Changing Cardiovascular Health: National Cardiovascular Health Policy 2010-2019

Objectives

Changing Cardiovascular Health is Ireland’s 2010-2019 national policy framework for reducing the burden of cardiovascular disease across the life course, covering prevention, detection, treatment, emergency care, rehabilitation, continuing care and palliative care. Its core objective is an integrated, quality-assured approach to cardiovascular disease, including stroke and peripheral arterial disease, that is safe, effective, timely, patient-centred and equitable.[1][2][3]

• Promote cardiovascular health as a national resource and support a vision in which every child can live to at least age 65 without avoidable cardiovascular disease.[4][5]
• Reduce population risk through healthier diet, physical activity, healthy weight, lower salt intake, smoking cessation and responsible alcohol consumption, while addressing the wider social, economic, cultural and environmental determinants of health.[6][7][8]
• Reduce inequalities in cardiovascular health by applying health-literacy and social-inclusion approaches and targeting vulnerable groups, including people on low incomes, older adults, minority and immigrant communities, and people with chronic physical or psychological conditions.[9]
• Combine population-wide prevention with intensified assessment and management for people at high risk, including those with established atherosclerotic disease, multiple risk factors, diabetes, microalbuminuria, or relevant family history.[10][11][12]
• Achieve measurable behavioural targets, including restoring adult healthy-weight prevalence from 38% to 43% and reducing obesity from 23% to 18% by 2019, alongside improving children’s weight profile.[13]
• Increase regular physical activity to 66% of adults and 49% of children by 2019, reduce average adult salt consumption to no more than 6 grams daily, reduce smoking prevalence from 29% to 19%, and reduce per-capita alcohol consumption to 9 litres annually.[14][15][16][17]
• Strengthen primary care for risk assessment, hypertension, cholesterol, diabetes, atrial fibrillation, heart failure and peripheral arterial disease through structured clinical care and common evidence-based protocols.[18][19][20][21][22]
• Improve emergency cardiovascular outcomes through rapid reperfusion for myocardial infarction, consultant-led stroke assessment and thrombolysis, coordinated ambulance services, advanced paramedics, public recognition of warning signs, and community first-response skills.[23][24][25][26]
• Deliver accessible cardiac, stroke and wider cardiovascular rehabilitation that restores function, supports self-management and secondary prevention, enables community reintegration, and provides psychosocial, carer and palliative-care support.[27][28][29][30]
• Organise cardiac and stroke services through population-based networks that link general centres, comprehensive specialist centres, hospitals, primary care and community services.[31][32][33]

Implementation

Implementation combines service reorganisation, intersectoral prevention, clinical networks, workforce development, information systems and quality improvement. The Department of Health and Children sets policy direction, while the Health Service Executive delivers services through annual National Service Plans, working with the Health Information and Quality Authority, professional bodies, voluntary organisations, research organisations and other public sectors.[34][35][3]

• Lead cross-government health-improvement action through the Department of Health and Children, with regular reporting to Government through the Cabinet Committee on Health and engagement from education, transport, planning, agriculture, food industry, media, sport and leisure sectors.[36][37]
• Use existing policies and service programmes on obesity, alcohol, chronic disease, hospital reconfiguration, primary care and patient safety to support delivery, particularly where immediate additional resources are unavailable.[5][38]
• Develop phased public-awareness and education campaigns through the Health Service Executive and voluntary agencies, reinforce messages in general practices and pharmacies, and use interim evaluations to inform later phases.[39][40][37]
• Deliver structured prevention and chronic disease management through multidisciplinary primary care teams, shared-care pathways, patient education, self-management support and links between primary care and hospitals.[12][18][41]
• Implement cardiac and stroke networks with defined roles for general and comprehensive centres, specialist diagnostic and treatment capacity, telemedicine where appropriate, and coordinated emergency, acute, rehabilitative and community care.[42][43][44][25]
• Develop workforce capacity through network-level gap analyses, annual staffing inventories, specialist nursing and multidisciplinary roles, consultant leadership, training, continuing professional development and links with education bodies.[45][46][47]
• Establish a Cardiovascular Policy Monitoring Group to meet twice yearly, provide annual progress reporting, identify barriers and coordinate a major mid-term review in 2014.[34][35]
• Agree national standards, guidelines, performance indicators and reporting structures, supported by routine clinical and organisational audit of cardiovascular networks and services.[3][48][49]
• Build interoperable information infrastructure, including a unique patient identifier, electronic health records, minimum cardiovascular datasets, disease registers, annual data validation and national adult and child population surveys.[50][51][48]
• Coordinate research and health technology assessment through a national stakeholder group led by the Health Research Board to assess clinical and cost-effectiveness and guide policy and service planning.[52][53]
• Reorganise current resources and seek efficiency from better clinical processes, workforce deployment and integrated care; the policy identifies a need for additional investment but does not specify a total budget, funding allocations or financing sources.[1][4][38]

