Heart failure has yet to be established as a political priority in Portugal, despite its impact on the population, health system and economy. An estimated 400,000 people live with the syndrome, and this figure is expected to grow as the population ages.1 In 2016, close to 19,000 hospitalisations were attributable to heart failure.2 By 2036, the annual cost of the syndrome is estimated to reach €503 million.3
Awareness of heart failure is low among policymakers and formal plans for the syndrome are lacking.4 Heart failure has historically been excluded from national healthcare initiatives, including the Integrated Care Protocols (Processos Assistenciais Integrados) and the National Programme for Cerebral and Cardiovascular Disease (Programa Nacional para as Doenças Cérebro-Cardiovasculares).2 5 In 2018, a working group created by the government developed recommendations to improve heart failure care, but they have yet to be implemented.6 7
In 2019, the Catholic University of Portugal coordinated the development of the Strategic consensus for heart failure in Portugal, with research support from the Heart Failure Policy Network.5 As the first step towards a national strategy, the consensus analyses the heart failure landscape in Portugal and identifies actions to improve policy and care.
The development of the consensus was guided by a steering committee, with input from an expert think tank group, that included healthcare professionals, public health specialists, patient advocates, policymakers and representatives from the life sciences industry.5
Members of the think tank attended three meetings that focused on the development of the consensus.5 They proposed actions to address challenges in six key areas: awareness, prevention and diagnosis; infrastructure, financing and training; organisation and continuity of care; monitoring and assessment; patient empowerment; and palliative care. In the final meeting, they voted to determine which actions should be prioritised to improve heart failure policy and care. This resulted in eight priority recommendations:
The consensus was the first national statement on heart failure in Portugal to incorporate the perspectives of patient advocates, policymakers and representatives of the life sciences industry, in addition to those of healthcare professionals.5 Experts who were involved in the initiative have said that the consensus could catalyse the development of new policies for heart failure in Portugal.
During the launch of the consensus, Assistant Secretary of State for Health António Lacerda Sales recognised the importance of addressing the growing burden of heart failure and pledged government support to improve care for the syndrome.8 The launch was also attended by representatives from the Ministry of Health, the National Programme for Cerebral and Cardiovascular Disease, and the Portuguese Society of Cardiology (Sociedade Portuguesa de Cardiologia).9
Experts report that the COVID-19 pandemic has hindered the implementation of the consensus, as resources and political attention have shifted towards protecting the Portuguese health system.7 10 However, as this public health emergency subsides, the heart failure community will have a unique opportunity to establish the syndrome as a political priority. Experts recommend framing action on heart failure within the context of reducing inefficiencies and conserving resources in the national health system, particularly in terms of lowering the hospitalisation rate.7 10 Gaining the support of the public, media and Directorate-General of Health (Direção-Geral da Saúde) is likely to advance progress towards creating a national strategy on heart failure.7