Heart Foundation and the Irish College of General Practitioners with funding from the Health Service Executive (HSE)/Department of Health, the patients of just 20 per cent of practices have benefited.
At the time there was a clear commitment to expand it nationwide, subject to evaluation. This never happened, despite an assessment showing the programme had prevented 81 deaths in its first two years. Patients on the programme also gained a total 522 additional life-years and the targeting of risk factors was highly cost-effective.
Unbelievably, despite the millions swilling around the national coffers at the time, the Minister for Health failed to ensure equal access for all patients in the State to a programme proven to save lives at minimal cost.
There has been little outcry about this scandal; I wonder if it happened in the area of cancer would there have been a more indignant response? And now, to add insult to injury, the programme is apparently under threat of complete cancellation.
The supreme irony of such a move, of course, is that primary care is being pushed by the HSE chief executive as the future of health service reform. Yet here we have a successful programme that keeps people out of hospital, while being looked after to a high standard in the community, and it is on the chopping block.
What would be appropriate would be a revamp of the programme to include the assessment of recently identified cardiac risk factors such as chronic kidney disease and depression.
As part of offering the intervention to all eligible heart patients, regardless of where they live, it may be appropriate to limit the number of visits made by each person. A budget neutral expansion of Heartwatch would appear to be a “no brainer”.
But just as one intervention may be under threat, another one is quietly getting under way. MyAction, a programme provided by Croí, the West of Ireland Cardiology Foundation and funded by the primary care department of HSE West, is aimed at people identified as being at high risk of having a cardiac event in the future.
The 16-week intervention by a multidisciplinary team of nurses, a dietitian and physiotherapist, includes a tailored exercise and diet programme, as well as help with smoking cessation. It also targets blood pressure and cholesterol control.
Provided in the community to patients referred by GPs, MyAction expects to have preliminary results on its first cohort of patients next February. It’s an exciting development, aimed at catching people before they end up in coronary care, rather than after.
It could well be implemented nationwide, but only if the kind of blinkered thinking illustrated by the failure to develop Heartwatch becomes a thing of the past.
- Declaration of interest – Dr Muiris Houston works with both the Heartwatch and MyAction programmes
- mhouston@irishtimes.com