The importance of policy reform for cardiovascular disease management

• Cardiovascular diseases are a leading cause of death globally, yet many countries do not prioritize public health policies that address the risk of heart disease
• 70% of clinical decision-making is influenced by diagnostics, yet diagnostics account for only 2% of total healthcare spending. 47% of the global population has little or no access to diagnostic services
• Countries need to invest in cardiovascular disease management to provide a long-term contribution to life expectancy, reduced hospital admissions, and economic growth

Cardiovascular diseases (CVDs) such as heart attack, stroke, and heart failure are the leading cause of death globally, killing 20.5 million people every year.¹ Unfortunately, many countries around the world do not prioritize cardiovascular disease management and don’t have policies in place that support the prevention and timely detection of CVDs. Over three-quarters of CVD deaths occur in low- and middle-income countries (LMICs), and there are access gaps to important diagnostic tests in many health systems.^2,3 This is a situation that the UN is seeking to address with the Fourth High-Level Meeting of the UN General Assembly in 2025, uniting Heads of State to establish a vision for preventing and controlling non-communicable diseases (NCDs).⁴

Healthcare Transformers spoke with Olivier Gilliéron, Life Cycle Leader Cardiometabolic, and Neurology at Roche Diagnostics, and Mikko Koo, Director, Health Policy & External Affairs also at Roche Diagnostics, to find out their thoughts on what needs to be prioritized to improve the prevention and treatment of cardiovascular diseases.

HT: What are the biggest gaps in healthcare systems that need to be addressed in order to improve the state of cardiovascular disease globally? How does it differ across regions?

Olivier Gilliéron: In my opinion, there are several significant gaps we can address. Firstly, I would highlight CVD prevention strategies. There’s always an opportunity to further increase awareness of risk factors, and really aim to drive behavioral change in a systematic way as we know a huge number of CVD-related deaths are preventable.

Mikki Koo: There is also a significant issue with health system readiness in all countries. For example, system readiness for heart failure (HF) care is inadequate. The HFA Atlas 2019 reports that data on dedicated HF centers exists for 32 countries (74%), with a median of 1.16 centers per million people. This number varies from <0.50 in lower-resourced countries to >7 in higher-resourced ones.¹

If we drill down to the availability of diagnostic blood tests for heart failure in emergency departments, the HFA Atlas 2019 report included data from 29 countries (69%), revealing a median of 3.58 emergency departments per million people that provide natriuretic peptide measurement. This figure varies from none in low-resource countries to nearly 20 in high-resource countries.⁵

In general, low- and middle-income countries (LMIC) are the most disproportionately affected by NCDs, including CVDs, as they are often unable to access, or afford, preventive services and ongoing treatments.⁶ The disparity of care across geographies is stark, and we must concertedly make more effort to close the gaps.

HT: Can you tell us about the continuum of care when it comes to heart disease and where diagnostics fits in?

Olivier Gilliéron: Generally, healthcare systems are fragmented. They are too focused on sick care, and not enough on healthcare. I think health systems need to adopt an integrated approach focused on timely detection, diagnosis, strategies to prevent cardiovascular disease, and optimized management of cardiovascular diseases that can help improve patient care while reducing costs related to hospitalizations and premature deaths. This includes at-home care, primary care, and the acute care setting. They need to leverage the use of technology and allow for task shifting if appropriate.

As diagnostic technologies progress, there will be a further shift of care to home care. We are already seeing the trend of patients and families taking a more proactive and practical role in managing their conditions and diseases, and so we will see this become more common.

HT: With regard to advances in cardiology and diagnostics, what are the game-changing testing technologies that healthcare systems should prioritize, and why?

Olivier Gillieron: In my view, there are three areas where healthcare systems should prioritize. The first one is mostly true for the specialized setting where we want to improve the performance of the diagnosis and decision support, and we can do that by introducing new technologies. There are technologies on the horizon that will be game-changing like mass spectrometry, and next-generation sequencing, but also next-generation protein detection technologies. As a result, we will have a more accurate diagnosis, and more personalized patient diagnosis and management.

When it comes to the primary care setting, I believe there will be a move to more patient-centric approaches. Self-sampling, self-testing, or continuous monitoring through sensors are examples. These solutions take testing closer to the patients and allow for early screening approaches, and early diagnostic approaches, but also continuous monitoring of certain conditions in a decentralized setting.

The third area is digital health solutions. Here the goal is to improve decision support by combining multi-modal patient data and to improve disease management by integrating longitudinal data points along the patient journey.

HT: Next year there will be a high-level meeting on NCDs at the UN. What policy changes or policy plans at the national level should be implemented to improve cardiovascular disease management?

