National Cardiovascular Health Policy 2010 – 2019

Objectives

Changing Cardiovascular Health is Ireland’s 2010–2019 framework for preventing, detecting, treating and managing cardiovascular disease, including stroke and peripheral arterial disease, through an integrated, quality-assured and equitable system spanning the life course. Its strategic aim is to combine cardiovascular health promotion and protection with prevention, early management and effective treatment, so that Ireland becomes healthier by 2020.[1][2][3]

• Reduce population cardiovascular risk and inequalities through action on tobacco, diet, physical activity, body weight, salt, alcohol, blood pressure, cholesterol and diabetes, while addressing wider social, economic, cultural and environmental determinants of health.[4][5][6]
• Combine population-wide prevention with targeted assessment, structured management and secondary prevention for people at high risk or with established cardiovascular disease.[1][7][8]
• Improve health behaviours through ten-year targets, including reducing adult obesity from 23% to 18%, smoking prevalence from 29% to 19%, smoking initiation from 31% to 21%, and increasing regular physical activity among adults from 55% to 66% by 2019.[9][10][11]
• Reduce adult salt consumption by 16% between 2008 and 2012 and to no more than 6 grams daily during the policy period, while promoting responsible alcohol consumption and a per-capita alcohol target of 9 litres annually.[12][11][13]
• Strengthen primary care as the foundation for cardiovascular prevention, risk assessment, chronic disease management, patient self-management and continuity between community and hospital services.[14][15][16]
• Provide rapid, evidence-based acute cardiac and stroke care, including primary percutaneous coronary intervention for ST-elevation myocardial infarction where it can be delivered within 120 minutes of first medical contact, and timely thrombolysis where this is not possible.[17][18][19]
• Ensure that hospitals admitting acute stroke patients provide stroke-unit care, supported by 24-hour emergency assessment, thrombolysis for eligible patients, early rehabilitation and multidisciplinary treatment.[20][21][22]
• Improve rehabilitation, continuing care, psychosocial support and palliative care so that people with cardiac, stroke and other vascular conditions can maximise function, quality of life, independence and community participation.[23][24][25][26]
• Build the workforce, information systems, clinical standards, research and health technology assessment needed to deliver safe, effective, timely, patient-centred and efficient cardiovascular services.[27][16][28]

Implementation

Implementation relies on service reconfiguration, intersectoral prevention, integrated care networks and strengthened quality governance. The Department of Health and Children sets policy direction, while the Health Service Executive leads most delivery, service development, workforce planning, information systems and audit activity; the Health Information and Quality Authority supports standards, quality and safety.[29][16][28]

• Coordinate population-health action across health, education, transport, planning, agriculture, food, private-sector and media actors, with the Department of Health and Children reporting regularly to Government through the Cabinet Committee on Health.[30][31][32]
• Deliver phased public-awareness campaigns on cardiovascular risk factors, symptoms and appropriate emergency responses through the Health Service Executive, general practices, pharmacies and voluntary agencies, using interim evaluation to guide later phases.[14][32][7]
• Establish multidisciplinary primary-care teams, shared-care arrangements, designated pathways and common clinical protocols, including use of the 2007 European Society of Cardiology Clinical Practice Guidelines for cardiovascular risk assessment and management.[14][15][8]
• Develop structured services for diabetes, hypertension, atrial fibrillation, heart failure and peripheral arterial disease, supported by disease registers, patient recall, audit, information technology, specialist advice and hospital-community collaboration.[33][34][35][36]
• Organise specialist cardiac care through population-based General Cardiac Centres and Comprehensive Cardiac Centres, and specialist stroke care through General Stroke Centres and Comprehensive Stroke Centres, with network configuration adjusted for population density and geography.[37][38][39][40]
• Link emergency medical services, ambulance and first-responder capacity, defined triage protocols, appropriate transport, hospital networks and telemedicine to improve timely access to acute cardiac and stroke treatment.[19][22][41][42]
• Provide cardiac and stroke rehabilitation through multidisciplinary hospital, outpatient and community models, including early supported discharge, formal needs assessment, key-worker coordination, access-sensitive delivery options and partnerships with local authorities and voluntary organisations.[43][44][45][46]
• Develop workforce capacity through network-level gap analyses, annual workforce audits, professional education, specialist nursing and multidisciplinary roles, and closer alignment between service planning and education bodies.[47][27][48][49]
• Operate a Cardiovascular Policy Monitoring Group that meets twice yearly, provides annual progress advice and coordinates a major mid-term review in 2014.[29][28]
• Support accountability through evidence-based guidance, performance indicators, national standards, routine data collection, population surveys, annual cardiovascular-network audits and a comprehensive cardiovascular information system, including common data standards, a unique patient identifier and disease registries.[29][50][51][52][53]
• Use research and health technology assessment to assess clinical and cost-effectiveness, prioritise future research and inform investment and service-design decisions.[54][55]

