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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn. European 4th Joint Task Force on CVD Prevention in Clinical Practice in the context of the National Cardiovascular Health Policy 2010-2019 Hannah McGee, PhD, FEHPS, FESC. “Changing Cardiovascular Health”

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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

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Royal college of surgeons in ireland col iste r oga na m inle in irinn

Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn

European 4th Joint Task Force on CVD Prevention in Clinical Practice in the context of the National Cardiovascular Health Policy 2010-2019

Hannah McGee, PhD, FEHPS, FESC


Royal college of surgeons in ireland col iste r oga na m inle in irinn

“Changing Cardiovascular Health”

[10 year plan: 2010-2019]

CVH Policy Group Terms of Reference

‘…to develop a policy framework for the prevention, detection and treatment of cardiovascular disease including stroke and peripheral arterial disease, which will ensure an integrated and quality assured approach to their management’.


Cvd medication use gms scheme 1998 2006

CVD Medication Use - GMS Scheme (1998-2006)


Royal college of surgeons in ireland col iste r oga na m inle in irinn

SLÁN 2007: Hypertension management

  • (N=1207, aged 45+)

  • Normotensive (<140/90mmHg)(no meds)40%

  • Hypertensive

    • On medication (<140/90mmHg) 8%

    • On medication (>140/90mmHg)18%

    • NOT on medication (>140/90mmHg)34%


Royal college of surgeons in ireland col iste r oga na m inle in irinn

SLÁN 2007: Hypertension management

  • Normotensive (<140/90mmHg)(no meds)40%

  • Hypertensive

    • On medication (<140/90mmHg) 8%

    • On medication (>140/90mmHg)18%

    • NOT on medication (>140/90mmHg)34%

    • Not Treated:

    • Men/women: 40 / 27%

    • Age 45-64 / 65+34 / 33%

    • Social class (1-2/3-4/5-6): 35 / 33 /39%


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Structure and Recommendations

  • 69 recommendations

    • Recommendation

    • Lead agency


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Structure and Recommendations

  • 69 recommendations

    • Recommendation

    • Lead agency

  • SIX SECTIONS

  • Prevention and Health Promotion

  • Primary Care

  • Hospital and Emergency Care Services

  • Cardiac and Stroke Care and Rehabilititon

  • Workforce Planning for the Policy

  • A National Framework for Quality in Cardiovascular Health


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Prevention and Health Promotion

  • 10-year population targets:

  • Smoking

    • annual 1% reduction prevalence

    • Annual 1% reduction in initiation rates

  • Healthy body weight [Healthy eating /physical activity]

  • - halt rise in 5 years

  • - restore 1998 levels by 2019

  • Salt consumption

    • EU 2012 Directive (16% reduction)

  • Alcohol use

    • Strategic Task Force on Alcohol targets (2007)


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Primary Care I

  • Patient/public awareness

    • blood pressure & cholesterol levels, family history, waist circumference, stroke signs/symptoms

  • High risk approach - extend definition using ESC’s 4th Joint SocietiesTask Force (2007) approach

    • established disease, family members - premature atherosclerosis/multiple risk factors

  • Risk identification & management

    • Single nationally agreed protocol

    • Opportunistic assessment (with systematic approach)

    • Phased evaluation of systematic assessment model


Royal college of surgeons in ireland col iste r oga na m inle in irinn

Population risk: systematic opportunistic assessment in general practice?

SLÁN 2007: Attending GP in the previous year

(gender, age and social class (%))


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Primary Care II

  • Stroke prevention

    • blood pressure

    • - rigorous assessment, treatment, monitoring

    • atrial fibrillation

    • - age 65+: pulse assessment in GP

    • - anticoagulation services

  • Heart failure management

    • Early detection:

    • - education of primary care teams

    • - liaison specialist HF nurses


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Rehabilitation

  • Commonalities - cardiac & stroke

  • Secondary prevention for all

    • from TIA/mild strokes to complex cardiac cases - heart failure/PAD

  • Step-down strategies from hospital to primary care services

  • Staff training - chronic disease model: build on CR experience


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: National Framework for Quality in Cardiovascular Health

  • Standards

    • Evidence-based guidelines/ performance indicators/ information & data requirements/updating guidelines

    • National Guidelines Coordination (liaise DoHC/HIQA)

  • Surveillance

    • Information systems - registers, data standards, population surveys, audit

    • ICT - infrastructure, capacity & training

  • Research and evaluation

    • Health Technology Assessment agenda


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: What happens next?

