The National Heart Programme should be formally restructured and strengthened as the overall governance and implementation structure for the development, enhancement and oversight of specialist cardiac services in Ireland, it has been recommended by a National Review of Cardiac Services.
The Programme should oversee the development, implementation and maintenance of models of care, clinical guidelines and national protocols to streamline the diagnosis and timely management of cardiac diseases and achieve integration between primary care and hospital settings.
Other recommendations included:
Specialist cardiac services should be organised into six regional cardiac networks, aligned to the six new regional health areas. These regional cardiac networks would include different types of hospital, each with a defined role, working with each other and with primary and community care services to provide seamless patient-centred care and promote heart health. The design of these regional cardiac networks should prioritise the delivery of cardiac services (and thus the allocation of resources) in primary and community care settings, supported by specialist cardiology services in regional and smaller hospitals, while at the same time concentrating complex cardiac and interventional care in a small number of centres. Cardiac services should be planned and distributed across the network to optimise quality of and access to care, support the health of the population, and promote the care of patients in their own community.
The National Heart Programme and regional cardiac networks should be supported by four national comprehensive cardiac centres (Mater University Hospital, St. James’s Hospital, Cork University Hospital and Galway University Hospital), where complex interventional cardiology services, including percutaneous coronary intervention (PCI), electrophysiology and percutaneous intervention for structural heart disease, should be concentrated alongside an appropriate cardiothoracic surgical service.
The 24/7 emergency care of patients with STEMI-ACS should continue to be concentrated in the four national comprehensive cardiac centres (MMUH, SJH, GUH and CUH) noting that these centres currently perform 75% of all primary pPCI for STEMI.
The National Centre for Advanced Heart Failure at the MMUH, should be developed on an ongoing basis with formal links to all of the regional networks.
Services for Adult Congenital Heart Disease should continue to be concentrated and developed as a national service at MMUH, with appropriate access to specialist imaging and cardiac investigations.
Interventional cardiology services should be sustained and strengthened at Beaumont Hospital, University Hospital Limerick, University Hospital Waterford, St. Vincent’s University Hospital and Tallaght University Hospital and these centres should focus primarily on scheduled care, and, as part of the planned arrangement of services across a regional network, the urgent care of patients with NSTE-ACS. The Department of Health and HSE, working with the National Heart Programme, establish a biennial process to review the nationwide provision of pPCI service to determine at which sites and on what basis pPCI should be offered.
The current cross-border arrangement whereby pPCI services are provided by Altnagelvin Hospital be continued to provide for timely and equitable access to pPCI for STEMI in the northwest. The NRCS does not recommend the arrangement be expanded beyond the services currently provided.
There should be a minimum of 30 Consultant Cardiologists per million of the population, working up to an ultimate goal of 40, to staff a comprehensive cardiac care service for Ireland.
Services in Model 3 hospitals should be focused and strengthened to offer leadership in integrated care, community cardiology, preventive cardiology and cardiac imaging, and to provide specialist care in heart failure, general cardiology, rhythm disorders, and the pre- and post-intervention care of coronary artery disease. Model 4 hospitals with specialist cardiology centres should in addition provide interventional cardiology services, normally focused on elective services and urgent treatment of NSTE-ACS. Primary PCI for STEMI
Interventional services for structural heart disease and electrophysiology services only should be developed in the four National Comprehensive Cardiac Centres, and such services should not be provided at other sites, with the exception that it may be appropriate for electrophysiology services to be distributed across different Model 4 sites in the Dublin region. Electrophysiology and elective coronary intervention services could be distributed across TUH, SVUH and BH, so that SJH and MMUH focus on emergency and urgent coronary intervention and structural heart intervention
Specific actions should be taken to enhance the practice of cardiology in Model 3 hospitals, including, creating opportunities for Model 3 hospitals to offer network leadership in heart failure, cardiac imaging, preventive cardiology and integrated care, joint appointments with Model 4 hospitals and phasing out the requirement on cardiologists to do general medical call. Each Model 3 and Model 4 hospital in a regional network should have a specific and properly resourced heart failure unit led by a cardiologist.
Six advanced cardiac imaging centres (one per regional network), to include dedicated cardiac CT and cardiac MRI services.
The development of a national plan for investment in cardiac imaging and cardiovascular information systems, to provide for the establishment of advanced imaging centres, and cardiac CT in Model 3 hospitals.
Cardiac CT should be available to all Model 3 and in all Model 4 hospitals; international norms and guidelines suggest demand for cardiac CT will exceed 500 examinations per 100,000 population per year and hence.
The equivalent of 10-12 dedicated scanners was the estimated minimum requirement for the Republic of Ireland.
The expansion of echocardiography services, including community echocardiography and GP access to echocardiography, under appropriate clinical governance and with clear onward referral criteria from primary care and community to outpatient services, with a target of three months from referral to report for routine echocardiograms, and one month for urgent referrals.
The National Integrated Medical Imaging System (NIMIS) be expanded to all acute hospitals currently not on NIMIS to allow for transfer of images across the entire network.
