The global death toll of cardiovascular disease (CVD) in 2021 exceeded 20 million, nearly doubling in 30 years. Often premature and preventable, awareness and access to care involves us all.

On World Heart Day, 29 September, we urge everyone to join the movement to make access to cardiovascular care everyone’s right. It must be a priority in policy and investment. When we know more about our hearts, we can make careful choices.

Prevalence of cardiovascular conditions

Four in five CVD deaths occur in low and middle-income countries (LMICs).Learning about our cardiovascular health for ourselves and those around us — and encouraging others to do the same — will increase awareness and promote the human connection that contributes to heart health.

Cardiovascular conditions can be caused by lifestyle or a genetic predisposition. In addition, neglected CVDs such as rheumatic heart disease and Chagas disease occur in some of the most vulnerable communities, affecting nearly 50 million people combined.

Four in five CVD deaths occur in low and middle-income countries (LMICs).

Improving knowledge, investment, equity

With in-depth analysis of CVD risk and mortality data worldwide and trends across gender and regions, the World Heart Report offers insight into approaches and policies to reverse the trend. One priority is Universal Health Coverage for interventions to prevent, manage and treat cardiovascular conditions and reduce the suffering they cause.

Healthcare investment as a percentage of gross domestic product (GDP) and lower death rates are correlated. CVD death rates are higher in countries where people pay more out-of-pocket for healthcare. Countries must invest at least 5% of GDP in cardiovascular health — a practice currently seen in 97% of high-income countries.

Building on breakthroughs

The signs are encouraging. Today, 91% of countries have policies or programmes targeting tobacco’s harmful impacts while 86% have established guidelines for managing CVD. The digital health landscape is another potential gateway to access by all.

The WHO Essential Medicines List now includes polypills that combine medicinal agents. Polypills offer hope for strengthening access and affordability of care and enhancing patients’ adherence to taking their medication.   Breakthroughs and positive developments often result from pooling resources and committing to change. Together, we can confront cardiovascular disease and give every person and all societies the best chance to flourish.

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When it comes to healthcare, the patient should be the central focus of attention. However, in reality, that is not always the case.

Multiple factors contribute to the lack of patient centricity. Among them is the role attributed to the patient in the healthcare ecosystem. Broadly speaking, the healthcare ecosystem is comprised of the key stakeholders, including the policy and decision-makers, payors, system managers and administrators, healthcare professionals — and the patient. Ironically, the weakest link in this lineup is the patient. Every other stakeholder is there by choice, but the patient assumes their role by default when they become ill.  

Traditional approach to patient care 

Historically, the interaction between key stakeholders and the patient, especially when it came to the actual delivery of care, has been largely autocratic. Notwithstanding individuals who fail to take any responsibility for their own healthcare (for a variety of reasons), typically, patients have been passive recipients of care. They accede to the superior knowledge of the doctor and just accept what they have been told or what has been prescribed.  

The rapid advancement of digital technologies
is transforming the way patients interact — and
will interact — with their healthcare providers.

Evolving patient demands and knowledge 

This is changing, however, and there is a new dynamic emerging. Patients and their carers have ever-increased access to information. The rapid advancement of digital technologies is transforming the way patients interact — and will interact — with their healthcare providers. Increased awareness of rights, stronger expression of preferences and greater demands for choice are fuelling something of a consumer approach to healthcare, which will continue to change the role of the patient.  

Increasing patient engagement and support 

Exemplars of the more informed and activated patient are seen in the rare disease or cancer communities, for example. Through their networked patient communities, the voice of the patient is being heard on matters ranging from equity of access to highlighting unmet patient needs.  

Concepts like ‘patient-centred care’ and ‘patient centricity’ are increasingly called out in health strategies and policies. Despite scepticism in the patient community that this is merely ‘tick boxing,’ there is evidence that ‘patient engagement’ across many areas of healthcare is an emerging reality.   

In sharp contrast to most other disease areas, despite the scale and burden of cardiovascular disease, the voice of those living with heart disease in Ireland has largely remained disconnected and unorganised. However, to reverse this, the recent launch of Heart and Stroke Voice Ireland (HSVI) aims to create change in cardiovascular disease patients.  

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Cholesterol is transported through the bloodstream by lipoproteins. There are two main types of lipoproteins, each with different impacts on your health and various management approaches.

Managing cholesterol-carrying lipoproteins

1. Low-density lipoprotein (LDL): Often referred to as ‘bad cholesterol,’ LDL carries cholesterol to your arteries, where it can accumulate, forming plaques and leading to health complications. A high LDL level is associated with an increased risk of heart disease.
   
