European Heart Network (EHN) – the aim to make CVD history

European Heart Network (EHN)- THE PAST, PRESENT AND FUTURE FOR CARDIOVASCULAR HEALTH IN EUROPE

Birgit Beger, Chief Executive Officer (CEO) of the European Heart Network

An interview with:

  • Birgit Beger, Chief Executive Officer (CEO) of the EHN since 1 August 2020. Previously, Birgit acted as CEO of the European Cancer Organisation (ECCO) and Secretary-General of the Standing Committee of European Doctors (CPME).
Prepared by Anna Dé and Shayda Moyassari. 
       
 
 
                                                                                 Birgit Beger, CEO of the European Heart Network

Introduction

The European Heart Network (EHN) is a Brussels-based alliance of foundations and associations dedicated to fighting heart disease, stroke and supporting patients throughout Europe.

 

Across the globe, cardiovascular disease (CVD) is still the leading cause of premature death and disability. For the 60 million people living with CVD within the European Union, the pandemic has added an extra challenge.  

 

More so than ever, the COVID-19 pandemic has highlighted the need for resilient health systems that are capable of functioning even during times of disaster whilst guaranteeing focus is not shifted away from chronic conditions, such as CVD.

 

One of the EHN’s main programmes is to reimagine cardiovascular health within the EU landscape with the proposal of the EHN’s Strategic Plan 2019-2023. Here, the EHN identifies three key pillars to improving cardiovascular health, which include prevention methods, strengthening support for CVD patients and reinforcing the need for CVD research.

 

We asked Birgit Beger for her ideas on what ideal policy environment may look like for the millions of people who live with CVD within the European Union and for her insights into how the EHN are committing to improving cardiovascular health for all European citizens.

 

 

The conversation is summarised within this blog. To listen to the full interview, you can access the podcast here.

1. Welcome to Birgit Beger - CEO of the European Heart Network (EHN). Can you introduce yourself and highlight your roles and responsibilities at EHN?

I am very happy to head the EHN as their CEO, my main role is to implement the vision of the EHN and support the organisation to thrive, connect members to the network, inspire research on CVD and also to support CVD patients.


Within my role it is vital that I get everyone on board to help identify the challenges and opportunities in the CVD field across the EU and globally even further…because after all, ‘health’ impacts everyone.


My background is in law, I previously trained as a lawyer and I am registered with the Berlin Bar and I also have a degree in policy. I have operated in the EU policy arena for over 20 years, I initially began in EU justice, but over the past ten years I focused on EU health policy. And as Anna mentioned, previously I worked at the CPME and ECCO which allowed me to become very prepared to work on CVD at the EHN.

The vision at the EHN is to reduce and prevent CVD so that it is no longer a leading cause of premature death and disability across Europe.

- Birgit Beger

2. PLEASE CAN YOU TELL US A BIT MORE ABOUT THE EHN’S VISION AND THEIR WORK? WHAT ARE YOUR MAIN OBJECTIVES? WHO ARE THE MEMBERS OF THE EHN?

Every action the EHN undertakes aims to achieve its mission – to prevent and reduce CVD.

The EHN strives on a Strategic Plan, the current plan spans from 2019-2023. It’s really important to not forget about CVD, even though there has been a decline in CVD over the decades it still remains to be the leading cause of death in Europe. During the EHN’s 25 years of existence we have demonstrated that we are here to engage with policymakers and influence policies that ultimately contribute to promoting cardiovascular health and preventing CVDs.

 

The EHN’s Strategic Plan 2019-2023 encompasses three pillars (general objectives):

 

  1. Prevent avoidable CVD
  2. Strengthen the support for people with CVD
  3. Reinforce CVD research

 The three pillars are supported by horizontal objectives.

 

The horizontal objectives aim to further our advocacy, networking and capacity building work as well as enhancing organisational strengths by building our memberships across Europe, strengthening cooperation’s with our partners and continuing to work in alliances.

 

The EHN is known for its contributions to politics, policy and research. We release a number of publications because we are passionate about the union between ‘science’ and ‘health policy’ in order to achieve our goals within the cardiovascular field and increase innovation in treatment and prevention.

 

Across Europe, the EHN has 27-member organisations and they are composed of either:

 

Heart Foundations – Charities that aim to finance CVD research at national levels.

 

or

 

Patient Associations – Groups that aim to inform patients on how to manage CVD and unite CVD patients.

The EHN fosters this wonderful network so that there can be sharing of information surrounding the topic of CVD across Europe.

3.HOW DO YOU ENGAGE WITH PATIENTS AND THEIR CAREGIVERS?

As some of our members are Patient Associations it is fairly easy to connect and create networking possibilities among them. However, the EHN also helps to ensure patients voices are heard and represented at an institutional level, whether that be to the European Institutions, WHO Europe or national governments. Thankfully, many key interlocutors now realise the importance of allowing patients to have a voice, as patients are also stakeholders in the process of shaping EU health policy.

 

The caregivers are not directly apart of our membership community, however at a national level the Patient Associations engage with caregivers because they are such an important part of a CVD patient’s life. At an EHN level we have not yet considered this but it is an interesting avenue to for us to explore!

4. WE READ WITH GREAT INTEREST THE PUBLICATION ‘FIGHTING CVD A BLUE-PRINT FOR EU ACTION’ LAUNCHED IN JUNE LAST YEAR. CAN YOU TELL US A BIT MORE ABOUT THIS PUBLICATION AND THE CALL-TO-ACTION OUTLINE?

This was a very well-received publication created by the EHN and the European Society of Cardiology (ESC). Our aim was to inspire the creation of an EU CVD plan, to make CVD ‘become history’. Together the EHN and ESC developed five very concise policy recommendations using the abbreviation ‘HEART’.

