The recent Irish Cardiac Society Annual Scientific Meeting received a comprehensive update on the national review of cardiac services. Niamh Cahill reports
After a long wait, the national review of cardiac services (NRCS) in Ireland was finally published in April 2025.
The review, which was conducted in 2018 and 2019, contains 23 ambitious recommendations and 34 sub-recommendations.
The review recommended: “The formal restructuring and strengthening of the National Heart Programme (NHP) as the overall governance and implementation structure for the development, enhancement, and oversight of specialist cardiac services, with a structure and remit similar to the National Cancer Control Programme and the National Women and Infants Health Programme.”
A three-year implementation strategy for the review has been approved by the HSE. The strategy has been sent to Minister for Health Jennifer Carroll MacNeill for overall approval and a decision on funding.
Speaking at the Irish Cardiac Society’s 76th Annual Scientific Meeting in Killarney, Co Kerry, last month, Prof Joe Galvin, Consultant Cardiologist, Mater Misericordiae University Hospital, Dublin, described the review as “a unique report in the history of Irish cardiology and cardiovascular service delivery”.
Prof Galvin said the group working on the implementation strategy had sought a timeline of five-to-10 years for its introduction, due to the volume of work required.
However, the group was told by the Department that the plan must be designed for implementation over three years.
Work on the plan coincides with the upcoming launch of the first European Union (EU) cardiovascular strategy, which is due later this year. Prof Galvin noted that Ireland will take up the presidency of the Council of the EU in the second half of 2026.
“To have [the national review of cardiac services] published, the timing really is wonderful, and I think it’s something politically the Government will be under huge pressure to act on,” Prof Galvin told delegates.
He outlined a number of the short- and immediate-term goals identified in the review.
They included reducing reliance on outsourcing from the National Treatment Purchase Fund (NTPF) through capacity creation in acute hospitals, improving access to prevention via chronic disease management and community programmes, and establishing robust data systems capable of tracking progress and informing funding allocation decisions.
The initial focus, he stated, has been on establishing national and regional governance for the NHP.
Central governance for the programme is in the process of being established, Prof Galvin said.
There will also be regional governance in the form of regional cardiology leads, cardiology nursing leads, and clinical physiology leads in each of the six health regions.
In addition, sub-specialty groups will be formed to oversee roll-out in specific areas.
A primary objective “was to get advanced cardiac imaging [CT coronary angiography (CTCA) and cardiac MRI (CMRI)] up and running in Ireland across the six regions”, according to Prof Galvin.
Other initial goals for acute services include the establishment of acute cardiac teams for emergency departments (EDs) and the development of arrhythmia services in the west and in south Dublin.
Additional priorities involve increasing capacity for elective coronary, arrhythmia, and structural procedures through the provision of staffed catheterisation laboratories (‘cath labs’) and beds.
The plan also aims to enhance consultant and advanced nurse practitioner (ANP) support, along with administrative capacity, in model three hospitals; ensure adequate resources and consumables for transcatheter aortic valve implantation (TAVI) procedures; and maintain the sustainability of the primary percutaneous coronary intervention (PPCI) services.
In the community, the initial focus will be on the completion of integrated care services for prevention and cardiac rehabilitation, Prof Galvin said.
Another priority is data gathering across all health regions in terms of resources, activity, and waiting lists. Prof Galvin noted the EuroHeart Data registry pilot in the south-west, which he said is looking at outcomes from procedures in Irish cardiology care.
Prof Galvin said that workforce considerations were a crucial element of the plan and that close interaction with training and educational organisations would be required to ensure that “intake” is appropriate.
There are 33 hospitals with cardiac services in Ireland.
They include seven model two hospitals that provide cardiac diagnostics only; 16 model three hospitals that have an ED; six model four hospitals that have a cath lab in which PPCI or device procedures are conducted; and four model five hospitals or comprehensive cardiac centres that provide electrophysiology, structural, and cardiac surgical work.
There are 33 integrated care hubs in the community connected to acute hospitals, he added.
Prof Galvin thanked hospital staff who replied to a call for information to collect data across the system on resources, staff, equipment, facilities, clinical activity, and other data points. About 60 per cent of hospitals responded, he revealed.
“This is an ongoing process and it is only the beginning,” Prof Galvin explained.
“We are going to be getting specialist service improvement leads to connect with hospitals and set up the channels for recording this data, because it is impossible to allocate funding and resources unless you know what is there and what activity is going on.”
Data
Turning to trends in hospitalisation using Hospital In-Patient Inquiry data from 2019 to 2024, where the principal diagnosis was heart disease, Prof Galvin noted a trend downwards in ED admissions for acute coronary syndrome/chest pain.