2. High-density lipoprotein (HDL): Known as ‘good cholesterol,’ HDL retrieves excess cholesterol from your arteries and transports it back to the liver for elimination. A high HDL level can help reduce the risk of heart disease.
   

Managing cholesterol levels entails lowering LDL while maintaining or increasing HDL cholesterol, ensuring a healthy balance for optimal heart health.

The role of diet in cholesterol management

Diet plays a significant role in controlling cholesterol levels. Making informed dietary choices can improve cholesterol levels and reduce the risk of heart disease. Some key dietary guidelines are:

1. Consume healthier fats: Replace saturated and trans fats, found in processed and fried foods, with healthier options such as monounsaturated fats (found in olive oil and avocados) and polyunsaturated fats (found in fatty fish, nuts and seeds).
   
2. Increase dietary fibre: Soluble fibre found in oats, fruits, legumes and vegetables can help lower LDL cholesterol levels by binding to cholesterol in the digestive system and aiding its elimination.
   
3. Monitor cholesterol intake: Limit your intake of high-cholesterol foods, such as certain cuts of meat, full-fat dairy products and organ meats.
   

Managing cholesterol levels entails lowering LDL while maintaining or increasing HDL cholesterol.

Exercise and cholesterol reduction

Regular physical activity is beneficial for overall health and can help improve cholesterol levels. Exercise can increase HDL cholesterol while lowering LDL cholesterol and triglyceride levels. Aim for at least 150 minutes of moderate-intensity aerobic activity (e.g. brisk walking or swimming) or 75 minutes of vigorous-intensity activity (e.g. running) per week.

When to seek medication for cholesterol management

For some individuals, lifestyle changes may not be sufficient to lower LDL cholesterol levels. In these cases, healthcare providers may prescribe cholesterol-lowering medications, such as statins, to further reduce the risk of heart disease.

It is essential to follow your doctor’s advice on the use of medication. Continue to implement healthy lifestyle habits for the best results in cholesterol management and overall health.

Online doctor offering cholesterol support in Ireland

Eirdoc Ltd’s online doctor services can provide invaluable support and personalised care for individuals managing high cholesterol.

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Dr Fiona Kiernan

Chief Economist, Care-Connect

Remote monitoring and virtual nurse support can help patients with heart failure (HF) or chronic obstructive pulmonary disease (COPD) improve their daily lives and, critically, avoid preventable visits to the hospital.

Today, at least 90,000 people in Ireland live with HF and 380,000 live with COPD, according to The Cost of Heart Failure in Ireland report and COPD Support Ireland. With constant remote monitoring, supported by technology and managed by a team of nurses, patients with cardiac and respiratory conditions can live with more support and swift access to care.  

Convenient, remote patient health monitoring  

For years, clinical guidelines have recommended regular monitoring of certain signs (e.g. blood pressure, heart rate and body weight), as they are invaluable for managing heart failure. By giving patients the tools to measure these signs at home, they can send valuable information to a clinical team that can monitor and assist in managing their condition more effectively.  

At Care-Connect, that allows us to see trends and indicators of deterioration in the patient’s condition earlier — often before symptoms start. This model of care helps people stay well at home and can reduce visits to the emergency department or lengthy hospital admissions.  

With technology, we can track our results
with clarity, so we can identify opportunities
to improve care quickly and efficiently.

Evidence-based care approaches  

We aim to provide the best evidence-based care possible. For years, we have been investigating how remote care can impact patient outcomes by reviewing international best practices and conducting detailed research.  

We team up with GPs and hospital specialists to best support people with HF and COPD. We aim to implement guideline-directed standards of care as efficiently as possible. With technology, we can track our results with clarity, so we can identify opportunities to improve care quickly and efficiently. This can increase the potential for an individual’s chronic condition to be clinically managed early.  

Toward better health outcomes for patients 

Many patients with HF or COPD can achieve improved outcomes and symptom control by following a structured team approach to their medication and treatment plan. Specifically, for patients with HF, optimising their medications promptly after diagnosis lowers their risk of subsequent hospital admission. However, researchers have reported that it is challenging to achieve this for patients with long-term conditions, partly because there are so many interactions to navigate — each carrying a risk of slight delay.  

A large part of Care-Connect’s role is to work with our patients and their doctors to coordinate everyone’s treatment plan to be as efficient as possible. We can then collaboratively reduce the risk of avoidable complications while providing a supported and positive experience to our patients.

