Heart, on prevention and fairness of care Italy is several speeds behind Europe

Cardiovascular diseases represent a major public health challenge, both globally and nationally. Prevention and early diagnosis are key to reducing the incidence and impact of these diseases. A joint effort between institutions, health professionals and citizens is needed to improve care, promote healthy lifestyles and ensure equitable access to treatment.

Cardiovascular diseases are the leading cause of death in Italy and worldwide, with a high epidemiological, social and economic impact. According to the World Health Organisation (WHO), they are responsible for more than 6.5 million premature deaths each year, surpassing cancer and chronic respiratory diseases. In Europe, these diseases affect more than 62 million people and generate an annual cost of approximately EUR 282 billion. The European Union is in the process of adopting a cardiovascular health plan, since early intervention in risk factors can reduce the likelihood of heart attacks and strokes: approximately 20-40% of heart attacks affect individuals with undiagnosed cardiovascular diseases. In Italy, ISTAT data for 2022 confirm that diseases of the circulatory system are the leading cause of death, with strong territorial inequalities: the South is particularly affected and people in fragile socio-economic conditions are more at risk. Health expenditure on cardiovascular diseases - taking into account only hypertension and dyslipidaemia - in our country is estimated at around 15 billion euro. Drugs for the cardiovascular system represent the second largest therapeutic category of public expenditure. These are the premises that prompted the Salutequità Observatory to carry out an analysis dedicated to cardiovascular diseases with a focus on cardiomyopathies.

'The issue has a very high priority,' explains Tonino Aceti, president of Salutequità, 'the numbers say so. But the responses are partial and heterogeneous across the country, the result of the ineffectiveness of the national planning done so far. There is no clear national framework from prevention to rehabilitation. In fact, it is not enough to have a share of the treatment in the national prevention plan; it is not enough to have a share of the treatment in the national chronicity plan, as approved (without a chronoprogramme, an effective control system, etc.), but we need a dedicated National Action Plan. This has been well understood by Europe, which is giving a single and integrated reading and is about to issue the European cardiovascular plan from a systematic and unified perspective, which will push us to do more and better'.

Paradigmatic are cardiomyopathies, responsible, among other things, for sudden deaths and heart failure. 'Here,' Aceti continues, 'there are so many pieces still missing: from the definition of pathways for taking care of the lack, to the correct classification in the Lea; from access to the Ngs examinations needed to discover genetic mutations and manage risk, as indicated by scientific societies, to the recognition of social and health benefits. The hope is that the good practices put in place to provide answers to unmet needs in the territories will find a synthesis and become a uniform reality at the national level and be monitored'.

According to the WHO, up to 80 per cent of deaths from heart disease and stroke would be preventable through regular check-ups, correct lifestyles and timely access to treatment. However, billions of people have undiagnosed risk factors for which effective treatments exist.
In Italy, many regions, including Veneto, Friuli Venezia Giulia, Campania, Puglia, Sicily and the Province of Trento, have included cardiovascular risk assessment programmes and dedicated screening in their Regional Prevention Plans. Despite this, the Cardiovascular Risk Card is still little used by General Practitioners (GPs) due to operational difficulties linked to the management of the numerous IT platforms and the automatic collection of the necessary information.