The European Society of Cardiology (ESC) has released updated guidelines for managing high blood pressure, aiming to significantly impact heart health across Europe.

Recent guidelines for managing high blood pressure

Co-chaired by Professor Bill McEvoy, Professor of Preventive Cardiology at University of Galway and Medical and Research Director of the National Institute for Preventive Cardiology (NIPC), these guidelines introduce more intensive treatment targets and a new ‘elevated blood-pressure’ category to help prevent heart attacks and strokes.

Hypertension is a leading cause of cardiovascular disease, affecting about 45% of European adults. The new ESC guidelines introduce an ‘Elevated BP’ category for blood pressures between 120–139/70-89 mmHg, allowing earlier intervention for those at risk. This change recognises that blood pressure rises gradually and certain groups, such as people with diabetes, could benefit from more intensive treatment before reaching the traditional hypertension threshold.

INTERASPIRE study highlights the real-world challenge: 61% of heart disease patients globally do not have controlled blood pressure.

Target systolic levels and rise of home monitoring

The guidelines now recommend a target systolic blood pressure of 120–129 mmHg for most patients on medication, shifting from prior, less aggressive approaches. This change is driven by evidence showing that more intensive targets can better reduce cardiovascular risks. Another major recommendation is the increased use of home and ambulatory blood pressure monitors, helping patients and doctors make more informed decisions based on accurate, real-world data.

Bridging evidence-based guidelines and real-world outcomes

Professor McEvoy’s leadership extends beyond the guidelines, as his work with the INTERASPIRE study highlights the real-world challenge: 61% of heart disease patients globally do not have controlled blood pressure. This connection between evidence-based guidelines and real-world outcomes underscores the importance of the new ESC guidelines.

Professor McEvoy is a unique and pioneering medic, a practising consultant preventive cardiologist and an academic clinician at University of Galway. He also leads research and its implementation through to clinical practice at the NIPC.

National initiative to improve cardiovascular health in Ireland

As an independent medical research and education institute, NIPC is dedicated to advancing cardiovascular health through a strong focus on prevention, education and research. Working in collaboration with key stakeholders, its primary objective is to reduce the burden of cardiovascular disease.

Professor McEvoy will launch NIPC’s latest ‘Irish Hearts’ research project, a national population study, in partnership with Croí, the heart and stroke charity and the University of Galway at this year’s Heartfest event (September 25–27, 2024). This research study aims to gather critical information on heart health in Ireland, where individuals from the general population will be randomly selected for cardiovascular screening. This initiative is designed to contribute to heart and stroke prevention research, helping to enhance public health strategies across the country.

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To address the growing impact of cardiovascular disease in the Irish community, a cardiac care clinic provides comprehensive diagnostic, preventive and interventional services for managing these conditions.

Each year, over 9,000 people in Ireland lose their lives to cardiovascular disease (Irish Heart Foundation, 2023), with thousands more people living with its life-changing consequences. The burden of cardiovascular disease continues to grow, driven by lifestyle-related factors that, with proper management, could be addressed to improve heart health and save lives.

Lifestyle changes for better cardiac health

Factors such as diet, smoking and a sedentary lifestyle are some of the biggest risk factors for cardiovascular disease. Active smoking and secondhand smoke exposure account for around 30% of deaths from coronary heart disease (Gallucci et al, 2020), and it is thought that over two-thirds of deaths from heart disease worldwide could be prevented with healthier diets (European Society of Cardiology, 2020). According to World Heart Federation statistics, 80% of premature heart disease and stroke are preventable.

Maintaining a balanced diet, staying physically active and avoiding smoking are simple but powerful steps anyone can take. These simple lifestyle adjustments not only reduce the risk of heart disease but also improve quality of life, making them essential tools in combating the epidemic of heart disease in Ireland.

Maintaining a balanced diet, staying physically
active and avoiding smoking are simple
but powerful steps anyone can take.

Expert cardiac care in Ireland

Recognising the growing need for specialised cardiac care in Ireland, Lifeline Cardiology Clinic was established to provide a range of cardiac care and treatment services and also create awareness in the community. Founded by Dr Abid Hussaini, Consultant Interventional Cardiologist with over a decade of clinical experience, the clinic offers comprehensive diagnostic, preventive and interventional services aimed at managing cardiovascular diseases, including hypertension, heart failure, arrhythmias and coronary artery disease.

