A frequent issue for both patients and GPs is the availability of and access to hospital cardiac diagnostics. To this end, the heart charity Croí has launched an innovative service in Galway City and county which is yielding huge benefits for patients, GPs and local hospitals. 

The Croí Rapid Community Cardiac Diagnostics Programme is a new community-based cardiac investigations service for GPs. Investigations such as echocardiograms (Echo), Holter monitoring (HM), BP monitoring (ABPM) and electrocardiograms (ECGs) are provided in a fraction of the time that it normally takes when referred to secondary care services.

This new service saves time and money for both the patient and the health service, but more importantly, it speeds up referrals for urgent specialist management and delivers a highly efficient diagnostic service. The main aim of this new initiative is to support GPs by providing direct access to cardiac diagnostics with the aim of improving patient outcomes. Delivering a six-week patient pathway from GP referral to start of treatment is one of the objectives of this programme. The programme removes the obstacles and delays that are typically associated with costly, time-consuming and often unnecessary referrals to over-stretched secondary care cardiac services.

Distress

An average waiting time of more than 12 weeks for a cardiology outpatient appointment is not uncommon and gives rise to considerable distress to anxious patients. Furthermore, restricted capacity for specialist tests (eg. echo, ECG, BP and Holter monitoring) leads to additional delays, often in excess of 16 weeks, before an appropriate care plan can be implemented. Meanwhile, consultations with a cardiologist can be wasted because patients may be either inadequately investigated or referred inappropriately.

The Croí service, which is a collaboration with HSE West, was established late in 2008. The initial primary focus was aimed at patients suffering from signs and symptoms of heart failure but it became apparent that the service required expansion for other indications such as palpitations, hypertension, murmurs, family history of cardiomyopathies and other cardiac investigations.

Echocardiography is the central core tool for the diagnosis of heart failure, cardiomyopathies and valvular disease. It provides a definitive measure of cardiac function and evaluation of valves. Echocardiography is the first-line test for patients presenting with signs and symptoms of heart failure, murmurs, dyspnoea and evaluation of heart size.

The service is currently provided in eight centres around Galway:

• Ardrahan health centre 
• Ballinasloe health centre 
• Clifden day hospital
• Clonbur health centre 
• Croí House 
• Merlin Park
• Tuam health centre 
• Tully Ballinahown health centre. 

The location and frequency of the clinics can sometimes change subject to the demand for the service in an area. Although the programme is currently only provided in Galway centres, GPs from neighbouring counties are welcome to refer to the service if their patients are willing to travel to Galway.

GPs can refer patients with signs and symptoms of heart failure, hypertension, palpitations, murmurs, family history of cardiomyopathy or heart disease, dyspnoea, dizziness and cardiomegaly. The service is provided for people 15 years old and upwards, GMS or private, and is offered by Croí as a free service.

Collaboration

The programme is also collaborating with the stroke consultants at University Hospital Galway by providing cardiac diagnostics to patients that have suffered from transient ischemic attack (TIA) and/or stroke. Patients suspected of TIA are seen in the newly-established TIA clinic in UHG. These patients have all their diagnostic tests completed and are followed up by the stroke team within three weeks

The Community Heart Failure Management Programme (CHaMP) is also supported with the provision of echocardiograms.

Echos are performed at two to four weeks from the date of referral and GPs receive a report within five working days. The service also incorporates direct referral to cardiology outpatient clinics in Galway hospitals. Any patients requiring further follow-up are seen by cardiology within three weeks of cardiac diagnostics being performed. 

On reviewing the service over the last two years, it was found that 85% of patients referred to this programme did not require outpatient follow-up and, therefore, were referred back to their GP for further investigation of their symptoms. In turn, the patient received faster diagnosis and treatment for their symptoms.

This is a valued-added service as it is saving time and improving patient care and their experience with the HSE. 

Every visit to the hospital can be stressful, even the car-parking. The potential to reduce the time patients have to wait for endless follow-up appointments, referrals and re-referrals is enormous and any savings can be re-invested into patient care.

Summary

The benefits of the programme can be summarised as follows:

• Improvement of the patient’s experience, access to diagnostic tests, and expedited treatment and management
• Consolidation and collaboration between primary and secondary care ensuring cost savings and other benefits
• Enhanced support and clinical governance from cardiologists
• Greater access to more appropriate and timely cardiac care. 

It has long been unacceptable and inappropriate for patients to have to wait many weeks, sometimes months, for what are relatively simple cardiac investigations. 

This in turn has delayed diagnosis and onward management or exclusion of serious illness, thus impacting on patients’ capacity to get on with their lives and be reassured. Croí’s programme is delivering tangible improvements by providing a rapid, locally-based cardiac diagnostic service.

For further information or to avail of this service, please email orlagh@croi.ie or contact Croí Community Cardiac Diagnostics, Croí Heart Health Centre, 2nd floor, Centrepoint, Liosban Business Park, Galway, Tel 091-775 906.