Dr. Niamh Murphy:

Cardiovascular imaging is an integral part of cardiology. We have very limited access in the public health system to advanced cardiac imaging, mainly cardiac CT and cardiac MRI. There are a limited number of hospitals performing these tests. If we take the 33 hospitals that admit chest pain, only 11 of them have access to cardiac CT and only six have access to cardiac MR. The hospitals that have access have extremely long waiting lists and very limited access. All these tests are time-dependent, so if there are excessive waiting lists we have to use alternative imaging and alternative testing, such as overreliance on invasive cardiology with its risks. Then a lot of hospitals that do not have access to these tests are outsourcing to the private sector, which is a huge cost for the HSE and one that would be much better off being used to invest in cardiac imaging services locally. I have been involved with the national heart programme to develop a business case for development of advanced cardiac imaging nationally. We have put through a proposal to develop advanced imaging centres in each region with dedicated cardiac MR and dedicated cardiac CT scanners, while at the same time upskilling all hospitals admitting chest pain to use their existing facilities to provide cardiac CT to inpatients who need it.

To take a step back, when somebody comes into hospital with chest pain the recommendation, after ensuring they do not have a heart attack, is to do a cardiac CT to diagnose coronary artery disease. Unfortunately, without access to cardiac CT we are still using other tests that are inferior, like stress tests, and then going on and doing invasive coronary angiogram to try to diagnose if these people with chest pain have cardiac chest pain or not. We would be much bettor off doing cardiac CT on these patients and thereby getting people out of hospital quicker, speeding up discharges and being able to discharge people directly from the emergency department.