Although health systems have made great strides in reducing the toll of cardiovascular disease (CVD) over the past few decades, heart diseases still account for nearly one-third of global deaths. They also create a growing burden on health systems and the wider economy, measured for example in disability-adjusted life years (DALYs), as more people live with heart diseases for longer. As hospitalisation costs rise, there is likely to be growing pressure on health systems to develop adequate prevention and intervention policies to boost heart health. 

In the second half of 2016 The Economist Intelligence Unit created a scorecard to help to assess the burden of, and government policy approaches to, diseases of the heart. Heart disease can take many forms, such as coronary heart disease (including heart attack and angina), arrhythmias (including atrial fibrillation) and heart failure. The scorecard is designed as a tool to allow comparisons between the individual policies of countries rather than comparing the total scores of countries.

The Economist Intelligence Unit assessed the approaches of 28 countries to heart health and scored them according to 21 indicators within five broader domains: (1) strategic plan; (2) public-health policies; (3) best practice; (4) access and provision; and (5) patient focus. The scorecard found significant variations in performance against the indicators, both between and within regions, something that experts interviewed for this paper confirmed.

Our research and interviews have shown that while strong progress has been made on extending the lives of those who might have suffered premature death from coronary heart disease a generation ago, many are still facing severe debilitation in later years. In addition, a lack of sufficiently integrated care between primary and secondary healthcare makes it difficult to properly manage patients and ensure that guidelines are being followed. Finally, experts emphasise the importance of primary care in collecting information on outcomes and in reducing rates of readmission to hospital after acute events. In order to cope with the growing needs of ageing populations, health systems will have to focus increasingly on managing diseases of the elderly (including heart health problems), for example through community-based services.

Key findings

Many countries have established strategic plans for heart health, but they are often not sufficiently comprehensive and lack adequate implementation. The lack of an overarching vision for heart health makes it more difficult for policymakers to understand the complexity of heart disease and its relationship with other chronic conditions, and to budget accordingly for prevention and treatment. At the same time, the absence of disease-specific plans is likely to make it more difficult to collect data on individual heart diseases and treatment outcomes. Following strategic plans through with clear action could translate into better outcomes, while the introduction of disease-specific strategies could help to address the areas of highest priority.

Strong public-health programmes and primary care are crucial for reducing mortality rates further but remain patchy in many places. Most countries in the scorecard have public-health plans in place for risk factors for heart disease, including smoking, obesity and sedentary lifestyles. However, a smaller number have specific awareness plans for heart health. Meanwhile, there is little in the way of dedicated region-wide public health programmes focusing on heart health and other non-communicable diseases (for example in the EU). More focused, better organisation and improved outreach and resource allocation could help to make prevention programmes more efficient.

The majority of countries surveyed provide integrated care pathways for one or more heart diseases, but there is room for improvement, especially in terms of comprehensive monitoring systems. Many countries are adopting elements of best-practice clinical guidelines relating to heart health. Almost two-thirds provide integrated care pathways for one or more heart diseases. However, only around one-fifth of countries surveyed have a monitoring system (such as a registry) in place for all heart diseases covered in the scorecard, and many of these are still struggling owing to pressures on funding. A move towards specialist heart centres, which has been debated in the UK, for example, could help to accelerate the delivery of more integrated care. “It would be very good to have hospitals concentrate on a smaller number of medical conditions, specialising more in depth and investing in knowledge and spreading and sharing knowledge through a network,” says Dennis van Veghel, director of the Dutch Meetbar Beter Foundation, a charity that aims to improve transparency and the quality of care for patients with heart diseases.

Access and provision of heart health varies significantly. The extent of government financial support for healthcare is one of the most significant variables for heart health. While most countries are good at fulfilling national guidelines, availability of cardiac rehabilitation programmes and regular referral to them is frequently dependent on countries’ income levels. Inequalities in access to primary and secondary prevention programmes, as well as to cardiac interventions, exist both within and between countries. There is a strong argument to be made for placing greater emphasis on cardiac rehabilitation, given that there is good evidence that it prevents secondary cardiac events, keeps people from ending up in hospital and helps patients to return to work.

Better involvement of patients could improve delivery of care and increase knowledge about the scope of heart disease. A majority of countries have patient advocacy organisations to promote heart health and provide patient education programmes of varying extent and depth. However, few employ relevant health status surveys or use e-health to deliver care and collect patient data. Fragmented policies and comparatively little in the way of patient-focused programmes are underlined by a lack of comprehensive data. This makes it difficult to adequately assess the impact of heart disease on national health systems and undermines efforts to get more value out of healthcare spending.

Earlier intervention can help to increase healthy life years in older age. In particular, patient involvement from the early stages of cardiac disease can lead both to greater self-management and to improved quality of care for older patients. Moreover, better control over hypertension, diabetes and other chronic diseases and better management of heart failure can yield gains for elderly patients. Stronger integration between primary and secondary care, through the creation of cardiac care networks, for example, can also help with the overall management of cardiac conditions.

This white paper is part of a series called "Global Heart Health". Click Here to read the full series.