These include cardiac consultation, resting ECG, echocardiogram, stress testing, 24-hour heart activity monitoring, BP monitoring and sudden cardiac death screening. With state-of-the-art services and personalised care, the team at Lifeline Cardiology Clinic not only offers expert cardiac care but also leads initiatives to promote heart health, raise awareness and improve outcomes for patients in Limerick and surrounding counties.

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Since June 2024, eligible cardiac patients who require in-patient acute care can now avail of a HSE Virtual Ward where they will receive the same expert clinical care and support in the comfort of their homes.

Eligibility for Virtual Wards is determined once a patient is deemed clinically stable and low-risk by their consultant, amongst other factors.

Connected cardiac care with Virtual Wards

Virtual Wards have evolved from pressures healthcare systems face in unscheduled care — pressures which increased during the pandemic. For some patients, monitoring by clinical teams harnessing technology can now offer a safe and preferable alternative to hospital admission.  

Central to Virtual Wards is the empowerment of patients to be active partners in managing their health and wellbeing. Jim Murphy (60s) from Limerick had a history of irregular heartbeat. Six months ago, his GP referred him to a specialist who carried out an angiogram.

Murphy shares: “They found that I had a blockage in one of my arteries, so I was admitted to University Hospital Limerick for a stent. I was in overnight, and the nurse contacted me offering the Virtual Ward service. They provided all the equipment — a table, a device to monitor blood pressure, my oxygen — it was all connected by Bluetooth and recorded on the tablets. The nurses would message me before they called. We would have a consultation via video call, and they could examine the surgery wound. It was all very well-connected and responsive.”

The new Virtual Ward service
has now supported over 170
patients in the participating hospitals.

Advancing digital healthcare

The new Virtual Ward service has now supported over 170 patients in the participating hospitals (St Vincent’s University Hospital and University Hospital Limerick) and will continue to grow in the coming weeks.

The new Virtual Wards service marks a new and exciting phase of the digital transformation of our health service in line with ‘Digital for Care’ the new Digital Health Framework for Ireland, recently published by the Department of Health. Digital for Care sets out how we can harness the power of digital technology to improve patient access, increase efficiency and ultimately provide better health outcomes and experiences for everyone.

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Ciara Cahill

Cardiovascular Clinical Nurse Specialist for CHO3, University Hospital Limerick

Dr. Neasa Starr

Consultant Cardiologist UHL & Mid-West Integrated CV Care, University Hospital Limerick

Discussing heart failure (HF) can feel daunting due to its negative connotations. However, advances in treatment inspire hope, shifting focus towards heart function — not failure — to foster more constructive conversations.

Heart failure is a serious condition with varying severity, indicating the heart’s inefficient pumping and circulation.

Early HF diagnosis enhances prognosis

Common symptoms include breathlessness, such as reduced ability to exercise and fluid retention or swelling in the ankles, legs or abdomen. Early diagnosis is key to improving patient prognosis long-term to enable prompt treatment of the condition. This ambition is driven by the major advancement in drugs and devices available to treat the condition in recent years that are proven to reduce hospitalisation and improve prognosis.   

Preventing HF through risk management

As important as treating the condition is prevention. The American Heart Association describes this well through their classification of HF as four stages (from A–D). Stage A incorporates those with risk factors for the development of HF but no structural abnormality of the heart, reminding us the condition is often preventable. The diagnosis and treatment of cardiovascular risk factors that often prevent the condition of HF — such as high blood pressure, high cholesterol and obesity — cannot be underestimated.

Treating high blood pressure is one of the
most effective ways to preserve our health.

Blood pressure control

From a population perspective, treating high blood pressure is one of the most effective ways to preserve our health against a multitude of serious medical conditions such as heart disease, stroke, kidney disease and vascular dementia. As reflected by the recent European Society of Cardiology, treatment of high blood pressure is not confined to older patients. The long-term changes resulting from persistently high circulatory pressures can cause complications to heart function, kidney function and brain function down the line. These complications are generally preventable by ensuring your blood pressure is within normal range.

Integrated cardiovascular care for patients

Through the Irish Chronic Disease Management programme, patients with common cardiovascular conditions such as high blood pressure or high cholesterol can sign up for a GP check-up twice yearly to monitor risk factors in an effort to maintain long-term good health.

Linking in with this programme is the national integrated cardiovascular care service. This programme improves GP access to cardiac diagnostics, including echocardiograms and specialist care, in non-hospital settings. With nurse-led education, it aims for prompt diagnosis and treatment of conditions like heart failure, atrial fibrillation, high cholesterol and high blood pressure, adopting a patient-centred approach to enhance long-term outcomes.

