New cardiology consultants, specifically for the care of heart failure patients, will soon be appointed to meet the demands of an ever-growing population, as the hospital numbers seen at its dedicated clinics have increased “incredibly” over the past years.

In 2023, more than 4,300 patients attended Mater Dei’s Heart Failure Clinics, ranging in age between 21 and 94, with a median age of 69, the Department of Cardiology said. In 2017, just over 2,600 patients were seen.

The authorities are emphasising the importance of strengthening primary care.

To this aim, the new Paola Hub Heart Failure Clinic will be an off-site extension, aimed at treating patients in the community, said Cardiology Department chairperson Robert Xuereb.

“Undoubtedly, the imminent opening of the Paola Hub, together with other health centres, should improve this rate,” he said.

Meanwhile, Xuereb is confident the clinics had everything in line to fulfil their criteria to achieve the title of a Heart Failure Centre of Excellence.

These centres were in the process of being set up across Europe by the Heart Failure Association, a branch of the European Society of Cardiology.

Together with consultant cardiologist Caroline Magri and cardiology specialist Alice May Moore, they were reacting to a recent study that warned heart failure would almost double by 2040 under current prevention and treatment trends.

Described as the first nationwide analysis on the follow-up of heart failure patients, it also pointed to inappropriate testing for treatment and lack of follow-up in the form of baseline blood tests, mostly under the care of non-cardiologists.

Carried out by Anthony Cutajar, an advanced pharmacist practitioner with the Health Ministry, the study showed how fast heart disease was progressing locally and that not all patients had access to guideline-directed medical therapy.

But the Cardiology Department expressed major concern about his thesis, saying the data, based on the decade between 2007 and 2017, was “outdated” and “not a true picture” of the current care given to heart failure patients at hospital.

The department had undergone important changes and “the vast majority of patients are receiving optimum care”, the cardiologists said, referring to the introduction of the dedicated clinics in January 2018.

These included the Specialist Led Heart Failure Clinic, the Cardio-Oncology Clinic and the Heart Transplant Clinic.

Since then, more patients have been referred to specialists, which meant their investigation and treatment has “dramatically improved and is now being implemented according to the latest international guidelines”.

This included follow-up, supported by the necessary investigations, such as echocardiography and cardiac magnetic resonance, the cardiologists said.

The care provided to heart failure patients was according to the latest European Society of Cardiology guidelines, the doctors said, pouring cold water on the study and pointing out the introduction of new modes of investigation and interventional forms of treatment.

The department has also set up a collaboration with the Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione (ISMETT) to offer a heart transplant service.

More free medicine

Replying to the study’s concern that additional therapy from the last two years – another two classes of drugs – was not on offer on the national formulary and unaffordable for a large group of heart failure patients, the department said it was working on introducing these medications for free.

One of these was also used for the treatment of diabetes and was currently on the national formulary for patients suffering from this disease. Since the vast majority of heart failure patients had diabetes, many were benefitting from these pills free of charge anyway, the cardiologists explained.

Patients not entitled to this were still advised to buy them if clinically indicated, they advised.

Doubts raised in the study on the right life-saving medication being prescribed adequately were also quashed by the cardiologists. They clarified that 44 per cent of patients attending the clinic were on all four pillars of treatment outlined in the international standards for heart failure, while 33 per cent were taking three.

It added, however, that all classes of anti-failure medication had important side effects and not all patients could tolerate them, particularly in the case of drops in blood pressure in the elderly and frail.

Malta’s sixth highest ranking for rate of avoidable hospitalisations – for a combination of heart failure, asthma, chronic obstructive pulmonary disease and diabetes – “reflects the need to strengthen primary health care,” the cardiologists agreed.

But the State of Health in the EU Malta Country Health Profile 2023 document, from where this statistic was derived, also stated that Malta’s life expectancy at birth was 82.7 in 2022, two years above the EU average, they pointed out.

“Life expectancy here is among the highest in the EU. We rank fifth in the latest Eurostat database. This is primarily due to a reduction in premature deaths from cardiovascular diseases,” the cardiologists highlighted.

Heart failure was, nevertheless, becoming more common in Malta due to a combination of improved survival after heart attacks, a growing elderly population and an increasing prevalence of risk factors, such as hypertension, diabetes and obesity.

“We are facing increasingly frail elderly patients with many other concomitant illnesses, who have to be managed in a holistic and patient-centred manner, by a multidisciplinary team, including geriatricians, diabetologists, nephrologists and other specialists,” the cardiologists said.