Excellence by collaboration in cardiology services 

The session on ‘Collaborative care across borders – experiences, insights and opportunities’ at the Irish Cardiac Society’s 75th Annual Scientific Meeting was chaired by Ms Sarah Early and Prof Monica Monaghan. It featured talks by Prof Frank Casey, Dr Alison Muir, Dr Deirdre Ward, and ICS past-President Prof Ken McDonald.

Prof Casey spoke on the topic, ‘Achieving excellence by collaboration: The All-Island Congenital Heart Disease (CHD) Network’; Dr Muir and Dr Ward spoke on ‘Inherited cardiac conditions across 32 counties: Cardiac genes don’t respect borders’.

Prof Casey provided background to the development of the CHD Network and an overview of its objectives. He explained that a UK-wide review of cardiac surgical services had concluded that specialised cardiac surgical services for children needed to be centered around bigger teams dealing with a larger number of cases.

He also touched on some of the barriers to the concept, including fears that such a network would diminish local services, and securing adequate resourcing. Now, around 200 children from Northern Ireland receive their surgery or interventional catheterisation through the Network’s services each year, and Prof Casey also paid tribute to the transport services as a vital part of the process.

“The keys to success are good communication and mutual respect across the team,” Prof Casey stated. “There is always the temptation for the bigger centres to become dominant and we have had to work to achieve a balance on that with building clinical and managerial relationships.

“What’s also really important is the IT infrastructure,” he continued. “We now have an image exchange portal where we can exchange images from echocardiography or CT angiography, and we have regular surgical video conferences. We have to be assured of the governance and clinical standards and family engagement… and bringing the patients along and reassuring them that they will get the best possible service [is key].

“Over the past 10 years we have been on a journey, and interestingly, I think it has raised the standards in both jurisdictions. I hope that the learning from what has been done here could be helpful to other specialties right across other medical fields.”

Dr Muir provided an overview of inherited cardiac conditions. She explained that, in this area of practice, cardiologists needed to build special relationships with other groups and individuals, such as state pathology, coroners, device specialists, electrophysiology professionals, advanced imaging specialists, and surgical and other cardiology colleagues, among others. Dr Muir also provided an outline of her role as a cardiologist specialising in inherited cardiac conditions in the Belfast Health and Social Care Trust, Northern Ireland.

“For us, among the big highlights of the service is that we have innovated to try to improve waiting times for patients,” said Dr Muir. “If you are found to have an inherited cardiac condition, you don’t want to wait for six months for your first appointment. New patient appointments in our service are now down to around 10 weeks, but if you present with a family history of sudden death, you don’t go on a waiting list; you are simply appointed to the next available slot.”

Providing a perspective from the Republic of Ireland, Dr Ward spoke on the service for inherited cardiac conditions she delivers with her colleagues. She said it is not always possible to know the exact prevalence of inherited cardiac conditions. “But we may have [approximately] 35,000 people over the island of Ireland with inherited cardiac conditions,” she stated. “We certainly don’t have the capacity to see all of those, and they are not all being addressed in the same way. It is an unmet need and something we need to develop,” she added.

Dr Ward explained that capacity and funding are challenges, and a registry is needed to serve as a shared and structured resource.