We have highlighted the significant mortality from CVD but it’s also important to remember the high morbidity that CVD represents with thousands of people living with the aftermath of a stroke or heart attack.

With our ageing population, rising levels of obesity, and other risk factors, unless we act there will be an ever-increasing burden of people living with heart failure and disability after stroke or with PVD. As nearly 80% of premature CVD is preventable there is an onus on the Government and all medical and allied professionals to help stem this tide.

The focus of our report is on the role of the health sector in secondary prevention which spans from early identification and treatment of risk factors, through to comprehensive rehabilitation to avoid repeat events.

We are all aware that there has been a vacuum since the last National Cardiovascular Strategy Changing Cardiovascular Health, which lapsed in 2019. We hope the Philip Nolan report will go some way to address the lack of direction, but his work has been based mainly around acute care, so may not represent a fully comprehensive CVD strategy.

Our paper identifies many of the gaps that need to be addressed such as waiting times for Cardiac Rehabilitation and the variations in access to GP and outpatient services. The Chronic Disease Management Programme is excellent, but limited to people with medical cards, meaning significant parts of the population are not covered by the programme.

We know 60% of individuals over 50 years of age have high blood pressure, a high percentage are undiagnosed, and even those with a diagnosis are on no medication or are poorly controlled. Hypertension is the silent killer as it is asymptomatic, and it leads to a seven-fold increased risk of stroke, a six-fold increased risk of heart failure myocardial infarction, AF, renal failure, impotence and dementia — if recognised it is treatable. We need to increase awareness amongst the public and all health care workers and allied health professionals, advocate to know your BP, and implement the guidelines, as well as reducing salt in food and increase physical activity, etc. We know children do not get the minimum recommended levels of PE/physical activity in schools — it starts there.

We know 40% of people who have a stroke have a new diagnosis of AF and we know that we can reduce the risk of stroke in people with AF by about 65%, if they are anticoagulated, so we need to improve pick up rates.

Furthermore, 60 % of adults are overweight or obese, as are 20% of children and young people. Yet, we have failed to address the underlying causes of our obesity crisis. We are no longer a world leader in tobacco control, and there is an increase in the number of 25-34 year old’s who smoke, and our e-cigarette use is increasing in young people.

The community-based model equipped to care for an ageing population with increasing complex health needs is supported by our report. We also need population-based strategies for primary prevention to slow and reduce the prevalence of risk factors for cardiovascular disease.

Policies are needed to address tobacco use and obesity, such as junk food marketing, no fry zones and to ensure all children have access to physical activity time in school etc.

Therefore, the IHF have been working with Prof. Ivan Perry to produce a primary prevention paper concentrating on aspects of population health, in addition to the standard risk factors it will address, including socioeconomic status, poor diet, political, commercial and environmental aspects of CVD.

That report will complement the Position Paper, and will help guide our future work so that we can enable people not only to live longer but have healthier and more productive lives.