ICS 2012 – Interview with the President of the Irish Cardiac Society Dr Donal Murray, Sligo General Hospital

by Edel O’Connell

–  CARDIAC medicine has come a long way in 50 years but the dual pressures of cutbacks in the health service and an increased sedentary lifestyle are creating challenging times for cardiologists, according to the Irish Cardiac Society’s new president.

Consultant physician at Sligo General Hospital, Dr Donal Murray said: “At population level, the current lifestyle-related risk factor profile of the Irish population is a major concern: levels of smoking have not changed in the last 5 years, while levels of obesity and  physical inactivity have increased . If these patterns continue, they threaten to reverse  the declining trend in cardiovascular disease mortality of recent decades.”

He believes there is thus considerable  scope for improvement.

“Apart from the human cost, the cost of cardiovascular disease to the Irish economy – which includes  the costs of healthcare, loss in productivity and informal care – is a significant burden. Spending on  cardiovascular health, while substantial, accounts for only 6percent of the Irish healthcare budget – lower  than the EU27 average of 10percent.

“The reality is there is increasingly more we can do for our patients- more complex, more costly procedures but at the same time resources seem to be ever diminishing and to try to square that circle is difficult. I suppose the big thing we have to try and do is to be more efficient in the way we provide care and services,” he said.

However, the physician has warned no matter what advances there are in cardiology the fact is changing people’s behaviour when it comes to lifestyle is very difficult.

The ICS annual meeting heard several eminent cardiologist present papers on the early development of heart disease and preventive measures which can be used to stop its progression.

“Preventative measures seem like a very good idea but in fact changing people’s behaviour is the real challenge,” said Mr Murray.

“Ireland has embarked on a new era of cardiovascular care where the goal will be to prevent, to treat and to manage in an environment that is both more challenged economically, but also more enabled by the many scientific, professional and societal  achievements of the last decade in this area,” he said.

“Ten or twenty years ago Ireland was one of the very worst countries in Europe with regard to the prevalence of coronary artery disease, we have improved considerably in the last 10 to 15 years years and we are now down more at the middle of the table rather than the very bottom, so we have improved a lot due to a combination of changing lifestyle behaviour and also improved provision of cardiac services. But Irish men are now the most obese in Europe, which is a very worrying development,” he said.

“The rates of obesity in Ireland have increased by almost 40 per cent since the Government made its first efforts at tackling this issue. This trend is single-handedly reversing the significant advances we managed to achieve in cardiac health, the president said.
“We return here again to the complex issue of changing how people behave. The graph with regard to the prevalence of coronary artery disease in the last 15 years had been improving but there is a fear in more recent times with the development of diabetes and the development of obesity that we may be seeing a temporary dip in CAD and over the next generation we may see the graph going back up again and this is a very real and a very genuine worry and we will start seeing very young people again presenting with coronary disease,” he said.

Its not all gloom and doom hover, improvements including the National Heart Failure strategy   which Dr Murray says is an exciting development.

“Cardiovascular disease remains the most common cause of death in Ireland, currently accounting

for one-third of all deaths and one in five premature deaths. However, there has been substantial

progress. Age-standardised death rates from cardiovascular disease have decreased by two-thirds over  the past 30 years. In cardiology improvements in the techniques for reperfusion in the cardiac cath lab have been very dramatic. We have a number of programmes which are being rolled out in the Republic now which are very welcome we have the national heart failure programme which is designed to improve and optimise the care of patients with heart failure. I think that promises to be very exciting and very helpful for patients we also have the acute coronary project, which is a national project designed to make sure patients presenting with acute myocardial infarctions are seen as early and quickly as possible and dealt with as quickly as possible, that again should lead to very considerable benefits for our patients,” he said.

However as mortality rates have reduced, demand on health services have intesntified but access to those services is still beyond the reach of many.

“We need to do a lot more when it comes to spreading the care more evenly. I am based in Sligo and we don’t have any reperfusion facilities. a cardiac catheterisation laboratory is now regarded as the treatment of choice for many patients with acute myocardial infarction within two hours of first medical contact. “The nearest such centre at present is in Dublin or Galway, a two to three-hour drive , too far to be of benefit for a heart attack patient in the northwest.”

The new president says trainee cardiologists are facing “stormy times ahead” with changes to the consultant’s contracts

“The society is primarily has an educational role with its annual meeting which has gone from strength to strength over the years- the society also has a big role to play in trying to develop and progress the careers of our young trainees in cardiology and again that is something that we will continue to work on, however for our trainees now there are certainly stormy times ahead with the changes in contractual issues looming on the horizon, this will be a difficult time and I think the ICS will try and support them as best they can,” he said.

I would like to think the Government would pay attention to organisations like the Irish Cardiac Society, I think it is fair to say that up until now the ICS hasn’t been at all involves with the organisation of services on the ground. I think an organisation like this should be more involved as incoming president that is something I will certainly encourage.