Heart failure patients at mercy of ‘postcode lottery’

Patients suffering from heart failure are at the mercy of a postcode lottery, with survival trends and hospital re-admission rates “dramatically” impacted by “patchy” distribution of hospital services.

That’s according to a new report, The Cost of Heart Failure in Ireland, which found a “profound regional disparity” in services and outcomes for those with heart failure.

Consultant cardiologist Ken McDonald said in terms of major population areas, the Cork/Kerry region was the “most poorly resourced” for treating heart failure.

“While services have evolved and developed around the main Dublin hospitals and in Galway and Limerick, Cork and Kerry need funding,” said Prof McDonald. “To set up the type of service we are talking about would take approximately €300,000-€400,000 per annum recurring, not a lot of money in the context of the overall health budget.”

However, the most basic need was to increase the number of cardiologists, from the current position of “second or third lowest number of cardiologists per capita in Europe”, he said.

Another fundamental need was to improve access times to echocardiograms, a diagnostic test for heart failure. Prof McDonald, who is medical director of the Heartbeat Trust, the charity that carried out this research with the Irish Heart Foundation, said there was a waiting list “of up to a year in several areas”.

“No-one can put up their hand and say waiting times are satisfactory, even our own unit in St Vincent’s,” he said.

There was also a need to improve links between hospital and community in treatment of what is a chronic disease, Prof McDonald said.

“It can be diagnosed and managed in the community. On the east coast, heart failure is being diagnosed more and more by GPs,” he said. In Wicklow and North Wexford, the Health Service Executive has piloted an early diagnostic project, that was “leading to early diagnosis or ruling out a diagnosis”.

The report also found less than 1% of patients are referred for cardiac rehabilitative services. “It is a lack, and there is no denying that,” Prof McDonald said.

“Every unit, including our own, can’t provide a service at the level or speed or to the numbers we’d like to — we don’t have the resources.”

However, the HSE’s National Heart Failure Clinical Programme was trying to roll out “a homogenous level of service”, and while it had made some strides, the recession had slowed progress.

The report, published today, found the cost of heart failure to Irish society is €660m, but Prof McDonald reckons this is an underestimation. Nearly 50% of costs are hospital-related.

One in five men and women will develop heart failure over their lifetime.