Monitoring & Evaluation

The policy establishes a national quality framework for cardiovascular health, combining population surveillance, routine data collection, clinical audit, service standards, research and health technology assessment. It assigns central roles to the Department of Health and Children, the Health Service Executive (HSE) and the Health Information and Quality Authority (HIQA).[29][28][52]

• Monitor implementation through a Cardiovascular Policy Monitoring Group that meets twice yearly, advises the Department of Health and Children, produces a brief annual report on progress and barriers, and coordinates a major mid-term review in 2014.[29][28]
• Link evidence-based clinical guidance and national quality and safety standards to performance indicators, reporting structures and defined information requirements.[29][28][51]
• Develop a comprehensive cardiovascular information system with common data standards, a unique patient identifier, routine minimum datasets and a cardiovascular disease registry to support surveillance, audit, research, equity analysis and assessment of service access and disease prevalence.[29][52]
• Conduct at least two national adult and child population health surveys during the ten-year policy period, alongside annual cardiovascular network audits covering service volume, quality, patient throughput, workforce, facilities, equipment, information systems and adherence to best-practice guidance.[50][56][53]
• Use national and condition-specific registers, including systems for acute coronary events, stroke, cardiac rehabilitation, out-of-hospital cardiac arrest and sudden cardiac deaths among young people, to improve data collection, collation and analysis.[57][24][56]
• Apply audit, accreditation and regular protocol review to service quality, including stroke units, thrombolysis pathways, carotid interventions, rehabilitation, heart-failure care and workforce needs.[58][20][59][43][47][35]
• Assess progress against quantified behavioural targets for weight, diet, physical activity, salt consumption, smoking and alcohol use, as well as inequality reduction and specified clinical time thresholds.[60][61][10][12][11][13][62]
• Evaluate phased public-awareness campaigns, structured cardiovascular risk assessment, atrial-fibrillation screening, peripheral arterial disease protocols and demonstration prevention services before wider implementation.[14][54][63][64][65]
• Review workforce capacity annually through a registry and network-level staffing analyses, including discipline, location, training and continuing professional development requirements.[27][48]

Important service-specific metrics include primary percutaneous coronary intervention within 120 minutes of first medical contact, thrombolysis for eligible stroke patients within 180 minutes of symptom onset, and a five-minute call-to-defibrillation target for out-of-hospital cardiac arrest.[62][22][42]The framework does not provide one fully consolidated indicator set or uniform reporting template for all policy actions.[28][53]

Costing & Financing

The policy recognises cardiovascular disease as a substantial economic burden and identifies a need for investment in workforce capacity, information and communications technology, facilities, research, health technology assessment and redesigned services. It does not provide a costed implementation plan, total policy budget, financing allocation or quantified funding gap.[2][3][16][55]

• Recognise that cardiovascular disease cost the European economy 192 billion Euros in 2006, comprising healthcare expenditure, productivity losses and informal-care costs.[66]
• Note that Ireland allocated 6% of healthcare spending to cardiovascular disease in 2006, compared with a 10% average across European Union Member States; comprehensive estimates of the direct and indirect cost to the Irish economy were unavailable.[66]
• Use further analysis of cardiovascular costs and wider health expenditure to inform investment and value-for-money decisions, including health technology assessment of medicines, devices, diagnostics and health-promotion interventions.[1][50][66][55]
• Deliver early implementation in a severe economic environment with little prospect of immediate additional resources, using existing initiatives, reorganisation, staff redeployment and alignment with national service plans where possible.[67][3][62]
• Balance longer-term additional resource requirements against service priorities, potential efficiency gains and savings from redesigned care processes, although no monetary estimates of these savings are supplied.[3][18]
• Provide targeted resources for clinical infrastructure and capacity, including stroke units, emergency transport, diagnostic and angiographic facilities, rehabilitation services, specialist staffing, primary-care systems, information technology and community support.[34][19][21][68][27]
• Use cost-effectiveness evidence to guide service development, including evaluation of systematic cardiovascular risk assessment, ambulatory blood-pressure monitoring, thrombolysis, structured heart-failure care and cardiac rehabilitation.[54][64][33][69][22][70]
• Consider fiscal measures on tobacco and alcohol, including higher taxation or excise duties, while considering removal of value-added tax from smoking-cessation products; the policy does not estimate revenues, costs or behavioural effects.[11][13][32]

Several initiatives are described as achievable within existing structures or resources, including the Organ Donation and Transplantation Unit, but the source does not quantify the resources required for most recommendations.[58][71]