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Changing Cardiovascular Health National Cardiovascular Health Policy 2010 – 2019

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Changing Cardiovascular Health National Cardiovascular Health Policy 2010 – 2019 Changing Cardiovascular Health National Cardiovascular Health Policy 2010 – 2019 MAY 2010 DEPARTMENT OF HEALTH AND CHILDREN Copyright © Minister for Health and Children, 2010 Department of Health and Children Hawkins House Hawkins Street Dublin 2 Tel: +353 (0)1 635 4000 Fax: +353 (0)1 635 4001 E-mail: [email protected] Web: www.dohc.ie Published by Government Publications, Dublin ISBN 0-7557-7639-9 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the copyright holder. For rights of translation or reproduction, applications should be made to the Head of Communications, Department of Health and Children, Hawkins House, Hawkins Street, Dublin 2, Ireland. ContentS Minister’s Foreword vii Acknowledgements ix Membership of the Cardiovascular Health Policy Group x Executive Summary 1 Introduction to the Cardiovascular Health Policy (Chapter 1) 2 Cardiovascular Disease – Trends in Ireland (Chapter 2) 2 Prevention and Health Promotion (Chapter 3) 3 Primary Care (Chapter 4) 6 Hospital and Emergency Care Services (Chapter 5) 11 Cardiac and Stroke Rehabilitation and Continuing Care (Chapter 6) 22 Workforce Planning (Chapter 7) 28 National Framework for Quality in Cardiovascular Health (Chapter 8) 31 1. Introduction 35 Cardiovascular Health Policy Group 36 Background 36 A vision for cardiovascular health 37 Structure of report 38 2. Cardiovascular Disease – Trends in Ireland 39 Life expectancy and healthy life years 40 Cardiovascular disease 40 Heart failure 46 Peripheral arterial disease 47 Sudden cardiac death 48 Congenital heart disease and grown-up congenital heart (GUCH) disease 48 Diabetes 48 Cardiovascular targets and trends in risk factor prevalence 49 Explaining changes in cardiovascular mortality from 2000-2006 50 Population projections and emerging cardiovascular disease trends 51 Costs 51 Summary 52 3. Prevention and Health Promotion 53 Risk factors for cardiovascular disease 55 Impact of health behaviour patterns on risk of cardiovascular disease 56 Targeted health behaviour interventions 57 Population health targets to address cardiovascular disease 58 Health behaviour profiles in Ireland 59 Intersectoral work 65 4. Primary Care 67 Primary care and risk awareness 68 Prevention – General principles 69 Management of high risk, including established disease 70 High risk 70 Prevention of cardiovascular disease in those with Diabetes mellitus 73 Prevention of stroke in primary care 73 Heart failure 76 Peripheral arterial disease 79 Information systems in primary care 80 5. Hospital and Emergency Care Services 81 Acute cardiac care pathways 83 Organisation of specialist cardiac services 90 Cardiac surgery 92 Acute stroke care 95 Organisation of hospital services for stroke 103 Emergency response for acute cardiovascular events 106 6. Cardiac and Stroke Rehabilitation and Continuing Care 109 Cardiac rehabilitation 112 Stroke rehabilitation 116 An integrated approach to cardiovascular rehabilitation 122 7. Workforce planning for the National Cardiovascular Health Policy 127 Medical consultant leadership roles 130 Stroke consultant physicians 131 Non-consultant hospital doctors 132 Multidisciplinary team involving health and social care professionals 133 Development of nursing roles 134 Technical support staff for cardiovascular diagnostics and procedures 134 Primary care and community services 135 Clerical and administrative support, including staff with expertise in database and patient register development and management 136 Community and voluntary involvement 136 8. A National Framework for Quality in Cardiovascular Health 137 National standards of Cardiovascular Health Services 139 Cardiovascular health surveillance 140 Health surveys 143 Audit 143 Role of information and communications technology 144 Research and evaluation, including health technology assessment 144 References 147 Appendices Appendix 1: ICD Codes 158 Appendix 2: IMPACT CHD mortality model 2000-2006 159 Appendix 3: Algorithm for management of presentation to hospital of suspected acute coronary syndrome 161 Appendix 4: Stroke Networks – Description and Governance 162 MiniSter’S Foreword I am pleased to introduce this new policy framework covering all aspects of cardiovascular health, including stroke. It is now a decade since the first National Cardiovascular Health Strategy, Building Healthier Hearts (1999), was launched. It introduced a wide range of new services and initiatives, which have had a positive impact on reducing the burden of cardiovascular disease through prevention, better diagnosis and treatment. However, given the pace of