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Cardiovascular disease (CVD) is the world’s biggest killer. This is a statement of shame when you consider that as many as 80% of these premature cardiovascular deaths could be prevented.

In this 21st century, why do we allow 19 million people worldwide to die prematurely from CVD every year?

Danger of atherosclerotic cardiovascular disease

Atherosclerotic cardiovascular disease (ASCVD) is the underlying cause of 85% of heart attack and stroke-related deaths and affects more than 500 million people worldwide, according to Invisible Nation. ASCVD is an umbrella term used to describe different diseases caused primarily by the build-up of fatty deposits, called plaques, in the arteries.

What’s especially worrying about ASCVD is its invisible nature. The plaques subtly build up over time, with many people not experiencing any symptoms until a plaque ruptures. When this happens, it can cause devastating consequences, such as a heart attack or stroke. 

Causes of ASCVD and risk factors

A key cause of ASCVD is high levels of cholesterol in the body. While cholesterol is essential to the normal functioning of our bodies, too much of the ‘bad’ type (called LDL-C) contributes to the build-up of plaques in our arteries. High cholesterol levels often go unnoticed because there are no symptoms until a sudden heart attack or stroke occurs. Several research studies show that large numbers of Irish adults are living with levels of ‘bad’ cholesterol, which significantly increases their risk.

A key cause of ASCVD is high levels of cholesterol in the body.

United in ASCVD prevention

The invisible nature of ASCVD and high cholesterol are perhaps two reasons why CVD deaths are so high. However, high cholesterol is easily identifiable through a simple blood test, and levels can be managed through lifestyle changes (such as exercise and diet) and medication. 

Despite the scale of the problem, many countries, including Ireland, do not have a national cardiovascular health strategy. As a society, we are just not taking this burden seriously. We need to reframe the discussion about cardiovascular disease, take a fresh look at it and wake up to the reality of just how significant a burden this disease has on individuals and populations.

On World Heart Day, I urge you to join the fight against complacency around the dangers of ASCVD. Support The Global Cholesterol Action Plan as it aims to reduce the impact of unhealthy cholesterol levels as recommended by the World Heart Federation. At Croí, we are at the forefront of the fight against heart disease and stroke in Ireland.

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Dr. Samer Arnous

Consultant Interventional Cardiologist and Cardiology Clinical Lead, ULHG

According to the Central Statistics Office 2022, 9,652 people died from cardiovascular disease in Ireland. Of these, 43% died from ischaemic heart disease — the most serious type is STEMI.

Ischaemic heart disease means that the heart is not getting enough blood and oxygen, usually caused by a narrowing of the coronary arteries. This narrowing can be caused by a blood clot or by a build-up of plaque (atherosclerosis).  

The most serious is an ST-elevation myocardial infarction (STEMI). A STEMI occurs when one of the coronary arteries becomes completely blocked. This is a life-threatening condition and requires immediate emergency treatment.  

Treatment services for STEMI 

The current gold standard of treatment for STEMI is primary percutaneous coronary intervention (PPCI). This emergency procedure opens up the coronary artery and restores blood flow to the heart muscle. In January 2013, UL Hospitals Group (ULHG) was chosen as one of five 24/7 PPCI centres to provide this service.  

Spearheaded by Professor Tom Kiernan we, at ULHG began accepting patients diagnosed with STEMI directly from our paramedic colleagues. We cover the geographical region of Limerick, Clare, Tipperary and North Kerry. We are the youngest of the five PPCI centres but our research has shown that we have decreased mortality from STEMI, improved outcomes for patients and decreased length of hospital stay.  

Patients at ULHG have timely access to many nurse specialists, such as in cardiac rehabilitation and heart failure, who see patients in outpatient clinics and take steps to improve long-term outcomes after STEMI. 

Although the chest pain is often severe,
some people may only experience mild pain.

Reducing risk of developing ischaemic heart disease 

Some risk factors can’t be changed, such as age, gender and family history.  

However, the following risk factors can be managed to reduce the risk of developing coronary artery disease: stopping smoking; regular blood pressure checks; normal cholesterol; healthy diet; regular moderate-intensity physical exercise; maintaining a healthy weight; and managing stress. 

Common signs and symptoms of a heart attack 

• Chest pain: sensation of pressure, tightness or squeezing in the centre of your chest; it can sometimes travel to the arms, jaw, neck or back 
• Feeling lightheaded or dizzy 
• Sweating 
• Shortness of breath 
• Feeling sick or vomiting 

Although the chest pain is often severe, some people may only experience mild pain. In some cases, there may be no pain at all.  

