• Introduction
• Key improved health service areas:
• Key changes in the trend in Heart Disease
• Age standardised Coronary Heart Disease Mortality Rates
• Changes in death rates between 1994-1998 and 1999-2003 from Coronary Heart Disease (CHD)
• Percentage decline in CHD mortality in Ireland between the time periods 1994-1998 and 1999-2003
• CHD Mortality Fall in Ireland 1985-2000 explained
• Important challenges to tackle now
• Click here to view Publications on Heart Health

During 2007 the HSE audited the implementation of the national cardiovascular strategy, Building Healthier Hearts. The purpose of this report was to identify the achievements during the first five years of the strategy’s implementation and to clarify the outstanding gaps. The report describes trends in cardiovascular health with an emphasis on the changes since the mid 1990s, outlines investment to date and sets out the current state of implementation of the recommendations and identifies the way forward.

Ireland, once the worst in the EU 15 for premature mortality from heart disease, now can show that the 1990s targets for a reduction in the death rate have been met.  Launched eight years ago, ‘Building Healthier Hearts’ set out the strategy to tackle Ireland’s high rates of CHD with the subsequent allocation of €72m specifically for work in this area, most of it being spent regionally.  The audit of the programme outlines key factors, which have contributed to a significant improvement in the country’s heart health.

Key improved health service areas:

• Major smoking initiatives – Smoking Ban, smoking cessation clinics and a national Quitline.
• Significant promotion of health in schools, workplaces and community –Health Promoting Schools and Hospitals initiatives, curriculum development.
• Improvements in secondary prevention to improve survival for patients with heart disease - a four-fold increase in prescribing of cardiovascular medication in primary care, initiation of structured care for cardiac (Heartwatch) and diabetes patients, improved access to diagnostic facilities.
• The appointment of 820 new posts by the HSE with specific remits in the cardiovascular field
• The increased availability of defibrillators in ambulances and with GPs, support for ‘first responder’ programmes in conjunction with communities and official agencies
• Most hospitals now carry out lifesaving anti-clotting treatment (thrombolysis) in Emergency Departments ensuring that practice is in line with international guidelines. There have also been sizeable increases in cardiac investigations and interventions
• Widespread and extensive development of cardiac rehabilitation services meaning six times more patients avail of this service now (4,200 patients in 2005)
• The spending of €18m on programmes like ‘Heartwatch’, Coronary Heart Attack Ireland Register (CHAIR), National Cardiovascular Information system; media campaigns and the initial implementation of the Sudden Cardiac Death (SCD) Taskforce report 

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Key changes in the trend in Heart Disease

Study of the epidemiological trends shows:

• A very welcome reduction (54%) in coronary heart disease (CHD) death rates since 1985 and in particular the accelerated pace of reduction in Ireland since the mid 1990’s compared with the EU average. Ireland no longer has the highest rate of premature mortality for CHD in the EU-15.
• Forty eight percent of the mortality fall (1985 – 2000) is explained by a reduction in population risk factors and 44% is due to improved treatments, with beneficial effects being offset by increases in diabetes, obesity and physical activity.
• In terms of treatment a two to four fold increase in prescribing of cardiovascular therapies in primary care has been observed along with increased throughput in hospitals particularly a two to three fold increase in interventional work.
• The biggest improvement in risk factor reduction has been in smoking yet modest improvements in blood pressure and cholesterol have also contributed.
• With the decrease in death rates comes increased survival, with increased need for ongoing care.
• Remaining inequalities are seen in geographical areas (former Southern, Midlands and South Eastern Health Boards), in gender and in social class.

Age Standardised CHD Mortality Rates per 100,000 for Males and Females in Ireland and EU-15

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Changes in death rates between 1994-1998 and 1999-2003 from Coronary Heart Disease (CHD) and from all causes

_{Source: PHIS V8}

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Percentage decline in CHD mortality inIreland between the time periods 1994-1998 and 1999-2003

<sub>Source: PHIS v 8 with statistical analysis by Drs O’Hara and Bennett.
*   denotes significantly LOWER mortality reduction than national average
** denotes significantly HIGHER mortality reduction than observed national average</sub>

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CHD Mortality Fall in Ireland 1985-2000 explained

_{Source: Bennett K et al¹⁸}

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Important challenges to tackle now

As well as outlining the achievements, the audit points to areas for further development.  One major consequence of this major success is that more and more people are now living with heart disease rather than dying from it. These people are benefiting from much more effective modern treatments to manage long-term conditions and they need follow up and ongoing care involving new and better drugs and therapies.

Other challenges at this stage are the twin epidemics of obesity and type-2 diabetes which present a threat to progress made. Major advances in tacking rates of cigarette smoking and increasing awareness of the role played by blood pressure must also be built upon. These are areas for focus by the HSE and other agencies.

Moving forward, the HSE Transformation Programme will directly influence the development of services aimed at improving heart health through better integration of services for the patient in their ‘journey of care’ and the prevention and management of chronic illness.

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