Arrhythmia and heart failure were the next most common reasons for admissions to hospital, he stated.
Prof Galvin noted that cardiology ANP teams and efficient ED pathways may be contributing to lower admission rates in some model four and five hospitals.
He said there were a “relatively” low number of acute cardiac admissions in two hospitals: Beaumont and St James’s Hospitals, both in Dublin. These hospitals have the best model of ED/ANP services nationally regarding cardiac care, according to Prof Galvin.
He highlighted data from Beaumont Hospital from 2022 and 2023 and said that 2,604 cardiac discharges from the ED had led to a saving of more than 6,000 bed days.
Prof Galvin also pointed to the volume of patients still waiting for cardiology outpatient appointments – citing NTPF data – and said some hospitals now have “particularly long waiting lists, longer than one year”.
He questioned what additional system changes and redesign could be implemented to materially reduce these waits for patients.
Prof Galvin said that guidelines from the Irish College of GPs on cardiovascular disease were very useful and effective in assessing who to refer to hospital for further investigation.
“I think we can do much better in terms of diverting or managing patients through what we’re proposing, which are e-health or [virtual] clinics.”
Prof Galvin said this would consist of “a polite, respectful, constructive, precise letter sent to the GP, copied to the patient, put into the medical record… advising them what to do”.
He explained that virtual clinics involve the electronic management of primary care referrals.
The plan is to establish these clinics for all consultants in the future, he said. (Virtual heart clinicals are also being rolled out in the community – see panel below.)
Prof Galvin noted that palpitations have become one of the most frequent reasons for hospital referral and said a new standardised “palpitations letter” has been developed to help manage these cases in primary care and reduce unnecessary clinic visits.
“It is very useful for diagnosing SVT [supraventricular tachycardia] in younger patients and atrial fibrillation in older patients and this encourages the use of wearables,” he said.
Posts
Prof Galvin told delegates that there are currently 110 whole-time-equivalent consultant cardiologists working in acute hospitals and 14.5 working in integrated care hubs.
The implementation team has requested 293 additional posts – including cardiologists, radiologists, public health consultants, anaesthesiologists, dietitians, laboratory scientists, and other nursing and allied health professionals – to be introduced between 2025 and 2028 across all six regions.
Of these, 69 are proposed for the HSE Dublin and Midlands region and 39 for the West and North West.
“I suspect we won’t get 100 per cent funding for the plan and our answer to that will be to try and spread out the plan over more than three years rather than cancel funding for certain [aspects],” Prof Galvin explained.
Proposed appointments include 46 consultant posts across the range of sub-specialties.
“One of the problems here is workforce planning… this sort of information is critical going forward, to be able to tell training boards what it is we need going forward in cardiology.”
A further 135 nursing posts, focusing on EDs and ANP teams, are also being sought.
“Difficulties with recruitment and trying to do everything in three years is a problem; we may have difficulty filling all of these posts,” Prof Galvin said.
“One place we were particularly weak in terms of data was clinical physiologist posts… we desperately need data, and we need more posts.”
He explained that, as more data is received, the plan around posts will be “tweakable”. This means that funding allocated for certain posts may be moved to other areas.
“We also need to cut down on inappropriate testing and referrals for cardiac investigations,” he advised.
Work practice changes
Alongside the development of virtual clinics, he said that in model three hospitals, a shift is proposed from cardiologists taking general internal medicine (GIM) calls to dedicated cardiology teams managing all cardiac patients.
“There are challenges with that, and I think our GIM colleagues need to be supported to allow that to happen with overnight back-up and phone cover and some cover over weekends. This is all up for discussion,” he said.
Extended cath lab capacity is also being sought. Prof Galvin noted that the Minister for Health would like to see these laboratories operational six days a week, 12 hours a day.
“We would certainly like to see five days a week” with additional nurses, physiologists, and radiographers along with protected beds, he said.
A new cath lab was recently opened in St James’s Hospital, (see panel, p6).
Extended imaging capacity (CTCA and CMRI) will require additional staff resources and is being sought 12 hours per day, six days per week.
Engagement with senior leadership in all six regions is next on the agenda, as well as filling service improvement lead posts to allow the establishment of channels of communication with every hospital and region to occur to help implement changes.
Gap analyses across every part of the service are required to determine where staff are required.
The creation of protected inpatient and day case bed capacity is also needed, Prof Galvin maintained.
“We now await the approval and extent of funding from the Minister for Health,” he concluded.
