Availability and reimbursement of diagnostics

We need

  • The full range of diagnostic tests as recommended by the ESC1 to be made available for all patients suspected of having heart failure2 – regardless of where they are diagnosed
  • Appropriate reimbursement for guideline-recommended diagnostic tests in all relevant healthcare settings, not just in hospital.3


  • Heart failure is difficult to diagnose4 and there is no single simple diagnostic test for heart failure.5
  • The ESC guidelines therefore recommend a number of tests to help doctors identify people with, or at risk of, heart failure.
  • Data suggest that many doctors do not perform all guideline-recommended diagnostic tests and base diagnosis on signs and symptoms alone.6 (see table below )
  • Some tests which have been shown to be cost-effective (e.g. the BNP, which may be used in primary care) are not fully reimbursed in a number of countries.7


Percentage of patients undergoing an echocardiogram across Europe

One of the most important diagnostic tests to help identify patients with heart failure is the echocardiogram. The EuroHeart Failure survey found that not all patients receive an echocardiogram to confirm their diagnosis of heart failure. Although these data are several years old, they point to inadequate adherence to guideline recommendations in many countries.

% of patients undergoing echocardiogram
Belgium 90% (of patients admitted to hospital)#
Finland 53% (of patients admitted to hospital)#
France 93% (of patients admitted to hospital)#
77% (in hospitals)
58% (in primary care)
Germany 88% (of patients admitted to hospital)#
Ireland 63% (of patients admitted to hospital)#
Italy 73% (of patients admitted to hospital)#
57% (in GP care)
Spain 62% (of patients admitted to hospital)#
Sweden 68% (of patients admitted to hospital)#
83% (in hospitals)#
Switzerland 55% (of patients admitted to hospital) #
75% (of patients referred to hospital – 2000)#
UK56% (of patients admitted to hospital)#
  • McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure 2012;14(8):803-69.

  • Cowie MR, Anker SD, Cleland JG, et al. Improving care for patients with acute heart failure Before, during and after hospitalization. Heart Failure Association of the ESC 2014.

  • Ponikowski P, Anker S, AlHabib K, et al. Heart failure: preventing disease and death worldwide. : European Society of Cardiology., 2014.

  • Remme WJ, McMurray JJ, Hobbs FD, et al. Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians. European heart journal 2008;29(14):1739-52.

  • Mon coeur entre parentheses. Insuffisance cardiaque: une charte pour améliorer la prise en charge des patients. , 2013.

  • Cleland J, Swedberg K, Follath F, et al. The EuroHeart Failure survey programme— a survey on the quality of care among patients with heart failure in Europe- Part 1: patient characteristics and diagnosis. European Heart Journal 2003;24:442-63.

  • Agvall B, Dahlström U. Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences. Scandinavian Journal of Primary Health Care 2001;19(1):14-9. Dahlström U, Hakansson J, Swedberg K, et al. Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden. European Journal of Heart Failure 2009;11(1):92-8. Stalhammar J, Stern L, Linder R, et al. Resource utilization and cost of heart failure associated with reduced ejection fraction in Swedish patients. Journal of Medical economics 2012;15(5):968-76.

  • Jonsson A, Edner M, Alehagen U, et al. Heart failure registry: a valuable tool for improving the management of patients with heart failure. Eur J Heart Failure 2010;12(1):25-31.

  • Muntwyler J, Follath F. Management of heart failure in Switzerland. European Journal of Heart Failure 2000;2:113-15.