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Arrhythmia detection and management are changing, with new self-referral pathways and arrhythmia Clinical Nurse Specialist clinics for arrhythmia patient management.

Alex Kenny, arrhythmia Clinical Nurse Specialist at Beacon Hospital, discusses her role in arrhythmia (irregular heartbeat) diagnosis and management. “My role provides a newly established service in which patients can receive sub-specialty care and access to treatment, including a same-day Consultant Electrophysiologist consultation,” she says. “The most prevalent arrhythmias we treat are atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT) and ventricular ectopy.”

Arrhythmia detection with smart devices

“We tailor our diagnostics and management based on each patient, with full cardiac assessment including a 12-lead ECG, echocardiogram, exercise stress test, 24 to 72-hour Holter monitor and potential referral for cardiac MRI,” explains Kenny.

Wearable devices, such as smartwatches, can help increase detection of arrhythmias significantly, particularly in individuals who might otherwise go undiagnosed. “Patients can self-refer to our service based on their symptoms or smart device data, or they can be referred to us by their GP,” she adds. “Smart devices are changing the way heart conditions are detected and diagnosed; there is an increase in patients presenting directly to our clinic as they are now taking more responsibility for their heart health. It’s a useful tool as Cardiologists can now rely on this data to diagnose symptoms.”

Patients can self-refer to our service based on
their symptoms or smart device data, or
they can be referred to us by their GP.

Why early detection matters

Kenny explains: “Symptoms can include palpitations, an increased/irregular heart rate above the typical 60–100 beats per minute, fatigue and shortness of breath — but for some people, there may be no symptoms at all.”

Organisations across Ireland promote cardiac screening in young people, especially for those who are asymptomatic or in high-risk groups, such as athletes or those with a family history of arrhythmias. She adds: “Follow-up is a big part of my role; one patient told me that finally getting a diagnosis completely changed her life.”

Treatment options for patients with arrhythmia

“We are lucky to be a technologically advanced hospital, so if there is a way to stop patients from being on long-term drug therapy, we will endeavour to find it,” says Kenny. “We are treating more patients than ever before with catheter ablation, which reduces the number of long-term medications they will require and improves patients’ ongoing quality of life.”

The procedure is not limited on the basis of age, and the success rate is high, according to Kenny. She concludes: “By leveraging the latest in diagnostic tools and treatments, we aim to provide tailored, effective care and enhance the quality of life for our patients.”

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As the burden of cardiovascular-related arrhythmias increases, new cardiac services in the South East alongside improved management techniques come at the right time to improve patient outcomes.

The burden of cardiovascular-related arrhythmias in the community is increasing. Factors such as poor diet, alcohol consumption and physical inactivity contribute to an increased risk of developing arrhythmias, alongside genetics, cardiovascular problems and high blood pressure.

Arrhythmia affecting more people

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, affecting around 59 million individuals, and is the leading cardiac cause of stroke. Prof Usama Boles, Consultant Electrophysiologist and Cardiologist, discusses the extent of the issue: “We are seeing younger and younger people present with arrhythmias, individuals leading high-stress lives, whether in their jobs, studies or personal circumstances — or athletes who regularly engage in intense physical training.”

Critical early detection

With a range of symptoms including palpitations, shortness of breath, lack of energy and fatigue, cardiac arrhythmias can significantly impact a person’s daily life. Early intervention is critical to preventing complications.

“In an audit done in the East of Ireland, 41% of strokes were attributed to AF; immediate assessment is required to start the patient on stroke prevention medications,” Boles says. “The earlier we can intercept cardiac arrhythmias and begin appropriate management, the better the outcome.”

Electrophysiologists are
medical specialists dedicated
to arrhythmia diagnosis and treatment.

Role of the electrophysiologist 

Electrophysiologists are medical specialists dedicated to arrhythmia diagnosis and treatment. Their expertise is essential in managing arrhythmias effectively, utilising advanced technologies and personalised strategies to improve patient outcomes.

“Electrophysiologists facilitate in-depth investigation and prediction of arrhythmia risk using specialised tools,” explains Boles. “Additional investigations, such as comprehensive echocardiograms and advanced management strategies, are key to understanding the extent of the disease and guiding treatment plans.”

