Sir, - The recognition given by your paper to the recent implementation of a Jarvik 2000 heart is well deserved, as this device represents a potentially important advance in our ongoing battle with end-stage heart disease. As stated, there is still a significant amount of work to be done on this device before we can confidently predict its role in the care of this patient population. Furthermore, I agree that such innovative developments should be encouraged and supported.
However, the attention drawn to this development by your paper is yet another example of a pattern of behaviour all too common among those involved in medical care, including care providers, Government strategists and the media. That is, to herald exciting new developments while ignoring the failure of our present medical structure to adequately support the delivery of effective basic care to populations of patients with common diseases, such as those with heart failure.
In an era in which other cardiovascular diseases are being contained, the prevalence of heart failure increases, reflecting an ageing population, improved survival from life-threatening heart conditions, which can leave patients with damaged hearts, and the continued poor control of high blood pressure. It is estimated that as many as 70,000 Irish people suffer from heart failure, with many experiencing shortened life expectancy and significant limitation of their day-today activities. Frequent hospitalisation is a common feature with as many as 20 per cent of this population requiring admission every year. Present economic data indicate that management of heart failure accounts for 2-4 per cent of total health-care budgets in the Western world.
Despite these gloomy statistics, there remains inadequate funding for the infrastructure and personnel to meet the needs of this group of patients. This results in poor application of basic therapies known to have a meaningful effect on this condition, too infrequent medical review of patients to maintain clinical stability and, because of the lack of education, a patient population who know little about their disease and therefore cannot contribute effectively to their own care.
One hopes that the Government's cardiovascular strategy ("Building Healthier Hearts") will go some way to address these deficiencies. So, as we expectantly await further news on the Jarvik heart and continue to support and fund its development, let us show similar interest and expectation of the development of a cardiovascular strategy designed to provide universal basic and effective heart failure. - Yours, etc.,
Dr Ken McDonald, Consultant Cardiologist, St Vincent's University Hospital, Chairperson of Irish Heart Foundation Council on Heart Failure, Elm Park, Dublin 4.