If you suspect you may be having a heart attack 

Immediately dial 999/112 and ask for an ambulance. A heart attack is a medical emergency. 

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Specialist blood tests taken in community healthcare settings are helping identify patients at risk of developing heart failure at the earliest opportunity.

Special blood tests taken in GP surgeries are highlighting heart failure (HF) sooner while virtual consultations between GPs and cardiac specialists are enabling better management of patients closer to home. 

Sláintecare reducing hospitalisations 

This initiative has been running in the Dun Laoghaire and Bray Integrated Care Hub area for four years and has already led to a reduced burden on emergency and outpatient departments, according to consultant cardiologist Dr Matthew Barrett.  

He says that the initiative, which is part of the Sláintecare transformation of healthcare in Ireland, is seeing primary and community health services delivered through new models of care. “One part of that is prevention,” he adds. “In Dun Laoghaire, we are trying to identify patients at risk of developing heart failure.” 

Routine tests to detect cardiac conditions 

Earlier identification of HF allows quicker treatment and may avoid deterioration of the condition. Patients at increased risk may be treated with medication while an NTproBNP blood test can efficiently identify potential cardiac problems, including HF. It is offered to patients with diabetes or high blood pressure during routine check-ups. “We hope to identify these patients early and get them treated early so that they will avoid more severe HF,” says Barrett. 

Patients at increased risk may be treated
with medication while an NTproBNP blood
test can efficiently identify potential
cardiac problems, including HF.

Virtual platform for specialist input 

An important element is a virtual platform for GPs to discuss their patients with cardiac specialists to decide if they need further investigation, medication or access to clinical HF services. “It is a rapid pathway for GPs to identify problem patients and get a specialist opinion,” he adds. “Sláintecare mandates novel methods of facilitating specialist opinion and review — that is where our virtual model of care comes in.” 

GPs are increasingly using the service instead of having to refer patients to the emergency department or outpatient clinics — with longer waiting times. “We have found a 90% drop in referrals to the ED or outpatient clinic, as a direct result,” reveals Barrett. 

Benefits and challenges  

Patients are getting prompter care with no travel. Hospitals benefit from reduced costs and pressure burden. Against a backdrop of rising HF, Barrett is involved with the PASSION-HF study, which is exploring ways to digitally automate routine engagement with HF patients. However, while the NTproBNP test and virtual platform are identifying potential HF patients, they must now navigate sufficient access to imaging, such as echocardiograms, to confirm the condition. 

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Emer Burke is an Advanced Nurse Practitioner in heart failure, working as part of the integrated heart failure service in Galway. Emer is also Public Relations Officer (PRO) of the Irish Association of Heart Failure Nurses (IAHFN).

For World Heart Day (29th September), the IAHFN are seeking to raise awareness about heart failure with their ‘Let’s Bump up the Pump’ campaign. This campaign focuses on raising awareness about heart failure signs and symptoms. It also signposts individuals to take action towards earlier detection and treatment. The IAHFN also supports patient education on how to live well with this condition.  

Nurses advocating for heart failure awareness 

Emer explains: “Heart failure can be an alarming diagnosis, and many do not understand the term. Heart failure is a condition where the heart fails to pump or relax well enough to circulate sufficient blood to meet the body’s needs. As a consequence, affected individuals can complain of breathlessness on exertion or even at rest, as well as swollen legs and tiredness.

“It is a serious condition. Left untreated, heart failure can be as deadly as cancer — but there is good treatment out there. The key is in early diagnosis and treatment to reduce death and disability from this disease. Attending your GP for a simple blood test called NT-proBNP can support diagnosis.”

Patients can live well with Heart
failure if diagnosed and treated early.

Why heart failure is a cause for concern in Ireland

Heart failure can happen for several reasons, but it is more common in older people and those with heart disease and high blood pressure. It affects about 2% of the population, rising to 10% in older age groups.

Worryingly, there are many more who remain undiagnosed. Heart failure cases are expected to rise due to ageing, increasing prevalence of obesity, diabetes and surviving longer due to improved cardiac treatments.

Educating people in Ireland about heart failure

The ‘Let’s Bump up the Pump’ campaign aims to raise awareness to ensure earlier detection of those who are at risk of heart failure. The campaign also highlights the signs and symptoms of heart failure — to bump up the number of people seeking an earlier diagnosis, knowledge of living with the condition and, ultimately, bump up survival.

Steps to a heart failure diagnosis

For people who are worried that they have heart failure, Emer insists: “Anyone concerned about symptoms of heart failure, contact your GP for an assessment. Ask about the NT-ProBNP test.

