Consultant cardiologist Ken McDonald said that, ideally, GPs should be able to send blood samples to the local hospital where they could be assessed for heart failure (HF) — there is a specific test to help detect heart failure — but that this was only possible “in about one third of cases”.
“It’s either not done in the local hospital or it’s not available to GPs,” said Prof McDonald.
A cardiac ultrasound or echocardiogram was the second step in the diagnosis, but waiting lists were “extraordinarily long”, said Prof McDonald.
“The best waiting times are 3-6 months and there are areas around the country where patients have to wait more than a year,” he said.
Prof McDonald said he was “100% in agreement with GPs” that they did not have the resources to take on management of chronic diseases in the community and that he could understand if there was “a push-back” against taking on management of heart failure.
“They need more resources,” he said.
Prof McDonald’s comments tie in with the launch of a new report, Heart Failure Country Barometer: Ireland which outlines four key policy priorities and calls on the Government to take action to improve the lives of the 90,000 people affected by the chronic disease. These actions include:
- Making HF a national priority by explicitly mentioning HF within existing chronic disease policies and ensuring there are sufficient resources to implement the National Clinical Programme for HF on a national level (adequately funding both General Practice and hospital care);
- Ensuring that patients with symptoms of HF, including breathlessness and fatigue — are diagnosed earlier and without delay;
- Creating a co-ordinated national programme linking hospital and community care — providing HF patients with greater continuity of care and encouraging patient self-management;
- Supporting a national HF prevention programme by raising public awareness of the risk of developing HF and ensuring access to high quality information and support for both the public and medical profession.
Prof McDonald said heart disease has essentially been the poor relation in the catalogue of chronic diseases.
“It’s not one that’s in the limelight but it needs to be,” he said. “The medical profession needs to be looking at it and saying ‘we’ve ignored that’.
“We’ve had to concentrate on the acute end, on emergencies such as heart attacks and heart rhythm disorders and we have not put the time into heart failure.”
Prof McDonald said that, with the exception of Iceland, Ireland had the lowest number of cardiologists per head of population in Europe. This was at a time when HF was costing at least €660m every year, a figure Prof McDonald was “if anything, an underestimate”.
“The problem is that cost is growing, but all the care is still focused on the hospitals where treating patients is more expensive,” he said. “If we changed the dynamic around, and delivered most of the care in the community it would be more cost-effective.”
For more on the report and to read the full framework of policy priorities, visit croi.ie, heartbeat-trust.ie, and novartis.ie and follow #heartfailure and #changeHFpolicy.