Table 1 Heartwatch (Ireland)

Heartwatch involves the evaluation of the first phase of a structured programme of secondary prevention of cardiovascular disease in general practice in Ireland. The overall aim of the programme is to reduce morbidity and mortality due to cardiovascular disease. Heartwatch is implementing the guidelines outlined by the Second Joint Task Force of European and other Societies on Coronary Prevention ('Prevention of Coronary Disease in Clinical Practice 1998') for the first time in the context of a national programme.

The Heartwatch Programme was agreed by the Department of Health and Children, the Health Boards and the Irish College of General Practitioners in collaboration with the Irish Heart Foundation, and is the culmination of several years of preparatory work. A National Programme Centre, Independent National Data Centre and regional infrastructures and processes have been established to implement and manage the Heartwatch Programme. The budget for 2004, excluding accruals is three million euros. The initial implementation phase focuses on secondary prevention amongst those with significant proven cardiovascular disease (e.g., history of acute myocardial infarction, coronary artery bypass surgery or PTCA).

The programme targets 20% of Irish general practitioners and provides a protocol for the continuing care of eligible patients including a schedule of four visits per annum initially, and details of the risk factors to be measured with targets levels of control to be achieved.

An explicit schedule of payments to general practitioners was agreed; care may be provided by a practice nurse. Payments are issued on a monthly basis to practitioners based on information supplied by the INDC to the GMS Payments Board.

There are now in excess of 11,400 patients in the programme and over 50,000 continuing care visits have taken place.

Heartwatch is significant in that it represents the first attempt to provide structured chronic disease management within Irish general practice to all patients irrespective of patient income.