The report makes a series of recommendations for how we can work together to improve heart failure care for patients. The findings in this report were informed by a survey of 372 heart failure patients in Ireland, conducted by Censuswide at the end of 2021. The patients shared their experiences of being diagnosed with heart failure; the impact of their diagnosis; and how COVID-19 has affected the way they live with the condition. Alongside this, we also spoke with patients directly about their experiences living with heart failure – their testimony is included throughout this report.

In 2014, heart failure was estimated to affect around 2% of the Irish population, with approximately 90,000 people in Ireland suffering from heart failure and another 160,000 people living with impending heart failure.1

Sourcing up to date prevalence data is challenging, but research carried out by IQVIA in 2022 (using the European Society of Cardiology (ESC) guidelines to review medication prescribing), indicates that an estimated 119,291 people are likely to have heart failure, with women making up 40% of this figure.2

Almost half of the people on heart failure treatment are aged 66 - 80 years.3 If we use the current Central Statistics Office population figures, that gives an overall estimate of 2.4% of people on heart failure treatment in Ireland.4

Diseases of the circulatory system are the second highest cause of death in Ireland behind cancers, with 5,886 deaths registered in the first 10 months of 2020, accounting for over a quarter (26.3%) of all deaths.5

In those over 80, diseases of the circulatory system are the leading cause of death, accounting for 31.5% of deaths in this age group.6

This report examines the diagnosis journey for heart failure patients in Ireland and finds that more needs to be done to improve awareness among healthcare professionals and the public of the signs and symptoms of heart failure. In particular, our survey asked heart failure patients about their experience being diagnosed, finding that:7

receive an incorrect diagnosis before being diagnosed with heart failure (19%)

to receive a formal diagnosis of heart failure compared to men who have to wait three weeks

believe that an early diagnosis would have made their lives better (72%)

Many of the patients we surveyed experienced difficulties while waiting to a receive a diagnosis, with our survey finding that a delayed heart failure diagnosis has a significant impact on patients’ quality of life:7

felt their daily life was negatively impacted

felt their mental health was negatively impacted

experienced financial losses and felt their ability to work was negatively impacted

Positive steps are being taken to improve heart failure care in Ireland – the Sláintecare Vision is aiming to drive positive reform across the health service to ensure the right care is provided in the right place and at the right time.8

Since its publication there has been some progress, including through the Sláintecare Integration Fund initiatives; the Integrated Care Programme for the Prevention and Management of Chronic Diseases (ICPCD); the 2019 GP Contract; and the Structured Chronic Disease Management Programme (CDM). These are driving improvements to heart failure care in the community and incorporating innovative new models of care, including virtual consultations and remote monitoring.9

For those living with heart failure, the impact of the pandemic has presented significant challenges, with our survey finding that a third of respondents felt their symptoms have deteriorated during the pandemic.7

Patients with chronic heart disease were among the cohorts worst affected by COVID-19, comprising 44% of deaths and 49% of related ICU admissions in Ireland.11

Our survey highlighted the challenges heart failure patients faced throughout the pandemic, with it affecting their daily life; mental health and ability to access health services. In particular, we found: A third (34%) have had a HCP appointment cancelled, 42% have had issues picking up prescription medication due to COVID-19, 41% agree that their quality of life has declined and the majority (69%) said their mental health has been negatively affected.7

have had a HCP appointment cancelled (34%)

have had issues picking up prescription medication due to COVID-19

agree that their quality of life has declined

say their mental health has been negatively affected (69%)

For those living with heart failure, the impact of the pandemic has presented significant challenges, with our survey finding that a third of respondents felt their symptoms have deteriorated during the pandemic.7

Patients with chronic heart disease were among the cohorts worst affected by COVID-19, comprising 44% of deaths and 49% of related ICU admissions in Ireland.11

Our survey highlighted the challenges heart failure patients faced throughout the pandemic, with it affecting their daily life; mental health and ability to access health services. In particular, we found: A third (34%) have had a HCP appointment cancelled, 42% have had issues picking up prescription medication due to COVID-19, 41% agree that their quality of life has declined and the majority (69%) said their mental health has been negatively affected.⁷

Heart failure has significant personal and socioeconomic costs in Ireland. The Irish Government is estimated to spend 1.2% of their healthcare budget on heart failure, with the total cost of heart failure in Ireland estimated to be approximately €660m.14

Our survey found that 58% of patients experienced financial losses and felt their ability to work was negatively impacted while waiting to receive a diagnosis of heart failure.7

There have however been important initiatives introduced through the Sláintecare reform programme, which have the potential to reduce costs for patients and the healthcare system – continuing to accelerate and implement learnings from these will be vital to reduce costs in the future.

