What is the ESC Atlas of Cardiology?
Despite huge advances in cardiovascular medicine, cardiovascular disease (CVD) remains the world's biggest killer.
To better understand why this is the case and how we can reduce CVD mortality, the ESC collects cardiovascular data from across its 57 members countries through its 'Atlas of Cardiology'.
This unique compendium underlines major healthcare gaps and inequalities and provides robust data for budget owners and decision-makers who can advance population health at a European level.
In order to complement the compendium by adding statistics from different sub-specialties, the ESC has also added heart failure and interventional data, with the help of the Heart Failure Association and the European Association for Percutaneous Cardiovascular Interventions.
ESC Cardiovascular Realities 2020
ESC Cardiovascular Realities 2020 is a unique publication that presents data from ESC Atlas, thus providing compelling arguments for increasing action to support cardiovascular health policy. This booklet is essential reading for anyone involved in healthcare policy and budget allocation. It includes comprehensive CVD data from the ESC Atlas of Cardiology covering risk factors, health behaviours, access to healthcare and the cost of CVD to the economy in 57 countries.
What does Atlas tell us?
European Heart Journal publication
An analysis of Atlas data was published in the European Heart Journal in December 2019.
Atlas in a nutshell
- Middle-income countries shoulder the bulk of morbidity and mortality from cardiovascular disease
- Compared to high-income countries, middle-income countries have:
- More premature death (before 70 years) due to CVD.
- A greater proportion of potential years of life lost due to CVD.
- Higher age-standardised incidence and prevalence of coronary heart disease and stroke.
- Three times more years lost due to CVD ill-health, disability, or early death.
- Middle-income countries are less able to meet the costs of contemporary healthcare than high-income countries leaving patients with no access to modern cardiovascular facilities
- The availability of transcatheter valve implantation, complex techniques for treating atherosclerotic coronary heart disease, and heart transplantation varies hugely
- CVD is the most common cause of premature death (before 70) in men, whereas in women the most common cause is cancer
- Coronary heart disease and stroke accounted for 82% of years lost due to CVD ill-health, disability, or early death.
- Age-standardised years lost due to CVD ill-health, disability, or early death have been in steep decline over the past 27 years, with just two middle-income countries recording an increase.
- The potential reversibility of risk factors, including high blood pressure and elevated cholesterol, and unhealthy behaviours such as sedentary lifestyles and poor diets provide a huge opportunity to address health inequalities
The first analyses of CVD statistics from Atlas was published in the European Heart Journal in November 2017. Read ESC CVD Statistics 2017
The five infographics in the series "Cardiovascular Realities in Europe" present key findings, revealing wide gender and geographic disparities and inequalities.
Data is collected from the Atlas paper and presents it in an easily accessible format by theme:
- Risk Factors: smoking prevalence, obesity and raised blood pressure
- Premature Deaths
- Number of Cardiologists
- Number of Pacemaker Implantations
- Number of Heart Transplants
Key messages from Atlas
- Although there has been a decrease in CVD mortality across higher income countries, huge inequalities persist with CVD accounting for >50% of all deaths in many middle income countries compared with <30% in the high income countries of Western Europe.
- Economic factors play a major role in the delivery of healthcare. But it’s not just about the money. National health policies, supported by implementation strategies, have a critical role to play in reducing CVD. Inequitable healthcare delivery is not an inevitable consequence of limited economic resource.
- Smoking prevalence is in decline across ESC member countries, but remains a huge public health issue, particularly in middle income countries where >40% of men smoke compared with ~30% in high income countries. Enforcement of smoking legislation and stricter control will likely yield important reductions.
- Hypertension is more prevalent in middle income countries. Just under half of the middle income ESC member countries have recorded an increase in disease prevalence over the last 25 years, unlike high income countries where there have been small but consistent declines.
- The erosion of health gains by the obesity epidemic and type 2 diabetes, is a tragedy waiting to happen. More than one in five adult women and men are obese.
- Inequalities in disease burden are emphasised by a greater than three-fold excess of disability adjusted life years lost to ischaemic heart disease (IHD) in middle income compared with high income ESC member countries.
- CVD is not only a problem for men. More women, and a greater proportion of women, across ESC member countries are dying from CVD. This is largely driven by the excess of stroke and other non-IHD deaths, with IHD mortality more evenly balanced between the sexes.
- Cancer is the most common cause of death among men in a number of high income ESC member countries and women aged <65 years. In younger women, however, deaths from CVD remain considerably more common than deaths from breast cancer and, importantly, are largely preventable through risk factor modification of risk factors.
- Health infrastructure, in terms of interventional, electrophysiological and surgical centres for example, was better developed across high income compared with middle income countries. Some middle income ESC member countries however, were comparable to those in wealthier high income member countries.
- The national availability of interventionists and catheter laboratories provides a snapshot of the quality of cardiovascular care that may not be reflected in national outcomes.
- Policy makers must reorganize service delivery by prioritizing initiatives of proven value in other healthcare settings. For example, the benefits of reperfusion therapy for treatment of STEMI are well established, but poorly applied, in some middle income countries.
The Atlas maps, analyses and compares from a cardiovascular perspective, the status of the healthcare systems in more than 40 countries in ESC member countries. It presents the evidence of trends, disparities, gaps and associations between fundamental variables, which can be used to elicit valuable insights for evidence-based health policy in cardiology.
Atlas reveals the serious disparities in service provision and cardiovascular outcomes across systems, as well as significant issues in health care management and many other gaps existing in Europe. All data converge to reinforce the need to make cardiovascular disease the number one health priority for any decision maker.
The Atlas helps the ESC to better fulfil its mission
The Atlas provides the ESC and its institutional members with a wealth of robust evidence, analyses and comparisons. It will inform new and stronger ESC recommendations as well as calls for action, supporting our efforts to shape cardiovascular policy and, regulation. The ESC and its participating member societies will provide key decision-makers with better elements than ever before that will inevitably influence the allocation of funds for prevention, treatment, education and research.
The Atlas reinforces further the ESC and participating member societies unified call for harmonisation of standards of care to achieve best possible patient outcomes across Europe.
Subscribing to e-Atlas
Depending on their subscription level, subscribers may:
- Profile the status of cardiology in a specific region (eg number of cardiologists/centres/services)
- Identify and follow trends, gaps, inequalities
- Monitor impact of policies on CVD service & outcomes
- Study best practice, optimal levels & determinants of care & outcomes
- Evaluate health system organisation impacts on CVD care & outcomes
- Assess how spending and investment in health care systems impact how cardiology is practised
Who can access the Atlas?
Organisations can subscribe to Atlas. To find out more contact firstname.lastname@example.org.
Data on economies, health, risk factors, demographics, several socioeconomic indicators, system structure and system policies are collected from international sources from:
- the World Health Organisation (WHO)
- World Bank and the Organisation for Economic Co-operation and Development (OECD)
- the Institute for Health Metrics and Evaluation (IHME)
Data on physicians, intervention laboratories, hospital beds, number of interventions are collected from local sources by the participating ESC Member National Cardiac National Societies.
Data are collected in a standardized manner and are checked for their quality and plausibility. A dedicated team of ESC experts and biostatistician undertakes quality controls, collates the data, undertakes standards and ad hoc analyses and prepares reports.