Mapping variations in heart failure care and guideline adherence across Europe
L Y Rekker, L C Kieviet, D Breucker, 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
Differences in organisation and delivery of cardiovascular care across Europe may affect access to diagnostic tests and implementation of guideline-directed medical therapy (GDMT) for heart failure (HF).
Purpose
To map cross-European variation in access to HF diagnostic modalities and pharmacological treatment in relation to European Society of Cardiology (ESC) guideline recommendations.
Methods
We developed a 36-item, disease-specific digital questionnaire capturing clinical workflow and resource availability for hospital treated HF patients. The survey was distributed to ESC-nominated key opinion leaders from 15 countries representing EU5, smaller Western and Southern European nations, the Nordic region, Eastern Europe and the Baltics.
Results
B-type natriuretic peptide (BNP) or N-terminal pro-B type natriuretic peptide (NT-proBNP) testing was available in all participating centres, in line with ESC recommendations for the diagnostic evaluation for suspicion of HF. In all centres, patients routinely received a 12-lead electrocardiogram at initial hospital presentation, and almost all centres performed a transthoracic echocardiogram at first assessment. All centres reported the ability to initiate GDMT during hospitalisation, although the consistency of initiation (always vs. sometimes) varied among centres. Assessment of iron status, as recommended by the ESC guidelines, was routinely. Structured medication dose uptitration within 4-6 weeks after initiation was possible in all participating centres, supporting guideline-endorsed treatment optimisation. In contrast, 50% of the centres reported using urinary sodium testing to guide decongestive therapy for acute HF, despite guideline recommendation.
Conclusion
This is the first pan-European survey of HF service organisation and resources demonstrating broad alignment with ESC guideline-recommended diagnostic testing and availability of GDMT, but reveals persistent variation in the consistency of GDMT initiation and the use of specific diagnostic tools such as urinary sodium testing. These findings highlight both strengths and actionable opportunities to further optimise HF care pathways across Europe.