• Survey Shows Interventional Cardiology Availability Largely Aligns with Countries’ Per-Capita Income

    A survey found a great deal of variation in the number of interventional cardiology procedures across 16 countries that are members of the European Society of Cardiology (ESC), a finding the investigators attributed to differing economic resources, according to results presented Thursday at the PCR e-Course.

    Emanuele Barbato, MD, PhD, of the University of Naples Federico II, Naples, Italy, and colleagues also reported their findings in a manuscript that was simultaneously published online in the European Heart Journal.

    The European Association of Percutaneous Cardiovascular Interventions (EAPCI) Atlas of Interventional Cardiology was developed to map and track trends in interventional cardiology practice across ESC member countries. The paper published Thursday examines the availability of interventional infrastructure, human resources and procedure volumes in each country, and it was the first EAPCI Atlas survey reported.

    The countries surveyed were Belgium, Denmark, Egypt, France, Germany, Greece, Italy, Netherlands, Poland, Romania, Slovenia, Spain, Sweden, Switzerland, Turkey and the U.K. The data reported are for 2016 or the latest year available. The World Bank categorized Egypt as lower-middle income, Romania and Turkey as upper-middle income, and the other countries as high income.

    The survey found that an annual median of 5,131 diagnostic heart procedures per million people were performed, which ranged from fewer than 2,500 per million in Egypt and Romania to more than 7,000 per million in Turkey and Germany.

    The EAPCI Atlas reported an annual median of 2,478 percutaneous coronary interventions (PCIs) per million people, ranging from fewer than 1,000 per million in Egypt and Romania to more than 3,000 per million in Switzerland, Poland and Germany. These rates, the authors reported, showed significant correlation to gross national income (GNI) per capita.

    Also, an annual median of 48.2 transcatheter aortic valve replacements (TAVRs) per million people were performed, ranging from fewer than 25 per million in Egypt, Romania, Turkey and Poland to more than 100 per million in Denmark, France, Switzerland and Germany. This also showed a significant correlation to GNI per capita.

    Age-standardized cardiovascular disease mortality across the participating countries was 317 per 100,000 people, ranging from fewer than 300 per 100,000 in Switzerland, Netherlands, the U.K., Belgium, France, Spain and Denmark to more than 800 per 100,000 in Egypt and Romania. There was significant negative correlation between mortality and GNI per capita, meaning that countries with lower GNI per capita had higher age-standardized cardiovascular disease mortality rates.

    However, the association of each measure with GNI per capita was not uniform. For example, Turkey had twice as many interventional cardiologists per million people as the U.K., placed second to Germany for number of diagnostic heart procedures performed, and was one of only five countries that reported more than 2,600 PCIs per million people in 2016. This shows that not only resources, but also policy decisions about the priority of interventional procedures, can play a role in making these procedures more widely available, the authors write.

    The EAPCI plans to collect Atlas survey data every 2 years and eventually include all 57 ESC member countries.

    “This will provide a stimulus for the establishment of national registries to document interventional infrastructure, procedure rates and, in the longer term, cardiovascular outcomes,” the authors write in their conclusion. “Importantly, the inequalities in service provision highlighted in this report will provide a basis for international benchmarking and a stimulus for policymakers across ESC member countries to develop interventional programs to match the best.”

    PCR e-Course is the virtual meeting being held in place of the annual in-person EuroPCR congress, which was canceled because of the COVID-19 pandemic.



    Barbato E, Noc M, Baumbach A, et al. Mapping interventional cardiology in Europe: the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Atlas Project. Eur Heart J 2020 Jun 25. https://doi.org/10.1093/eurheartj/ehaa475

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