Changing face of treatment

Ablation, a procedure to destroy abnormal heart tissue causing arrhythmia, has improved significantly. It is becoming more effective and efficient with fewer complications and shorter recovery times. “There is a massive improvement in what we can provide. Ablation is becoming the first-line treatment in many situations and is more widely available, enabling us to offer life-changing interventions to more people,” says Boles.

Alongside the risk of stroke, AF can cause additional health complications, making ablation a powerful solution to manage and even eliminate symptoms. “We have various pathways, with rapid access arrhythmia clinics in public and private sectors, ensuring we can fast-track people with high risk, where all available treatment options are discussed,” he continues.

UPMC Whitfield Hospital now offers electrophysiology studies and catheter ablation for South East residents, allowing them to access these services closer to home. 

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Trudie Lobban MBE

Founder and Trustee, Arrhythmia Alliance

We can make a lasting impact on the health and wellbeing of people in low and middle-income countries (LMIC) by recycling pacemakers, which are currently put into landfills.

Recycling explanted cardiac devices to countries where they would not otherwise have the opportunity to receive treatment for heart rhythm disorders can provide valuable medical support.

Inequity of life-saving cardiac technology

In the UK, cardiac implantable devices give approximately 68,000 individuals a second chance at life each year. Yet, when a device user dies, the device is buried with them, or if the deceased chooses to be cremated, it is discarded and goes to landfill. 

Many times, a device has many years of battery life left and yet, it is a ‘throwaway.’ In stark contrast, in LMIC, around 2.5 million people die every year because they do not have enough money or access to a lifesaving cardiac device operation.

This is an opportunity that can protect our planet from harmful waste and provide life-saving cardiac care to others.

How cardiac devices can save a life, twice

Arrhythmia Alliance Pace4Life (A-A P4L) is a charity that tackles this disparity head-on by donating cardiac devices to people in need in LMIC who otherwise would not be able to afford the lifesaving implant. The charity sources cardiac devices, identifies viable clinics in LMIC, sets up programmes at these clinics, trains local cardiac teams, organises pacing missions and provides ongoing online support to those programmes. This is an opportunity that can protect our planet from harmful waste and provide life-saving cardiac care to others.

Repurposing cardiac devices for impact

The key is connecting LMIC and higher-income countries (HIC) communities through the reuse and recycling of pacemakers and other cardiac devices once they are no longer needed. By gathering these life-saving devices from hospitals, funeral homes, crematoriums and mortuaries, this programme can make a real difference in the lives of those in need. The aim is to ensure that every cardiac device is given a second chance to bring hope and healing to those who need it most.

A-A P4L has created a system that allows the repurposing of explanted and end-of-shelf-life cardiac devices and equipment. By redirecting these items to a distribution centre, the used devices are collected by a re-processing company, cleaned, decontaminated, tested and re-packaged sterile. The devices can positively impact the lives of those in need while contributing to a sustainable future by avoiding landfill.

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Currently, up to 30% of individuals who have atrial fibrillation (AF) are undiagnosed and are at risk of complications, such as an AF-related stroke. So, it is important to know your pulse to know your heart rhythm.

What is atrial fibrillation?

Atrial fibrillation, or AF, is a heart condition that causes an irregular and often abnormally fast heart rhythm. It is the most common heart rhythm disturbance encountered by doctors, affecting around 1.4 million people in the UK. It can affect adults of any age but is more common as people get older; in the over-65-year-old age group, it affects about 10% of people.

AF causes irregular, rapid heartbeats

A normal heart rhythm should be regular and between 60 and 100 beats a minute when you are resting. In people with AF, it can be considerably higher than 100 beats a minute. This can cause problems including dizziness, shortness of breath and tiredness. You may be aware of noticeable heart palpitations, where your heart feels like it’s pounding, fluttering or beating irregularly — often for a few seconds or, in some cases, a few minutes.

AF is not a life-threatening heart rhythm problem, but it can be troublesome and often requires treatment. AF is more likely to occur in people with other conditions, such as high blood pressure (hypertension), atherosclerosis or a heart valve problem.

AF increases stroke risk significantly

People with atrial fibrillation have a five times greater risk of having a stroke. In some cases, atrial fibrillation can also lead to heart failure. So, it is very important to know the signs, detect AF, protect against AF-related stroke and correct the irregular heart rhythm. 

A normal heart rhythm should be regular and between 60 and 100 beats a minute when you are resting.

