VODI

Covid-19 has proven a seismic event for our societies, and it is easy to forget that the pandemic will not dominate the debate on healthcare forever. Yet by any rational measure, efforts to manage long-term conditions will continue to be responsible for the majority of healthcare costs into the future. Heart failure (HF) is, and will remain, one of these crunch issues. Simply put, we have very little choice but to pursue the timely prevention and care of HF, due to the sheer scale of the disease and the high price attached to failure, both human and economic. HF occurs when the heart is unable to pump enough blood to meet the body’s needs, resulting in a heavy physical and psychological burden. Outcomes are often poor, including mortality and quality of life. In fact, HF is the most common cause of hospital admissions in people over 65 and the leading contributor to unplanned hospital readmissions overall. Yet few political leaders across Europe appear to grasp that HF is a major battle ground for preventable morbidity, mortality and cost. Rapid access to effective diagnostics and the best use of diagnostic information are essential to reducing the burden of HF. Therefore, we welcome MedTech Europe’s case study exploring how the information generated by in vitro diagnostics can help to improve HF care, and in particular by cardiac biomarkers such as natriuretic peptides (NP testing). Unfortunately, the use of diagnostic information for HF is routinely suboptimal in many European countries. Poor multidisciplinary working, misdiagnosis, lack of capacity and inconsistent application frequently lead to harmful delays, meaning HF is often confirmed late, after severe damage to the heart has occurred. Bottlenecks are commonplace for echocardiography, the specialist-led ‘gold standard’ diagnostic test, and key tools such as NP testing are still not fully reimbursed or...
Prevention is better than cure. It’s cheaper too. In fact, preventing future illnesses and preventing complications from existing conditions, are vital to the future sustainability of health systems. For a vaccine that prevents measles, or a medication that prevents a heart attack, the value is obvious. But what about the value of learning that you are at risk of heart attack? This information could trigger changes in behaviour and lifestyle that reduce the chances of hospitalisation or death. What about the value of regularly monitoring your blood glucose if you have diabetes? This could prevent profoundly negative (not to mention expensive) complications such as blindness, amputation or stroke. And what about the value patients and society gets when a clinician knows whether to use an antibiotic – and which one to choose. Not only does this enhance the patient’s chances of a timely recovery, it supports responsible use of antimicrobials and makes better use of resources. Investing in prevention With many conditions, earlier intervention improves patient outcomes and spares them – and the health system – avoidable illnesses and treatments. The obvious example is cancer: effective treatment of early stage cancers can dramatically improve prognosis. That’s why screening is so important. Screening is also an example of how population-based prevention programmes can deliver for citizens across the social spectrum, regardless of income or health literacy which can otherwise exacerbate inequality of outcome. I realise this is not breaking news. Yet less than 3% of health budgets is devoted to prevention. The rest goes on cure and care. I sometimes think we should refer to healthcare as ‘sick care’ – a system focused on ‘healthcare’ would dedicate itself to preserving good health for as long as possible. As rates of diabetes, heart failure and other chronic conditions continues to rise, and...