Monitoring & Evaluation

The policy establishes a national quality, monitoring and accountability architecture for cardiovascular health, combining population targets, service standards, routine data systems, audit, research and formal policy review. A Cardiovascular Policy Monitoring Group is to meet twice yearly, advise the Department of Health and Children, publish an annual progress report on barriers, and coordinate a major mid-term review in 2014.[35][34]

• Track behavioural and population-health targets over the policy period, including healthy weight, diet, physical activity, salt consumption, smoking, alcohol use and inequalities in cardiovascular health.[54][55][39]
• Measure explicit milestones, including halting the rise in overweight and obesity by 2014, reducing obesity by 2019, reducing smoking prevalence from 29% to 19%, and reducing per-capita alcohol consumption to 9 litres annually.[54][16][17]
• Establish evidence-based guidelines, national standards, performance indicators and reporting structures through the Department of Health and Children, Health Information and Quality Authority and Health Service Executive.[34][3]
• Develop a comprehensive cardiovascular information system with common data standards, a unique patient identifier, electronic health records, minimum datasets, patient registers and a Cardiovascular Disease Registry.[50][51][48]
• Validate data and report annually through a quality and standards monitoring system, while strengthening mortality, morbidity and Hospital In-Patient Enquiry data.[51]
• Conduct at least two national adult and child population surveys during the 10-year policy period and undertake annual audits of cardiovascular networks covering service volume, quality, throughput, guideline adherence, workforce and facilities.[50][48][49]
• Use disease-specific audit and surveillance mechanisms, including stroke-service audit and accreditation, carotid-intervention audit, heart-failure registers, pre-hospital electronic patient-care records, and registers for out-of-hospital cardiac arrest and sudden cardiac deaths in young people.[56][57][21][26][27]
• Evaluate major interventions through interim assessment of awareness campaigns, formal evaluation of atrial-fibrillation screening, clinical studies and health technology assessment of primary-care cardiovascular risk ascertainment, and clinical audit of stroke guidelines and rehabilitation.[39][58][59][24][28]
• Review intersectoral health-improvement work through regular reporting to Government via the Cabinet Committee on Health.[36]

Many service recommendations specify local audit, protocol review, registers or named lead bodies, but do not provide a complete national indicator set, uniform reporting template or detailed evaluation timetable for every clinical pathway.[60][61][62][63]

Costing & Financing

The policy recognises cardiovascular health as an investment priority but was developed in severe economic constraints, with little prospect of immediate additional resources. It therefore emphasises reorganisation of existing services, redeployment of staff, integration with national service plans and selective longer-term investment.[1][38][23]

• Allocate additional financial investment for prevention and management of cardiovascular disease, while re-engineering services and work practices rather than relying on investment alone.[4]
• Deliver early actions through existing Health Service Executive initiatives, hospital reconfiguration, primary care development and resources that can be reorganised without significant investment.[5][38]
• Specify longer-term resource requirements through future National Service Plans.[38]
• Support targeted resource needs for workforce expansion, specialist training, rehabilitation facilities, stroke units, emergency services, information systems, telemedicine, clinical registers and multidisciplinary care.[64][28][45][49]
• Assess health and economic benefits, clinical effectiveness and cost-effectiveness before expanding structured cardiovascular risk ascertainment in primary care.[58][19]
• Use health technology assessment to assess the clinical and cost-effectiveness of medicines, devices, diagnostics and health-promotion interventions.[52][53]
• Consider tobacco taxation, alcohol tax or excise measures, and pricing restrictions as public-health instruments, without specifying expected revenue or its use.[16][17][37]

Cardiovascular disease accounted for 6% of Ireland’s total healthcare budget in 2006, compared with an average of 10% across the 27 European Union Member States.[65]European cardiovascular disease costs totalled 192 billion euro in 2006, comprising healthcare, productivity-loss and informal-care components.[65]The policy calls for stronger analysis of Irish cardiovascular expenditure, potential savings, investment needs and value for money, as Irish direct, productivity and informal-care costs were unavailable.[66][65]

No total policy budget, programme-level allocation, funding source, quantified funding gap, unit cost or detailed economic assumption is specified.[34][50]