A pan-European multi-level pathway mapping framework for heart failure and cardiovascular care
D Breucker, L Y Rekker, L C Kieviet, L M Verheul, M Gallego-Llorente, L Tjon Joe Gin, M Von Scheidt, G Pasterkamp, M I F J Oerlemans, P Van Der HarstAbstract
Background
Cardiovascular care in Europe is highly heterogeneous, with marked variation in organisation, access and outcomes, particularly for heart failure (HF). Robust, standardised pathway mapping is a prerequisite for meaningful cross-country comparison and for scaling innovations in HF care.
Purpose
To develop a standardised, pathway-related data collection framework that captures routinely unavailable information on organisational structures, care processes, and system capabilitie in heart failure and cardiovascular care across diverse European health system settings, enabling robust cross-national comparison and evaluation of cardiovascular care pathways.
Methods
We designed a multi-level, pathway-based survey consisting of a general health system module and four disease-specific modules for Heart Failure (HF), cardiac amyloidosis, coronary artery disease and out-of-hospital cardiac arrest. A multidisciplinary group of cardiologists and health services experts co-created indication-specific care pathways along two axes: points of care and phases of care. These pathway matrices informed a harmonised data dictionary combining system-level variables with indication-specific metrics on structures, processes, timing, rehabilitation, and outcomes. Draft surveys were refined through workshops and semi-structured interviews and validated in a dedicated ESC expert workshop with 15 cardiologists from multiple European countries. The final survey strategy targets 180 key opinion leaders across 15 European countries, spanning EU5, small Western and Southern Europe, Nordic countries, Eastern Europe and the Baltics and across tax-funded, insurance-based and hybrid health systems, with 3–4 respondents per country and indication.
Results
The final framework comprises: (i) a general system module, and (ii) four disease-specific modules aligned to the pathway matrices. Each module provides a structured template to capture national and institutional organisation of care, diagnostic and therapeutic capabilities, timing metrics follow-up models, rehabilitation, and patient-reported outcomes. The number of questions per module is: n(General) = 22, n(HF) = 35, n(CA) = 43, n(CAD) = 30, n(OHCA) = 22. The instrument is deployable as an online survey and as a structured interview guide, enabling scalable, standardised pathway mapping across diverse health systems and disease areas, with HF as a core component.
Conclusion
This work delivers, for the first time, a unified, pan-European, expert-driven framework for cardiovascular pathway mapping, centered on HF but extendable for other major cardiac conditions. The multi-condition, multi-country survey provides the methodological backbone for subsequent cross-country benchmarking, identification of best practices, and evaluation of innovative care models in HF and broader cardiovascular care.