Heart, how to save 4 billion with better territorial management of interventions

In Italy, one in four cardiovascular hospitalisations could be avoided with more effective territorial management and real continuity of care after the acute phase. This is a figure that forces us to reflect, especially if we consider that every year there are approximately one million hospitalisations for cardiovascular causes: this means 250,000 fewer admissions, with potential savings estimated at around EUR 4 billion out of a total expenditure of more than EUR 16 billion per year, particularly for heart failure and atrial fibrillation.

These numbers should be read within a broader framework. In Italy, per capita spending on cardiovascular disease is higher than the European average, but the care network remains uneven and underdeveloped. Regional differences in access to care persist, the use of telemedicine is still limited, and integration between hospital and territory is often insufficient, with non-uniform diagnostic-therapeutic paths. Cardiovascular diseases remain the leading cause of death in our country, accounting for more than 30 per cent of all deaths, and generate an overall economic impact estimated at around EUR 20 billion a year in direct healthcare costs and lost productivity. In addition, 41 per cent of the adult population aged between 18 and 69 have at least three cardiovascular risk factors.

It is in this context that the Italian Society of Interventional Cardiology presented at the Risk Management Forum in Arezzo a proposal divided into three lines of action, with the aim of improving the organisation of care, reducing waste and ensuring greater equity of access to life-saving procedures.

Il first point concerns the consolidation and updating of time-dependent networks for acute diseases, which have been shown to significantly reduce mortality and disability over the past two decades. The networks for STEMI, the most severe acute myocardial infarction, are a concrete example of how early intervention can change the clinical history of patients. Today, however, it is also necessary to extend this model to other highly complex cardiovascular emergencies, such as cardiogenic shock, pulmonary embolism and aortic dissection, which are still only managed in a structured manner in a few local or regional settings.

Il second axis of the proposal concerns continuity of care after interventional procedures. Patients' survival and quality of life do not depend solely on the quality of the technical procedure, but on follow-up management. Too many patients are admitted again within a few months due to the lack of a shared pathway between the hospital, territorial cardiology, general practitioners, pharmacies and Community Centres. This is compounded by problems of therapeutic adherence and coordination between the different levels of care. This is why GISE calls for the adoption of national diagnostic-therapeutic care pathways that include telemonitoring, scheduled checks, and clear criteria for integrated risk management.