Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association.

AIMS: The aim of this analysis was to provide comprehensive information on the access to and use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. METHODS AND RESULTS: The European Heart Rhythm Association (EHRA) has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This year 50 of the 56 ESC member countries provided data for the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on demographics, economy, vital statistics, local healthcare systems, and training activities is presented for each country and the 5 geographical ESC regions. Our analysis indicated that considerable heterogeneity in the access to arrhythmia therapies still exists across the ESC area. In 2015, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Overall, the procedure rates were 3-10 times higher in the European than in the non-European ESC countries. Economic resources were not the only driver for utilization of arrhythmia therapies as in some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. CONCLUSION: These data will help the healthcare professionals and stakeholders to identify and to understand in more depth the trends, disparities, and gaps in cardiac arrhythmia care and thereby promote harmonization of cardiac arrhythmias therapies in the ESC area

e-Health and Co-production: Critical Drivers for Chronic Diseases Management.

A progressively ageing population makes the healthcare management of chronic diseases (e.g. heart failure (HF), diabetes, geriatric psychosis) an extremely relevant matter for worldwide national health systems, as chronicity persists for a long time and generally cannot be permanently cured. In order to ensure the economic and social sustainability of treating such diseases, new healthcare business models, based on innovative tools and patients’ participation, should be considered. The adoption of new technologies and the active involvement of patients in the therapeutic pathway might represent fundamental drivers in healthcare delivery innovation. Accordingly, empirical evidence about Chronic Diseases Management, based on new technologies, such as remote monitoring (RM) systems, shows how patients are enabled to actively take part in the follow-up process. This “co-production” approach to the service has shown a reduction in health organizations’ workload for the same level of outcome (e.g. hospitalization rate reduction), suggesting new opportunities in the design of healthcare delivery systems. Moreover, within this evidence, end-users’ (patients and their caregivers) collaboration, i.e. more skilled and ICT-adoption oriented, represents strong support to the medical profession, as well as to patients’ satisfaction and loyalty. Drawing from these premises, this work aims at summarizing Italian empirical evidence highlighted through the case study method) of co-production and telemedicine joint implementation. Specifically, through such evidence, we aim to describe how e-Health and co-production could prove to be crucial organizational drivers in Chronic Diseases Management, both in cost reduction and in service (outcome) innovation