  • Policy delivery

    • 1. HSE Service Plan - Clinical Directorate priorities set

    • Appointments: Stroke, Acute cardiac, Heart failure, Primary care

    • 2. Cabinet Sub-Committee on Health: monitor population targets

    • 3. Overall: CVH Policy Monitoring Group to be established

  • Full formal review at 5 years (2015)

    • CVH Policy Monitoring Group


Hospital discharges by cvd diagnosis 1998 2008

Hospital discharges by CVD diagnosis (1998-2008)


Hospital discharges by cvd diagnosis 1998 20081

Hospital discharges by CVD diagnosis (1998-2008)


Hospital discharges by cvd diagnosis 1998 20082

Hospital discharges by CVD diagnosis (1998-2008)


Hospital bed days by cvd diagnosis 1998 2008

Hospital bed days by CVD diagnosis (1998-2008)


Hospital bed days by cvd diagnosis 1998 20081

Hospital bed days by CVD diagnosis (1998-2008)


Hospital bed days by cvd diagnosis 1998 20082

Hospital bed days by CVD diagnosis (1998-2008)


Hospital bed days by cvd diagnosis 1998 20083

Hospital bed days by CVD diagnosis (1998-2008)


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Workforce Planning

  • Medical Staffing

  • Consultant workforce:

    • Cardiology: Joint Working Group (2004) – 10 per 500,000 needed

    • (preventive cardiology & heart failure expertise for network coverage)

    • Stroke: combination geriatric medicine/neurology with special interest in stroke/geriatric medicine/rehabilititon medicine

    • (5 acute stroke, 2-3 for other services, additional rehabilitiation physician expertise per 500,000)

  • NCHD workforce:service need/capacity for next generation

  • Multidisciplinary Team Staffing (+ICT)

  • Primary Care Staffing (PCTs)


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Structures - Networks

  • Regional networks

  • Serving populations of c.500,000

  • Every hospital provides a complete range of services

  • (cardiac or stroke) either on-site or in formal partnership with others in the network)

  • Equitable - all can access same range of services

  • Hospitals Two types:

    • GENERAL cardiac(stroke) centre (provides sub-acute and chronic care)

    • COMPREHENSIVE cardiac(stroke) centre (provides acute care)

  • Some consultant and other staff with ‘network’ responsibilities


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Hospital Care I

  • Clinical management - cardiac (ACS)

    • STEMI & treatable within 180 mins: primary PCI

    • Centres with access, workforce expertise and adequate cover

    • STEMI & not treatable within 180 mins: thrombolysis

    • Timely provision = priority

  • Structures - cardiac

    • PCI: full range of imaging facilities/ 2 labs for timely access

    • CCU reconfigured - Critical Cardiac Care focus

    • Thrombolysis: pre-hospital/advanced paramedic and hospital combination


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Hospital Care II

  • Services

    • Emergency services: advanced paramedics/ICT essential

    • Rapid Access Chest Pain Services

    • Heart failure - ambulatory services: shared care model

    • PAD services: vascular service access

    • Cardiac surgery: workforce adequate

    • - Protected ICU beds (single room) the priority

    • Congenital heart disease /GUCH: needs separate focus


Royal college of surgeons in ireland col iste r oga na m inle in irinn

POLICY: Hospital Care III

  • Clinical management - stroke

    • Thrombolysis: ‘consultant stroke physician’ administered

    • 24/7 cover needed

  • Structures - stroke

    • Stroke units: capacity, MD Teams, care protocols, early start to rehabilitation; discharge plan

    • TIA/Stroke Prevention Clinics: same day assessment; timely access to vascular surgery where needed

    • Neuroradiology/Vascular Surgery: services access


Royal college of surgeons in ireland col iste r oga na m inle in irinn

Philosophy - REDUCING THE INCIDENCE OF CVD: The European Heart Health Charter “Every child born in the new millenium has the rightto live until the age of at least 65 without suffering from avoidable cardiovascular disease” (June 2007)


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