Mikki Koo: Globally, NCDs kill 41 million people each year, and CVDs are the leading cause of these deaths.⁷ As it stands, only six countries are on track to meet the UN’s goal of reducing premature deaths in men and women from NCDs by a third by 2030, so it’s clear that urgent action is needed.⁸

Some progress has been made in addressing NCDs, but more needs to be done at both the national level and the international level. I think it is important to strengthen the NCDs policy by advocating for a robust political declaration on NCDs at the United Nations High Level Meeting (UNHLM) in 2025. Member States should commit to developing, funding, and implementing national cardiovascular health plans. They need to ensure the comprehensive execution of these policy commitments and support evidence-based actions.

HT: When it comes to diagnostics in particular, what policy-level changes need to be considered?

Olivier Gilliéron: Diagnostic capabilities are a critical component of a sound public health system in terms of patient outcomes, disease surveillance, and global health security. However, the value of diagnostics is under-recognized, leading to underfunding and inadequate resources. As a consequence, 47% of the global population has little or no access to diagnostics.⁹

The WHO recognized this issue at the 76th World Health Assembly on May 23, 2023, when they passed a resolution to enhance diagnostic capacity for universal health coverage and health equity. Investment in diagnostic capacity such as lab resources and equipment, is required to improve the capabilities, capacity, and integration of health system delivery.

At a national level, Member States should develop and implement national diagnostic strategies for CVD management that support the design, strengthening, and maintenance of integrated diagnostic networks, including high-volume labs, near-patient, and point-of-care testing.

HT: From a health economics perspective, what are the returns on investing in expanding and updating laboratory capacities to detect heart disease?

Mikki Koo: 70% of all clinical decision-making is influenced by individual diagnostics despite accounting for only 2% of the total healthcare spending, so investing in diagnostic capacities doesn’t only impact heart disease, but would actually benefit health in general.¹⁰

That said, there are specific examples where we can see a positive impact in the area of CVD. In Portugal, for example, an econometric study found that the use of the natriuretic peptide test could generate up to 3 million euros of savings for the NHS if it could be made available in Primary Health Care.¹¹

Another example is using NT-proBNP as a diagnostic tool for suspected acute heart failure in emergency departments where it improves outcomes and reduces costs. It lowers average inpatient cost by 10.3%, and we’ve seen savings of $2,400 per patient. Most savings come from reduced hospitalization costs and a 31.3% decrease in echocardiograms per patient.¹²

HT: What are some examples of key points policymakers must consider concerning health inequities and unequal access to healthcare when it comes to heart disease?

Olivier Gilliéron: There are many different aspects to consider. Mikki previously mentioned access issues in low- and middle-income countries, and we also see a huge difference in access between people living in rural areas and those living in cities. These are topics that need to be addressed.

However, a key topic for me is CVD in women. It’s estimated that 35% of all deaths in women worldwide are caused by CVDs, and that is a massive figure. In 2019, 275 million women were diagnosed with CVD, and 8.9 million women died from it.¹³ CVDs in women are under-studied, under-recognized, underdiagnosed, undertreated, and women are underrepresented in clinical trials. There is bias throughout the process and it’s an area where we need to do more.¹⁴

Timely detection and management of cardiovascular disease risk factors are crucial for enhancing women’s heart health and reducing premature death across the world. There is a pressing need to enhance awareness and understanding of CVD in women among healthcare professionals, as well as the general public.

Established risk factors significantly contribute to heart disease, but overlooked factors such as psychological, social, economic, and cultural influences—often shaped by gender—also play a critical role. We also have female-specific factors like gestational hypertension, gestational diabetes, preterm delivery, and premature menopause which increase the risk of developing cardiovascular disease. These factors obviously do not exist in men.

It is crucial for the CVD community to identify these sex-specific differences and create targeted strategies to enhance guidelines.¹³ There are opportunities to progress in this area by developing gender-specific solutions through, for example, algorithms and also combining biomarker data with gender-specific data. Proper representation of women in clinical trials is also essential for understanding sex-related treatment differences and improving outcomes. This is a key component of Roche’s collaborative X-project, which is helping to close the gaps in women’s health.¹⁴

HT: What is the core message that you would underscore for policymakers and high-level decision-makers in healthcare when it comes to the future of cardiology and cardiovascular disease?

Mikki Koo: There is a necessity for increased political focus on cardiovascular disease, and we need to see national CVD strategies with concrete action plans being implemented. These plans should include time-specific, measurable goals to reduce the disease burden and ensure early detection and intervention, such as reducing heart failure incidence and heart failure-related hospitalizations, as well as decreasing waiting times for diagnostics.

The plans should also include investment in guideline-based disease management programs delivered by multidisciplinary teams that span both primary and tertiary care. In such programs, the routine use of diagnostics and basic symptom monitoring will assist with specialist referrals, treatment titration, and care adjustments.

Additionally, the plans should aim to improve access to diagnostics and treatment in both primary care and emergency departments to facilitate the effective management of both chronic and acute CVD conditions.

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