Heart failure has historically been excluded from healthcare strategies in Spain, despite affecting at least 5% of the country’s population.1 The syndrome is a leading cause of mortality and, for people aged 65 and over, the most common cause of hospitalisations.2-4
The inclusion of heart failure in a national strategy has been a long-standing goal for clinical leaders and patient advocates in Spain.5 Some regions, such as Extremadura, have developed integrated cardiovascular plans that prioritise heart failure,6 but many others have yet to follow suit.7 8
In 2020, clinical leaders and patient advocates convened an expert national working group to develop a clear strategic vision for heart failure in Spain.9 The resulting white paper, Heart failure on the horizon 2025, makes detailed recommendations for regional and national policymakers to address common challenges in heart failure care. The document was developed with input from patient advocates, as well as healthcare professionals working in cardiology, internal medicine, primary and emergency care, and nursing.9
The white paper details a national multidisciplinary model for heart failure care that integrates services along the patient care journey.9 It includes best-practice recommendations for diagnosis, hospitalisation, discharge planning, early follow-up care and the division of clinical responsibilities. The document is based on The handbook of multidisciplinary and integrated heart failure care, a pan-European policy resource created by the Heart Failure Policy Network,10 but it was closely adapted to the regional and national context in Spain.5
The white paper presents a clear call to action for national and regional policymakers to:
The working group recommends measuring and publishing data on process and outcome indicators, so centres can compare their services and identify opportunities for improvement.9 Indicators may vary across centres and regions, but the white paper recommends measuring performance in the following priority areas: patient health education, access to specialist care, use of guideline-recommended medications, community and outpatient care, discharge planning, hospital admissions and quality of life. According to experts involved in the white paper, performance data are essential to track local and regional progress against national policy recommendations.5
Heart failure on the horizon 2025 was launched during a webinar in November 2020.11 The event featured representatives from the white paper’s working group and Pilar Aparicio, National Director of Public Health, Quality and Innovation.
This is the first comprehensive white paper making the case for multidisciplinary and integrated heart failure care in Spain.9 Its recommendations were given close consideration by the Spanish Ministry of Health during the development of the forthcoming Strategy on cardiovascular health.5 The ministry has since confirmed that heart failure will feature as a priority in the strategy, alongside coronary heart disease, arrhythmias and heart valve disease.12 While its finalisation and launch may be delayed owing to the ongoing COVID-19 pandemic,13 the strategy represents a significant step forward for heart failure advocates in Spain.
Some of the professional societies involved in the white paper have set up their own heart failure registries to monitor and compare performance across centres.14-17 Experts report that data from these registries will be used to monitor the implementation of the white paper’s recommendations at both the local and the regional level.5
Professor José Ramón González Juanatey (Professor of Cardiology and Director of the Cardiology and Intensive Care Department, University Hospital Santiago de Compostela): jose.ramon.gonzalez.juanatey@sergas.es