Department advised to discontinue heart attack register

Consultant advice: External consultants have advised the Department of Health that the State's coronary heart attack register (Chair) should be discontinued in its current form.

Chair was established as a pilot initiative in 2002 under the Government's Cardiovascular Health Strategy. The project aimed to gather information on hospital patients admitted with suspected or confirmed acute coronary syndromes in order to improve the delivery of healthcare and patient outcomes. It operates across eight hospitals in Cork and Kerry with a budget of just over €400,000 a year.

However, external consultants Capita, commissioned by the Department of Health to carry out an evaluation of the initiative, has concluded that there was no real benefit in continuing with Chair in its current format.

It proposed that the project be subsumed into an overall new national cardiovascular information system which is being designed for hospitals around the country.

The Capita report, submitted to the Department of Health late last year, found that Chair bore many similarities to other European cardia treatment databases such as those in the UK or Sweden. However, it maintained that Chair had not "assumed the central role" which its counterparts have achieved in terms of acting as a catalyst for improving patient care and treatment in hospitals either through participation by all relevant clinicians in using the information to improve care or by having a transparent basis for recording and publishing performance figures for each hospital.

The report says that Chair was a well-managed project and points to examples of good clinical practice and development in connection with it. It says that in one hospital Chair data was used to identify the need for a new chest pain clinic.

However, it says that despite the substantial effort invested in the "mechanical" aspects of Chair, the initiative has failed to deliver significant benefit in terms of its objectives articulated by the European Society of Cardiology, namely helping to produce improvements in clinical practice regarding existing guidelines, applicability of results of major clinical trials and outcome of different strategies for patient management.

"Following our discussions with Chair personnel and with consultants in the eight hospitals, we are of the opinion that Chair in many cases failed to become a fully integrated component in the delivery and development of clinical care for acute coronary syndrome patients," the report says.

"Although some cardiologists and consultant physicians are actively involved in using the data from Chair to improve their clinical practice, it would seem that a larger number are not involved and have largely failed to engage with the project," it says. "As a result, Chair's ability to deliver real benefits is hampered and the situation will not be rectified until the vast majority of clinicians engage with Chair more effectively and begin to use its outputs in a much more comprehensive way than is currently the case."

Capita says its conclusion was that if Chair was to remain unaltered and its future position to be that of a standalone project, it would be "extremely difficult" to justify the continued level of public investment given the limited extent of qualitative benefit obtained to date. It said that in that event its recommendation would be to terminate the pilot.