The Irish Government spends an estimated 1.2% of their healthcare budget on heart failure.14

Throughout this report we have made a number of recommendations around how we can improve heart failure in Ireland. These include:

1. Development of a new national cardiovascular strategy

2. Increased focus on prevention of heart failure

3. Accelerate access to diagnostic tools in primary care

4. Enhanced training on the signs and symptoms of heart failure for healthcare professionals

5. Appropriate provision for emotional and social support for heart failure patients and public education around the symptoms of heart failure

6. Support for the expansion of innovative diagnosis and management tools

7. Prioritisation of heart failure post COVID-19 to accelerate community care - Stay Left, Shift Left

Medical Director, Irish Heart Foundation

General Practitioner, ICGP Clinical lead for Cardiovascular Disease. Clinical Associate Professor UCD

Clinical Professor at UCD and Consultant Cardiologist at St Vincent s Healthcare Group. Clinical Lead of the HSE National Heart Programme

Chief Executive, Croí­, the West of Ireland Cardiac & Stroke Foundation & National Institute for Prevention and Cardiovascular Health

References

  1. Caples N, Cronin E, O’Connor CT, et al. (2018), Turning the tide of heart failure: The Irish experience in the implication of a modern community outreach programme. European Heart Journal 39(Supp 1): 1198.

  2. Data provided by IQVIA in March 2022. An analysis of prescribing data in Ireland with reference to the European Society of Cardiology guidelines for heart failure to determine treatment combinations.

  3. Data provided by IQVIA in March 2022. An analysis of prescribing data in Ireland with reference to the European Society of Cardiology guidelines for heart failure to determine treatment combinations.

  4. Data provided by IQVIA in March 2022. An analysis of prescribing data in Ireland with reference to the European Society of Cardiology guidelines for heart failure to determine treatment combinations.

  5. Central Statistics Office (2020). Analysis of Underlying Cause of Death Data, including COVID-19 January - October 2020. Available at: https://www.cso.ie/en/releasesandpublications/fr/fr-ucd2020/analysisofunderlyingcauseofdeathdataincludingcovid-19januarytooctober2020/ (Date Accessed: 12/04/22)

  6. Central Statistics Office (2020). Analysis of Underlying Cause of Death Data, including COVID-19 January - October 2020. Available at: https://www.cso.ie/en/releasesandpublications/fr/frucd2020/analysisofunderlyingcauseofdeathdataincludingcovid-19januarytooctober2020/ (Date Accessed: 12/04/22)

  7. Censuswide, Data from survey of 372 heart failure patients in Ireland analysed for this report. Data on file.

  8. Irish Government (2021). Sláintecare Implementation Strategy. Available at: https://www.gov.ie/en/campaigns/slaintecare-implementation-strategy/ (Date Accessed: 23.02.22)

  9. The Heart Failure Policy Network (2020). Heart failure policy and practice in Europe: Ireland. Available at: https://www.hfpolicynetwork.org/wp-content/uploads/Heart-failure-policy-and-practice-in-Europe-Ireland.pdf (Date Accessed: 24/02/22)

  10. Houses of the Oireachtas (2021), Joint Committee on Health debate - Wednesday, 16 Jun 2021. Available at: https://www.oireachtas.ie/en/debates/debate/joint_committee_on_health/2021-06-16/3/ (Date Accessed: 12/04/22)

  11. Houses of the Oireachtas (2021), Joint Committee on Health debate - Wednesday, 16 Jun 2021. Available at: https://www.oireachtas.ie/en/debates/debate/joint_committee_on_health/2021-06-16/3/ (Date Accessed: 12/04/22)

  12. The Heart Failure Policy Network (2020). Heart failure policy and practice in Europe: Ireland. Available at: https://www.hfpolicynetwork.org/wp-content/uploads/Heart-failure-policy-and-practice-in-Europe-Ireland.pdf (Date Accessed: 24/02/22)

  13. Health Service Executive (2021). The impact of the COVID-19 pandemic and the societal restrictions on the health and wellbeing of the population, on our staff and on health service capacity and delivery: A plan for healthcare and population health recovery. Available at: https://www.hse.ie/eng/about/who/qid/covid-19-qi-learning/qi-resources-to-support-learning-from-covid19/covid-19-pandemic-impact-paper-2021.pdf

    (Date Accessed: 24/02/22)

  14. The Irish Heart Foundation et al (2015), The Cost of Heart Failure in Ireland - The social, economic and health implications of Heart Failure in Ireland. Available at: https://www.rte.ie/documents/news/cost-of-heart-failure-report-web.pdf

    (Date Accessed: 02.02.2022)

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