We're among the worst in Europe for coronary disease deaths. So what is being done about it, and how can you make sure you don't become a part of these grim statistics? Muiris Houston, Medical Correspondent, reports
We have the highest death rate from coronary heart disease in men in the European Union. And for women it's not much better, as the Republic has the third highest death rate from heart disease among females in the EU.
When premature deaths (under 65) of both sexes are compared, we also have the highest death rate from heart disease, running at almost double the EU average (see graph below right).
In light of these grim statistics the Irish Heart Foundation is critical of the fall-off in funding for an agreed five-year plan to tackle the incidence of heart disease. And consultant cardiologist Dr Vincent Maher questions how the Minister for Finance, Charlie McCreevy, prioritises national expenditure. How is our country's health weighed against other priorities, he asks.
"The health of a nation is its wealth. Unless we consider the well-being of our inhabitants, we are doomed to long-term failure in the economy." Referring in particular to cardiovascular health, he says, "We have been firefighting for years, but we must now emphasise fire prevention."
The most common type of disease to affect the cardiovascular system is arteriosclerosis, or hardening of the arteries. When this process causes a blockage in the arteries that supply blood and oxygen to the heart it is called coronary heart disease.
Heart disease may cause cardiac arrest, angina (chest pain), a heart attack or heart failure, depending on the extent and the location of the disease.
In 2001, 11,914 people in the Republic died from diseases of the circulatory system. Coronary heart disease caused 14 per cent of premature deaths (people aged under 65 years) during the same period. Death rates from heart attack remain high at 176 per 100,000 of the population.
In Eastern Europe death rates from heart disease are on the rise among both men and women in the Russian Federation and are high in other countries including Poland and Hungary.
In contrast, death rates from heart disease have dropped in the United States - 50 per cent of this reduction is attributed to treatment, including bypass surgery, of acute episodes. It is estimated that secondary prevention of heart disease accounts for a further 25 per cent reduction in deaths.
At one point during the 1960s deaths from heart disease were substantially higher in Finland than the Republic. Now death rates for men under 65 in Finland are lower than Irish men and the rates for women have dropped also. The government and people of Finland have shown what can be achieved by adopting a structured aproach to reducing the national burden of heart disease.
What treatments are available for heart disease? Apart from using various medications (see panel below), patients with severe coronary heart disease may require a coronary artery bypass or a procedure called angioplasty. This involves passing a catheter into the blocked coronary artery and compressing the blockage either with a balloon or a stent (hollow tube).
The State's hospital inpatient data on these procedures show a substantial variation by health board. Men living in the Southern Health Board and in the Eastern Regional Health Authority (ERHA) area were more likely to have a bypass performed. In other words, the closer a man lives to a cardiac surgery centre, the more likely he is to have a bypass. When figures for angioplasty are analysed, men fare substantially better than women, with more than double the number of procedures. Rates of angioplasty were highest in the ERHA and lowest in the Western Health Board region.
This is clear evidence of unequal treatment based on gender and where you live. Waiting times to see a specialist and to have investigations are outlined in the accompanying panel (right).
Government policy to combat heart disease is based on the National Cardiovascular Strategy published in 1999, titled "Building Healthier Hearts". A fine document with clearly laid out recommendations - but without a timescale for implementation - it was endorsed by the then Minister for Health, Brian Cowen. In addition, the Minister promised the strategy would be funded "either in whole or in part by increasing taxation on tobacco consumption".
Three years later, how much of the strategy has been implemented? Michael O'Shea, chief executive officer of the Irish Heart Foundation, is critical of the fall-off in funding for the strategy. Some €170 million was promised for the strategy over five years. In year one, €27 million was provided.
However, according to the Irish Heart Foundation, by year two this was down to €12 million which, O'Shea says, "leads us to question the Government's commitment to fund the Cardiovascular Strategy".
He would like to see "a visible link between increased tax on tobacco products and health service funding - in particular, ring-fenced money to drive the Cardiovascular Strategy".
Both O'Shea and the foundation's health promotion manager, Maureen Mulvihill, are keen to give credit for the many positive changes the strategy has brought about. "There has been a big increase in the number of health promotion posts across all health boards and it is noticeable how the priority of cardiovascular health within health boards has been raised," Mulvihill notes.
A formal review of the stategy's progress was carried out last June and 10 priorities were identified, including:
Each acute hospital to have an acute chest pain clinic to provide timely access to the cardiac assessment of patients with recent onset chest pain.
Progress so far: a minority of hospitals have chest pain clinics up and running.
Each hospital admitting patients with acute cardiac problems should have an approproiately trained physician and all tertiary referral centres to have a minimumm of five consultant cardiologists.
Progress: Not done. The Republic has seven cardiologists per million people compared with an EU average of 35 per million. It is understood that a further eight consultant cardiologists may be sanctioned shortly for some health boards. This is well below the number required to make the strategy work.
Every hospital that treats patients with heart disease should provide a cardiac rehabilitation service.
Progress: good - 36 out of 41 hospitals have a service up and running.
Secondary prevention should be an integral component of care for all patients with cardiovascular disease.
Progress: programme agreed and initial phase to start in January 2003.
Dr Vincent Maher, medical director of the Irish Heart Foundation and consultant cardiologist at Tallaght Hospital in Dublin, acknowledges progress has been made but is still concerned about the manpower issue.
"In the United States, there would be in excess of 30 plus cardiologists in a large teaching hospital like Tallaght. Here there is the equivalent of two full-time cardiologists," he says.
It is hard to argue with O'Shea when he says: "With double the number of deaths in the EU from cardiovascular disease, we continue to perform poorly in comparison to other countries".
Definitely a case of a lot done but much more to do.