See p44-46 for full coverage of the Irish Cardiac Society Annual Scientific Meeting and AGM.
Heart virtual clinics ‘progressing’ across community specialist teams
David Lynch
Over 800 heart virtual clinics (HVCs) have been held nationally so far this year, according to figures supplied to the Medical Independent (MI) by the HSE.
The roll-out of the HVCs has been “progressing across the chronic disease community specialist teams over the year”, a HSE spokesperson told MI.
Up to mid-October 2025, 801 HVCs had taken place. This has resulted in 801 fewer referrals to hospital outpatient departments for specialist consultant opinions, as these were provided through the community specialist teams, according to the spokesperson.
At present, 12 community specialist teams are offering the HVC service. “Additional teams are being supported to implement the HVC service as part of the integrated cardiology service in their regions,” the spokesperson said.
Progress on the service was discussed at the Sláintecare programme board meeting in June. According to the minutes, at that time, the HVC service was being delivered across nine chronic disease management community specialist teams. They had received 238 direct referrals in the first three months of 2025, resulting in over 250 patient contacts.
The 2019 GP Agreement introduced a range of new services, including the structured review of patients through HVCs. The virtual clinics form part of the integrated model of care for the prevention and management of chronic disease, which is being rolled out nationally under the enhanced community care programme.
According to the HSE, “underpinning the HVC model” is a collaborative approach by GPs, cardiology consultants, and cardiology clinical nurse specialists to deliver comprehensive, coordinated, and integrated care to patients in the community.
Using video-conferencing technology, GPs can access specialist cardiology advice for their patients. This service is supported by direct GP access to diagnostics and follow-up clinical contact with the patient from the integrated care cardiology specialist team, where required.
“This model will support the provision of GP-led primary care, reflecting the Sláintecare vision of delivering care as close to home as possible,” the HSE spokesperson said.
St James’s Hospital increases cardiac procedures with third cath lab
St James’s Hospital, Dublin, has increased its capacity to deliver life-saving cardiac care by 50 per cent with a new catheterisation laboratory (‘cath lab’).
The lab – the third of its kind at the hospital – treats more than 400 patients experiencing acute heart attacks and rhythm disorders per month.
Heart disease remains the leading cause of death in Ireland, affecting one in two people during their lifetime. St James’s Hospital treats a quarter of all heart attack patients nationwide each year. Without urgent treatment, known as primary percutaneous coronary intervention (PPCI), a severe heart attack has a fatality rate of up to 50 per cent.
With modern interventions, such as stenting and valve replacement, in-hospital mortality for heart attack has fallen to around five per cent. For those receiving valve replacement procedures, survival rates return to normal for their age group.
Inside the cath lab, cardiologists access the heart through a small artery and use x-ray imaging to identify and treat blockages or structural problems using balloons, stents or replacement valves. For rhythm disorders, thin catheters deliver targeted energy to correct abnormal electrical signals. Most procedures are performed without open-heart surgery, allowing patients to recover faster and with fewer complications.
Speaking at the official launch of the cath lab in October, Minister for Health Jennifer Carroll MacNeill, said: “The opening of this cardiac catheterisation laboratory marks an important milestone in advancing patient care and strengthening our healthcare service. It is the result of strategic investment, strong partnerships and the dedicated work of many people and represents our ongoing commitment to ensure that every patient has access to life-saving cardiac care.”
Prof Caroline Daly, Consultant Cardiologist and Clinical Lead for Cardiology, St James’s Hospital, said: “With this third cath lab, we can deliver faster treatment for emergency patients and increase capacity for those needing complex or elective procedures such as stenting, valve replacement, or rhythm correction. This means safer, more efficient care and better outcomes for patients.”
The lab expansion includes a new purpose-built recovery area with 14 beds, allowing more patients to be treated and discharged on the same day.
A total of 35 new specialist staff across anaesthesiology, nursing, radiography, and physiology have been recruited to work in the lab. For the first time, a dedicated anaesthesiology team is embedded within the cath lab, enabling more complex procedures under general anaesthesia.
Prof Mary Day, Chief Executive Officer, St James’s Hospital, said: “This is a major milestone in cardiac care at St James’s Hospital. The new cath lab and recovery area mean we can treat more patients, reduce waiting times, and continue to deliver world-class care for patients in the south-east of the country.”
Since becoming fully operational earlier this year, the cath lab has reduced monthly waiting times across St James’s Hospital and increased monthly procedure volumes by 35 per cent.
St James’s Hospital is one of four comprehensive cardiac centres in Ireland, working closely with cardiology teams across Ireland to provide care for patients with complex heart problems.
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