RHASP Programme Offers New High-Tech Low-Cost Solution to Ireland's Cardiovascular Crisis >

Interim Report concludes that National Application of the RHASP programme would result in a Significant Reduction in Ireland's Unacceptably High Level of Cardiovascular Disease

An innovative new treatment and prevention programme can make a significant contribution to tackling Ireland's continuing cardiovascular crisis according to the results of an independent report which were published in Dublin today, (June 9th, 2004). The RHASP ( Reduction of Heart Attack Through Prevention ) programme, a unique collaboration between the Department of Health, Beaumont Hospital, General Practice and dabl®Ltd, has been the subject of a 12 month pilot scheme in six general practices on the north side of Dublin city. The independent report analysed the results of the pilot and considered how the RHASP programme could be used more broadly to meet the growing needs in the area of cardiovascular care.

RHASP has been proven to be effective in addressing cardiovascular disease, one of the most critical issues in healthcare in Ireland. More people die from strokes and heart attacks in Ireland than in most other European countries. One of the primary reasons for this is that efforts to date have been insufficiently targeted at those in the high-risk category and because of insufficient data identifying those most at risk.

Through RHASP a number of general practices have been linked electronically with the Blood Pressure Unit in Beaumont Hospital to share a common database for patients with cardiovascular disease. Sharing of data in this innovative manner has allowed the provision of a management, treatment and prevention programme that is identical in both the specialised hospital unit and general practice.

The key operational elements of RHASP are:

  • Sharing of a common database between general practice surgeries and the Blood Pressure Unit in Beaumont Hospital using electronic communication
  • Sharing common protocols for management and treatment of patients with nurse-led clinics in the hospital and general practices
  • Using the specialised dabl ® cardiovascular software programme in both hospital and general practice clinics to analysis the risk status of patients for heart attack and stroke
  • Collection of electronic data in the hospital and general practice clinics allowing a common means of monitoring progress

The immediate key benefits of the RHASP operational process that have been identified by the independent report include the following:

  • More timely and appropriate patient treatment through enhanced collaboration between general practice and hospitals. In the RHASP Pilot project, drug prescribing of blood pressure and cholesterol lowering drugs was increased from 17% at the start of the project to 66% after 6 months.
  • Strict reduction of blood pressure and cholesterol levels to pre-determined targets using the most recent drugs. In the RHASP Pilot project, blood pressure was lowered by 14/5 mmHg after only 6 months
  • Strict adherence to pre-determined targets for treatment of selected patients.
  • Effective management of patients who have had a heart attack or stroke on a shared care basis between hospital and general practice
The RHASP Pilot study results clearly indicate that RHASP is a particularly effective programme for the detection and management of patients at high risk from heart attack and stroke in general practice.

The RHASP model is equally effective in helping deal with medium and low risk patients and means less hospital care for persons in those categories and significantly improved quality of life. It is also easily understood by patients who can participate actively in improving their cardiovascular situation through lifestyle and other changes. It is clear that a national application of the RHASP programme would result in a significant reduction in Ireland 's currently unacceptable level of cardiovascular disease.

RHASP also has a key role in meeting the VFM (Value for Money) objectives of national health policy as set out in the Deloitte and Touche (2001) and Brennan (2003) reports. The fact that the system could be made available to every general practice in the country at a cost of less than €10,000 per practice for non-recurring costs, which represents excellent value for the health service through the efficiencies that would be achieved and through the impact on individual's health.

Commenting on the success of the pilot the consultants, who co-ordinated the RHASP Pilot Project at Beaumont Hospital, said: “The interim data indicate s that the RHASP target of at least halving stroke and heart attack in high-risk cardiovascular patients, through evidence-based prescribing of cardio-protective medication and by reducing and maintaining reductions of blood pressure and cholesterol to pre-determined goals, together with life-style changes, is realistic and achievable. If the RHASP Project was extended to the management of 20,000 high-risk patients in the Eastern Regional Health Authority over a 10-year period, this would result in the prevention of over 1,000 heart attacks and over 500 strokes.”

Dr. Colm Killeen , Mountjoy Family Practice, one of the participating general practices commented: "The Mountjoy Family Practice has been involved with the RHASP project since it was launched. RHASP has proved invaluable in the evaluation, investigation and treatment of hypertension and the identification of cardiovascular risk factors. The direct link with the dabl ® cardiovascular system enables swift analysis of ambulatory blood pressure measurement and correlation of biochemistry and other risk factors on line with the hospital database. It is presented in such a way as to make clinical decisions easier and more efficient, which is important in a busy GP practice. A close liaison with the hospital and the blood pressure unit is an important asset for general practitioners as we try and tackle the epidemic of heart disease in our society ."

Another participating GP, Dr. George Roberts , Beaumont Park Clinic, said: “We are delighted to be involved with this very important collaborative project between Primary Care and Beaumont Hospital . We believe this project will have a significant impact on the prevention of cardiovascular disease and will provide a blueprint for future initiatives as it has demonstrated what can be achieved when Primary and Secondary Care work closely together to deliver high quality care.”

Mr. Bill Rickard , Managing Director, dabl Ltd said: “The interim report summarising the pilot results shows that RHASP can meet two fundamental objectives of national health policy; firstly it can make a significant contribution to the prevention of heart attacks and strokes and secondly it does so in a manner which is a model for VFM. It is our view that applied nationally RHASP can become a key instrument of national health policy and, in doing so, serve to reverse Ireland's currently unacceptable level of cardiovascular risk'.

Mr. Peter Lennon , Director of the National GPIT Group, established by the Department of Health & Children, stated: “RHASP is an excellent example of what can be achieved by various healthcare stakeholders working together to provide better patient care. The RHASP Project also highlights the role that modern information technology can play in supporting clinical excellence in general practice and secondary care.”