HSE takes next step to improve services for cardiac rehabilitation patients

Cardiac rehabilitation significantly improves outcomes for patients with established cardiovascular disease, reducing hospital admissions and increasing quality of life.

The HSE Enhanced Community Care Programme has provided significant additional resources to support existing hospital-based cardiac rehabilitation services. However, a HSE report published today shows further work is needed to continue the progress made so far in improving cardiac patient outcomes and ensure timely access to standardised cardiac rehabilitation services for all patients who need it.

The report ‘Overview of Cardiac Rehabilitation Services in Ireland,’ outlines current services, and identifies areas where additional resources are needed to enhance access to cardiac rehabilitation.

To support the ongoing development of cardiac rehabilitation services, the report makes several recommendations, including the need:

• to prioritise regional cardiac rehabilitation posts across community and hospital services
• for dietetic and psychology resources to ensure a high-quality, person-centred service
• to develop a national, accredited cardiac rehabilitation programme that can be delivered in-person, online, or in a hybrid format to improve accessibility for all eligible patients.

Welcoming the report, Dr Sarah O’Brien, HSE National Clinical Advisor and Group Lead for Chronic Disease, said: “This is a significant step forward in advancing cardiac rehabilitation services in Ireland. The report highlights where we need to improve in the design and delivery of cardiac rehabilitation services for both patients and staff. The report makes clear recommendations on the steps that need to be taken to ensure that every patient requiring cardiac rehabilitation will have access to and receive a timely, high quality, person-centred and evidence-based programme, no matter where they live in Ireland.”

Work underway

The HSE is already taking steps to address key service needs identified in the report. A pilot project is underway in HSE West and North West which will demonstrate the positive impact of the full end-to-end implementation of the Model of Care for Integrated Cardiac Rehabilitation.  Funding has been secured in two Integrated Health Areas (IHAs), IHA Galway-Roscommon and IHA Mayo, to convene complete integrated cardiac rehabilitation teams, and enable these teams to deliver and evaluate an end-to-end implementation of the Model of Care.  The findings from this project will be shared across all Health Regions and will help inform future service improvements across cardiac rehabilitation services.

In addition, the HSE is collaborating with the National Institute for Prevention and Cardiovascular Health (NIPC) on the development of a Clinical Action Guide. This will provide practical guidance on implementation of the Model of Care nationally and will ensure delivery of a standardised, high quality, evidence-based cardiac rehabilitation service that is patient centred and outcome-focused.

The HSE acknowledges the contributions of cardiac rehabilitation staff and management who supported the development of this report, as well as the Prevention Sub-Group of the National Heart Programme for their guidance.

Prof J William McEvoy, Chair of the Prevention Sub-Group of the HSE National Heart Programme and Director of the National Institute for Prevention and Cardiovascular Health, said: “The Overview of Cardiac Rehabilitation Services in Ireland has been developed and refined by a wide range of stakeholders within the Irish healthcare system, and particularly by cardiac rehabilitation staff on the ground who have first-hand knowledge of the challenges involved in delivering cardiac rehabilitation. This report outlines challenges and highlights the gaps which need to be addressed in order to implement the Model of Care and advance integrated cardiac rehabilitation services. I hope this publication will advance improvements in timely access to and consistency of care for patients who require cardiac rehabilitation across the country.”

Prof Ken McDonald, Clinical Co-Lead, HSE National Heart Programme, said: “This report clearly sets out the actions required to implement the Model of Care for Integrated Cardiac Rehabilitation across the country. It sets out a robust cardiac rehabilitation service as part of an integrated framework for the prevention and management of chronic disease in Ireland, placing patients squarely at the centre of care. The National Heart Programme endeavours to address the actions outlined in the report and support cardiac rehabilitation professionals, as we work together to implement the Model of Care and progress cardiac rehabilitation.”

Dr Angie Brown, Medical Director, Irish Heart Foundation, said: “We know that cardiac rehabilitation reduces mortality, hospital readmissions and improves quality of life. The Overview of Cardiac Rehabilitation Services in Ireland is an important piece of work highlighting the gaps in service around the country. The Irish Heart Foundation welcomes this report and the recommendations to address the issues identified, in particular the recommendation to prioritise allocation of posts to cardiac rehabilitation, with a particular focus on ensuring access to dietetic and psychology services. Implementation of these actions will lead to a high quality cardiac rehabilitation service available to patients wherever they live in Ireland.”

Mark O’Donnell, Chief Executive, Croí said: “Croí, the West of Ireland Cardiac & Stroke Foundation, welcomes the publication of the Overview of Cardiac Rehabilitation Services in Ireland.  Of particular note is the significant decline in staff resources deployed to this area since 2009, as well as the substantial variances in waiting times across the country. The report contains a very clear set of recommendations around staffing, as well as structures and processes, and it is critical that these are used to inform and drive timely, measurable actions to address the issues highlighted.”