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Regional Disparities and Unmet Needs in Long-Term Durable Left Ventricular Assist Device Support Across Europe
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DOI：10.1111/aor.70077.png)
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Abstract
En 中文
Background Despite advances in durable left ventricular assist device (LVAD) technology and improved survival outcomes, significant disparities persist in its utilization across Europe, particularly in Southern regions.Aims To evaluate variability in LVAD implantation rates among representative European countries and estimate the unmet needs in Greece.Methods Market data reflecting the sales of long-term LVAD systems across various countries from 2019 to 2024 were combined with registry-based LVAD implantation records to estimate the number of eligible patients and actual LVAD implantations in selected European countries. A stepwise epidemiological modeling approach was applied to estimate LVAD-eligible patients in Greece.Results In several Southern European countries, LVAD implantation rates in 2024 were no more than 2 per million population (Greece: 0.78/million, Italy: 1.89/million, Spain: 1.79/million, Portugal: 0.88/million). In Greece, even though an estimated 349 patients were eligible for LVAD implantation in 2024, based on demographic and clinical criteria, only seven devices were implanted while 24 patients underwent heart transplantation, reflecting a treatment gap of 318 patients (approximately 91% of the eligible population). In contrast, countries in Western and Northern Europe (Austria: 4.57/million, Germany: 8.74/million, France: 2.47/million, the Netherlands: 5.71/million, Switzerland: 3.28/million, Hungary: 2.08/million, Czech Republic: 6.19/million, Sweden: 2.19/million) reported LVAD implantation rates up to 9 per million. Significant discrepancies were reported also in the number of available LVAD centers as well as LVAD implantations per million between Greece and countries with similar populations (approximate to 10 million residents) from Europe and Asia.Conclusions LVAD implantation rates vary among representative Southern European countries, with the lowest rates being observed in Greece. Insufficient number of implanting centers, limited reimbursement, and fragmented post-implant care contribute to this disparity.
Keywords:
destination therapy
Greece
heart failure
left ventricular assist device
regional disparity
Southern Europe
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