change in scientific development and medical practices in this area during the last decade, an updated policy was required. Furthermore, any policy on cardiovascular care would be incomplete unless it includes a strategy on stroke. This new policy, Changing Cardiovascular Health, covering the period 2010-2019, addresses the spectrum of cardiovascular disease and stroke, including prevention and management and how these are integrated to reduce the burden of these conditions. It covers the whole area of prevention, including measures that individuals can take as well as population interventions, and areas in which intersectoral action is necessary. It deals with the clinical management of cardiovascular disease and stroke, and covers all aspects of healthcare – from childhood through old age, from pre-hospital emergency care to rehabilitation and palliative care. The policy is being launched in a challenging economic climate with little prospect of additional resources. However, the policy covers the period 2010-2019 and much can be done to advance it in tandem with other national strategies and the reorganisation of current resources. The Health Service Executive has been tasked with developing an implementation plan detailing how it intends to arrange services to support the delivery of care. This policy represents a significant development coming after previous policies on cancer and diabetes, which together will account for the majority of healthcare in this country. The policy will operate alongside and complement existing policies on obesity, alcohol and chronic disease. The review is timely given the considerable changes in health services, the impact of unhealthy lifestyles, the future demand on health services and the scope for substantial improvements in cardiovascular mortality in the years to come. I am confident that this policy paves the way for enhanced prevention and care of cardiovascular disease and stroke in the next decade and will mark a new chapter for service delivery in this area. I would like to take this opportunity to thank the members of the Cardiovascular Health Policy Group, who gave freely of their time and expertise in order to develop this framework, and especially Professor Hannah McGee, Professor of Health Psychology at the Royal College of Surgeons in Ireland, who worked tirelessly on this project. _______________________________________ Mary Harney, TD Minister for Health and Children vii ACKnowledgementS This National Cardiovascular Health Policy was commissioned by the Minister for Health and Children. Its aim is to provide an integrated and quality-assured policy framework for the prevention, detection and treatment of cardiovascular disease, including stroke and peripheral arterial disease. The policy comes a decade after the important first National Cardiovascular Health Strategy in Ireland (Building Healthier Hearts, 1999) and is a timely successor. Since Building Healthier Hearts, we as a country have improved our evidence base on population health and on service delivery and cardiovascular outcomes, although there is much still to do to ensure our information collection methods are systematised to deliver evidence in a dependable periodic manner. I am very grateful to the hard-working and enthusiastic Working Group who developed this policy. The similarity of the professional challenges of working in the traditionally separate areas of cardiac and stroke care, and the opportunity to work together to develop a common approach to the variety of presentations of cardiovascular disease (from prevention through emergency care to early rehabilitation and lifelong chronic disease management), was an important stimulus to work to achieve an integrated vision for the coming decade in the management of cardiovascular disease. While all of the Working Group provided their unique perspectives to make a comprehensive final product, I know that members will concur with me in particularly thanking Dr. Brian Maurer who combined his lifelong career expertise from cardiology and his advocacy role from the Irish Heart Foundation to bring wisdom and a sense of responsibility to our deliberations. It was a pleasure to be part of the developmental processes of the Working Group. Thanks are extended to many people outside of the core Working Group for their support. It is not possible to individually list all who provided some assistance. We thank Dr. Kathleen Bennett and Dr. Tom O’Hara, Department of Pharmacology & Therapeutics, Trinity College Dublin, for biostatistical support, and we acknowledge their Department head and mentor – Professor John Feely, Chair of the HeartWatch Implementation Committee, whose untimely death during this period deprived the academic and clinical cardiovascular community
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