Heartwatch: a chronic disease management program for heart disease in Ireland.

Fintan Stanley, Robyn Homeniuk, Claire Collins

Keywords: chronic disease Management, cardiovascular, heart disease,

In Ireland, the standardised death rate from ischaemic heart disease in Ireland was 133 per 100,000 inhabitants, which was slightly more than the EU rate of 119.4 per 100,000 inhabitants. In 2003, Ireland started Heartwatch, a secondary prevention programme for patients with a history of coronary heart disease during which patients have up to 4 specialised visits per year across 20% of Irish GP practices.

Research questions:
Do patient health outcomes improve over the course of the programme?

Data is collected in general practice during structured visits and is held in a central database. Variables collected include blood pressure (systolic & diastolic), cholesterol (total & LDL), waist circumference, as well as HbA1C and fasting glucose for diabetic patients. Data was extracted and analysed using R (4.1.0).

Between when signup began in 2003 and May 2021, 21,000 patients participated. Over 17,000 have 1 year follow-up, while more than 7,000 patients have participated for at least 8 years. Based on patients with at least 1 year of participation; 73% are male; they sort equally into 0-74, 75-84, and 85+ age bands; and most were retired (56%).

Mean systolic BP among patients with 4 yrs. follow up was 132.7mmHg down 1.4 from their average baseline. The target systolic BP within the program is <140mmHg, and divergent results are seen based on weather patients begin the program above or below this target. For the same cohort, patients starting with a systolic BP >140 see an average decrease of 13.2 (mean 138.8), while patients who enter the program with BP <140 see an average increase in of 6.18 (mean 128.7). Other metrics show a similar pattern of divergence.

Patients do see an overall improvement in some targeted health metrics, however there is a divergence in the direction of metric change based on baseline readings.     

Points for discussion:
What drives the divergence of patients, where those outside targets see improvement, while those entering the program within targets drift closer to being off target over time?