CARDIOLOGY patients in the Mid-West who need urgent angioplasty are now getting a service “on a par with if not above” that provided by all other major centres in the country, according to a senior doctor at University Hospital Limerick.
Prof Tom Kiernan, consultant interventional cardiologist and associate professor of medicine at the Graduate Entry Medical School (GEMS) at UL, has pointed to hugely encouraging data since UHL became a dedicated centre for a specific category of patients under the national acute coronary syndrome (ACS) programme in 2012.
Last year, almost 200 patients received life-saving treatment having been rushed to the hospital’s new coronary care unit after suffering what doctors call a STEMI, a particularly serious heart attack that requires urgent treatment.
The specific procedure - a primary percutaneous intervention (pPCI) - involves inserting a balloon into an artery to disrupt a clot and then inserting a stent to restore blood flow to the heart.
Prof Kiernan, who joined the unit in July 2012, said that until October of that year, patients in Limerick could not have the procedure done after 5pm.
“The service delivery actually started in the old unit downstairs in October 2012 just prior to us moving over here,” Prof Kiernan said in his office at the new critical care unit.
“The vast improvement,” Prof Kiernan explained, “is going from a 9 to 5 service to a 24-7 service. That is the fundamental improvement; where patients who were outside that five o’clock window had to go to Cork or Galway for life-saving intervention often in times that were outside international guidelines. They now could be treated safely and within better time guidelines at UHL.”
Now recognised as a national centre under the ACS programme, Limerick takes in STEMI patients not only from its own catchment but from north Kerry and, depending on circumstances, occasionally gets patients in by helicopter from as far away as west Kerry, Offaly or even Sligo.
“Of acute coronary syndromes, approximately one third are STEMIs and two thirds non-STEMIs but the reason that STEMIs are so important is time. And you really have, from a patient perspective, a golden window which if you get to us within the window, you could typically leave the hospital with no damage done to your heart whatsoever.”
He points to a 70-year-old woman who was rushed to UHL by ambulance from Tipperary having suffered a STEMI heart attack on Monday of last week.
“This lady should do very well because the restoration of blood flow to her heart was timely, delivered safely and competently and she made an excellent recovery. She is going home today (Thursday),” Prof Kiernan said.
“We use the term door-to-balloon time, so for a patient coming directly to the hospital, it is 90 minutes, and for a patient coming on a hospital-to-hospital transfer, it is 120 minutes.”
Prof Kiernan said the hospital could take huge encouragement from its performance as part of the acute coronary syndrome programme. The latest available data, from 2013, showed “Limerick is on a par with if not above (other centres) in terms of door-to-balloon times; in terms of patient survival; in terms of time to discharge. So we performed excellently”, he said.
STEMIs, he pointed out, only account for 200 to the 650 interventions - both acute and elective - carried out in the coronary care unit every year. And the new unit provides for the region’s patients “an infrastructure that is first class, top of the range and second to none”.
The department of cardiology has also been beefing up its manpower in recent years. Prof Kiernan is one of four consultant cardiologists in the pPCI programme and the imminent recruitment of a fifth will bring the region into line with international best practice. There are in addition another three consultant cardiologists not involved in the pPCI programme.
“When I started in July 2012, there were only two registrars here. We now have five, as well as one research registrar and one clinical lecturer and we have been lucky to attract good people into these jobs,” Prof Kiernan said.
When GEMS was established at UL, its founders said one of the main advantages of having a medical school in the region would be attracting top specialists to practice, teach and conduct research. And Prof Kiernan himself is an example of that promise being fulfilled.
From Laois, he studied in UCD and trained in Ireland and in the United States - at the Mayo Clinic in Minneapolis and Massachusetts General Hospital in Boston.
“The majority of trainees, certainly in cardiology, to gain a broad experience would have to go overseas and like everything else bring back a repertoire of skills to the homeland. That has proved more and more difficult as Ireland is not as attractive any more for our bright and best trainees to come home,” he said.
That was down to working hours and conditions, contracts and other factors but Prof Kiernan perceives “it is beginning to change a little and I hope as we move forward we will attract more and more back because without those people the future is bleak”.
The position in Limerick - associate professor of medicine and consultant interventional cardiologist - “was a nice combination for me, bringing together clinical practice and operational procedures for patients along with education of students and junior doctors and the research component”.
From his time in Boston, he was able to bring home some new skills and last year, an 83-year-old Limerick man who suffered a heart attack was the first in Ireland to undergo a particular procedure involving the insertion of a pumping device in the heart to allow for the insertion of a stent. The procedure was pioneered in this country in UHL by Prof Kiernan and colleague Brian Hynes.
The patient “was in outpatients last week, still very much alive and doing very well” said Prof Kiernan.
“We have done about five cases and it is going very well. It has also been done in the Mater but not in any of other centres. It’s a device you don’t use every day of the week but it is excellent to have that availability and have the skillset to use it when you need it. It has definitely saved patients’ lives on occasion.”
As for looking after his own heart, Prof Kiernan - who it must be said looks younger than his 39 years - said everybody knew the basics.
“I do a bit of cycling, a bit of running and a bit of five-a-side soccer. I try and eat healthy and show moderation.”