Cardiac rehabilitation service in crisis

Cardiac rehabilitation services in Irish hospitals are in “absolute crisis”, the Irish Heart Foundation (IHF) has warned.

Cardiac rehabilitation is a supervised programme designed to improve cardiovascular health. When properly resourced, it is delivered by a range of different healthcare professionals, including cardiologists, specialist nurses, physiotherapists, occupations therapists and psychologists.

It is offered to people who have experienced a heart attack, angioplasty and heart surgery, and increasingly to people who are being medically managed for angina, those diagnosed with heart failure or peripheral vascular disease, and those who have had a stroke.

Cardiac rehabilitation reduces heart disease deaths by 20%. However, the waiting list for heart attack, stroke and heart failure patients now exceeds 2,800 – a jump of 54% since 2013. At the same time, staffing levels have fallen by 40%.

According to the IHF, this vital service is now being treated as an ‘optional add on’ in hospitals. It made the claim after carrying out joint research with the Irish Association of Cardiac Rehabilitation (IACR). 

“This service was considered world class in 2005, but it's now in absolute crisis. HSE recruitment embargoes and chronic under-investment have stripped it bare.

“Nurses are being transferred to other work and not being replaced and even though it’s an essential service, none of our hospitals have all the expertise in place to deliver high quality cardiac rehabilitation,” commented IHF medical director, Dr Angie Brown.

The IHF and IACR research revealed that 77% of cardiac rehabilitation centres closed during the pandemic, the majority of them for over 12 weeks.

Staffing issues are also rife. Only seven of the 35 centres that were surveyed had access to a psychologist, while 12 centres did not have access to a physiotherapist. Furthermore, since 2010, the number of dietitians in the programme has fallen from 36 to 24.

Meanwhile, the research also found that 40% of patients are waiting at least three months for cardiac rehabilitation when they should be starting within weeks of being discharged from hospital.

Noel Flannery (52) from Dublin had seven stents inserted following a heart attack in March 2020. The father of two said he struggled to understand why he had suffered a heart attack given his active lifestyle, and went to a “dark place” as a result.

However, he was able to access pharmacists, physiotherapists, dietitians and a psychologist at a cardiac rehabilitation centre at the Mater Hospital. 

“It was absolutely brilliant. It was an eight-week course, two days a week and I’d be 100% behind it. It helped me to move on. They were telling me ‘Noel this isn’t the end, it’s not your fault, you can get over it’,” he recalls.

Dr Brown emphasised that this service is a lifeline for people suffering from the physical and psychological impact of a heart attack.

“The number of patients going in is rising, but staffing is down 40%. Lack of investment also creates a false economy as the failure to provide a full range of care is impacting on patients who are more likely to end up back in hospital for treatment,” she added.