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:
- Launch national heart failure awareness campaigns and promote adopting a healthier lifestyle.
- Develop a national Integrated Care Protocol for heart failure, with care led by multidisciplinary teams and a referral network between different care settings.
- Incorporate multidisciplinary palliative care into heart failure services.
- Use quality indicators to measure performance across different settings in heart failure care.
- Improve the interoperability of IT systems to share data across care settings and create a national heart failure registry.
- Reimburse natriuretic peptide tests requested by primary care physicians.
- Invest in outpatient heart failure clinics and fund integrated programmes linking primary and hospital care.
- Offer undergraduate and postgraduate study as well as continued on-the-job training in heart failure for healthcare professionals, and formally recognise heart failure skills in nursing.
What has been achieved?
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
Policy tips for heart failure advocates
- Develop recommendations with input from policymakers: invite policymakers to provide input in the early stages of your initiative. Developing consensus with their insights can ensure your recommendations are appealing for policymakers and are more likely to be implemented.
- Focus your efforts on a small number of priorities: use a voting system to develop consensus among stakeholders on which recommendations would provide the greatest benefit to people living with heart failure. Narrow down your recommendations to a few priorities and encourage stakeholders to commit to their implementation.
- Define the value of your initiative in the existing policy landscape: communicate to stakeholders how your initiative differs from previous or ongoing initiatives. Establish how it will help to advance heart failure policy; for example, developing consensus is a stepping stone towards establishing a national strategy.