“The earlier you get diagnosed, the earlier treatment can begin — which can potentially alter the course of this serious disease. With treatment, you can live well with heart failure. Remember: ‘Ankles swollen, tired and out of puff — an NT-proBNP test is just the stuff’.”

[1] .Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail. 2020 Aug;22(8):1342-56.
[2] Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023 Jan 18;118(17):3272-87.

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Women can reduce their risk of heart disease with lifestyle interventions, including self-care, reducing stress and engaging in physical activity.

One in four women die from heart disease and stroke each year — the same as men. There are female-specific factors that affect a woman’s risk, including menopause. However, the good news is that around 80% of premature heart disease and stroke is preventable through healthy lifestyles.  

Empowering women with a healthy heart 

Most women already know what makes a healthy lifestyle, but the many demands of modern life can get in the way. The Irish Heart Foundation has developed the ‘Her Heart Matters’ campaign to help women look after their hearts and advocate for themselves. 

This September, the Irish Heart Foundation is calling on women to put themselves first and make their heart health a priority. It’s not just up to women themselves, so we are also calling on the public to talk, share and empower women to look after their heart health. 

Translating mindset into change 

Getting into the right frame of mind is essential for change. You need to feel ready and have clear, powerful reasons for making a change. As part of the Her Heart Matters campaign, the Irish Heart Foundation has created a free Self-Care and Wellbeing Journal to encourage women to reflect on their lifestyle habits and prepare for meaningful change. 

Getting into the right frame of
mind is essential for change.

Taking steps to manage stress 

While stress is a normal part of life, it can be negative when it starts to impact day-to-day tasks. Many women are juggling multiple demands, and this can be particularly challenging during menopause. Try to keep a regular sleep routine, be physically active and stay connected to friends and family. If you are struggling, contact your GP. 

Physical activity and nutrition 

Regular physical activity and a Mediterranean-style diet are two of the greatest tools for preventing heart disease and stroke as well as helping to reduce some menopause symptoms. Getting at least 150 minutes a week of moderate-intensity activity is recommended for good health.  

The Mediterranean-style diet is based around fruit and vegetables, whole grains, beans and other pulses, nuts and seeds. It includes some olive oil, fish, seafood and poultry and is low in sugar, salt, processed foods and red meat. 

Start the conversation  

Be part of the movement with people who want to see change and protect all women from one of Ireland’s biggest killers. Spread the word with your sisters, mothers, daughters and friends.  

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Hockey veteran Ed Cherry warns people to seek early diagnosis and treatment for any heart problems after he experienced an episode during a match while on tour in Spain.

It was during a veterans’ hockey tour in Spain, that Ed Cherry first realised he had an issue with his heart. Nearing his 50th birthday, he was fit and active but — while running around in 35-degree heat after what he describes as ‘a good night out the previous evening’ — his heart rate took off. “I felt dizzy,” he recalls. “But within minutes, these symptoms went away; but I got a fright.”

Recurring heart symptoms

Having returned home from Barcelona to Ireland, the sensation of increased heart rate symptoms started happening more frequently; often while watching TV after an evening meal with a glass of wine, he says. Even then, it took months for him to seek medical help, and only after his wife insisted.

Having cut back on his alcohol intake, he visited his GP who referred him to a specialist. “If I ever needed a wake-up call, that was it. From there, I was referred to an electrical heart specialist,” says Cherry, now 53. “Given the delay in my seeking help, I went straight to the interventional treatment.”

Via a wearable device, it was identified that he had both atrial fibrillation and an atrial flutter.

Diagnosis and treatment

Via a wearable device, it was identified that he had both atrial fibrillation and an atrial flutter. “This is important information for the consultant to improve the treatment efficacy. If only one problem is identified initially but you have both, then you will need to go back for another procedure.”

Cherry underwent catheter ablation under a general anaesthetic. Although he recalls waking up in the intensive care unit, he was back at work with his healthcare company in a matter of days. “Since the treatment, I have regained my life; I am symptom-free. Consequently, I have improved my level of exercise and reduced weight.”

Find support for your heart

Having joined Croí, a patient advocacy group for people in Ireland with cardiovascular disease and stroke, he stresses the importance of raising awareness and prompt diagnosis and treatment of heart conditions. Addressing symptomatic people sitting at home who are hesitant to seek treatment, he underlines the importance of early referral for diagnosis and treatment at a specialist centre of excellence — even if it means travelling to receive the right care.

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