Know your pulse

Typical symptoms such as palpitations, chest pain, shortness of breath, fatigue, dizziness and fainting. However, this does not apply to everyone. Some people experience no symptoms at all and are considered ‘asymptomatic.’ Therefore, it is important to ‘Know Your Pulse to Know Your Heart Rhythm’ — it could save your life. Detecting an irregular pulse is often the only symptom of AF.

Reducing stroke risk and managing symptoms

It is important to reduce the risk of an AF-related stroke with anticoagulation therapy. Treatment for AF aims to restore the heart’s normal rhythm. If that’s not possible, the goal shifts to slowing the irregular heart rate to relieve symptoms.

Global AF Aware Week

The AF Association hosts Global AF Aware Week (GAFAW) each year. GAFAW on 18–24 November 2024 aims to raise awareness of AF across the globe so that people can be detected, protected and treated earlier and live healthier and happier lives.

Raising awareness of AF is vital for the public to understand the associated dangers, its link to stroke and the importance of a regular pulse rhythm check. Currently, up to 30% of individuals who have AF are undiagnosed and at risk of complications, such as AF-related stroke.

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Learn to recognise heart attack symptoms in women. The Her Heart Matters campaign offers tips to prevent heart disease and improve women’s heart health.

One in four women die from heart disease and stroke each year — the same as men. Yet, women are less likely to recognise the symptoms of heart attack. They also take longer than men to get medical help and treatment after experiencing a heart attack.  

Start the conversation on heart conditions

The Irish Heart Foundation, supported by the Department of Health and the HSE, has developed the Her Heart Matters campaign to help women look after their hearts. The good news is that 80% of premature heart disease and stroke is preventable through healthy lifestyles. Running throughout September, the campaign provides practical information and supportive tools for women.

If you are concerned about your risk of heart disease, talk to your doctor. You can use the tips on our website to get the conversation started.

Symptoms of heart attack in women 

As well as making heart-healthy lifestyle changes, be aware of heart attack symptoms. By knowing what the symptoms are, you can take the steps that can help get timely treatment. 

The following symptoms are common in women: chest pain that spreads to the neck, shoulder and left arm; difficulty breathing; dizziness; vomiting or feeling like you are going to vomit; sweating. Less common symptoms that may occur: back pain; stomach pain; extreme fatigue.

Some of these symptoms are common in other health conditions too, so you may not think they could be a heart attack. Don’t ignore them. 

What should I do if I think I am having a heart attack?  

Call 112 or 999 immediately. A heart attack is a medical emergency — when the supply of blood to your heart is suddenly blocked. The faster you get treatment, the less damage to your heart.

Try to stay as calm as possible while waiting for help to arrive. Taking deep, slow breaths can help. Do not drive yourself to the hospital. 

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Improvements in hospital services have reduced stroke deaths by 48% in a little over a decade, with cases of severe permanent disability requiring direct discharge to nursing homes also declining sharply.

Despite a rapidly rising stroke rate, more people in Ireland are surviving stroke. Lives are being saved, but the recoveries of many stroke survivors are squandered because of a lack of corresponding investment in vital community services and supports that enable people to live the best lives possible at home.

Stroke services to help navigate challenges

Consequently, there is a widespread sense of abandonment among stroke survivors who must navigate the often significant physical, communication and psychological challenges of their brain injury without professional help.

The Irish Heart Foundation is filling this void through a pathway of practical, social and emotional services that support stroke patients countrywide — available from as soon as they leave the hospital, for as long as they need it.

Services include: nurse-led needs assessments and support calls; emotional and psychological support; cognitive therapy; communication support; peer-to-peer and online supports; social re-integration; self-management support, information and education; helpline; return-to-work programme; art and music therapy; physical activity sessions; long-term support; carers’ support.

In total, the Foundation is supporting around 7,500 patients a year.

Fulfilling health and wellbeing needs

Many survivors call our services their lifeline. They empower participants to take control of their own health and wellbeing, prevent them from having to move into long-term care and remove a major burden from frontline services.

Although stroke results in high levels of post-traumatic stress disorder and suicidal ideation, just five hospitals nationally provide any level of clinical psychology for stroke patients. For many, their only access to psychological support available is through the Irish Heart Foundation’s Stroke Connect programme.

Over a third of all stroke survivors returning home from hospital nationally are being referred to Irish Heart Foundation services, which also support thousands of heart patients annually. In total, the Foundation is supporting around 7,500 patients a year.

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