 

Actions for the EU:

 

Healthy lifestyles through ambitious EU policy and regulation to reduce critical risk factors (smoking, obesity, sedimentary lifestyles, etc.).

 

Equality in heart health by reducing the huge disparities in Cardiovascular Disease mortality that exist between and within EU Member States.

 

Advancing knowledge by increasing EU funding by Cardiovascular Disease research.

 

Registries for continuous quality improvement, registry-based clinical trials and safety surveillance of new treatments.

 

Transfer of knowledge and best practise among Member States in prevention, diagnosis and management of Cardiovascular Disease.

'HEART' recommendations developed from the 'Fighting CVD a Blue-print for EU Action' launched in June 2020.

5. MORE THAN 60 MILLION PEOPLE LIVE WITH CVD IN THE EU, AND CLOSE TO 13 MILLION NEW CASES OF CVD ARE DIAGNOSED EVERY YEAR. CVD ACCOUNTS FOR 36% OF ALL DEATHS AND IS A MAJOR CAUSE OF PREMATURE DEATH, WITH AROUND 20% OF THE MORTALITY BEFORE THE AGE OF 65 CAUSED BY CVD IN THE EU. WHAT ACTIONS CAN BE TAKEN AT EU AND NATIONAL LEVELS TO FURTHER ADDRESS THE BURDEN OF CVD?

Despite the ‘HEART’ initiative, the EHN also thinks Article 168 of the EU treaty should be properly operationalised by 2024. The EHN would like there to be impact assessments and methodology that considers CVD inequalities in relation to different European regions.

 

There are a number of EHN recommendations that are currently ongoing:

 

  • The EHN looks at nutritional profiles and health claims as required by the EU Nutrition and Health Claims
  • Restricting the marketing to children of foods high-in-fat, salt and sugar– this also includes digital marketing
  • Raise minimum tobacco/alcohol excess duties to the highest possible level
  • Improve the funding of projects that are supported by EU Structural Funds
  • Recommend that Horizon Europe recognise CVD as a key focus area for research and raise a possibility of an EU action plan for CVD
Image from the EHN's Strategic Plan 2019-2023, depicting the impact of CVD across Europe

6. WHAT ARE YOUR MAIN POLICY PRIORITIES? HOW DO YOU ENGAGE WITH POLICYMAKERS? CAN YOU TELL US MORE ABOUT THE MEP HEART GROUP?

The EHN engages with policymakers via different means, we are part of the EU Health Policy Platform. The EHN has contacts in the European Commission, in particular, DG SANTE, and we look to engage with multiple health alliances i.e., European Public Health Alliance (EPHA) and the European Chronic Disease Alliance (ECDA).

 

The EHN is recognised for our publications and ‘forward-looking’ approach to identifying important topics that can help transform the future of CVD. Particularly, with the approaching Horizon Europe programme we aim to push for an increase in research into the use of digital tools for CVD patients in regard to treatment, monitoring and prevention.

 

Our MEP Heart Group been active for a number of years. The EHN organises the secretariat with our sister organisation the European Society of Cardiology. The EHN brings together MEPs with an interest in CVD and those who are already involved within the CVD policy field. For example, Maria da Graça Carvalho MEP (EPP, Portugal), who is the co-chair of the European Parliament Heart Group, together with Brando Benifei MEP (S&D, Italy). 

7. WHAT IMPACT HAS THE COVID-19 PANDEMIC HAD ON HEART HEALTH AND THE DELIVERY OF CARDIOVASCULAR CARE? PLEASE TELL US MORE ABOUT EHN’S WORK DURING THE COVID-19 PANDEMIC.

At a very early point in the pandemic, EHN members provided as much information to their CVD patients as possible. It is vital that the EHN and its members continue to provide reliable, transparent and valuable information to their networks during these challenging times. It is important to remember that CVD patients are vulnerable to COVID-19. COVID-19 has been seen to impact blood vessels which is particularly concerning for those living with CVD who are at a predisposed risk of developing more serious outcomes. For patients who survive COVID-19 we have also observed a higher risk of serious outcomes which include CVD symptoms, this requires urgent attention and research from the scientific world.  

 

Furthermore, many CVD patients had treatments cancelled due to the pandemic or were too scared to attend GP appointments which has meant that in some cases, CVD status has progressed, and overall health has declined.

 

 

It is important to not focus just on the challenges of the pandemic, but also on the opportunities that have emerged. Our members have been very inventive in overcoming the access barriers to their patients. In particular, physical isolation has allowed us to focus on the potential benefits of distance monitoring using digital tools – a very interesting means of increasing health access in the future.

8. WHAT ARE THE KEY FINDINGS OF THE NEW EHN PAPER ON CVD RISK ASSESSMENT PROGRAMMES PUBLISHED IN JANUARY 2021?

It was a very interesting paper, the EHN built upon evidence from several studies and evidence gathered by experts as part of WHO’s initiative on screening published in the WHO Health Evidence Network (HEN) report . The EHN reached very similar conclusions to the WHO Health Evidence Network report.

 

Conclusions from the new EHN paper on CVD Risk Assessment Programmes:

  • European and International frameworks and commitments by government create momentum for actions to reduce the burden of CVD in societies.
  • A significant percentage of cardiovascular disease morbidity and mortality can be prevented through a combination of primary prevention measures, early detection of individuals at high risk of developing CVD or living with a specific cardiovascular condition.
  • Systematic population level screening programmes could be effective in reducing risk factors of CVD in the short term.
  • The potential of stratifying the population into risk groups using available data from electronic health records should be further explored.
  • Evidence-based, targeted outreach and screening in selected settings and to specific population groups known to be at high risk are more likely to be effective than population level screening programmes. This includes screening of family members in certain cases (cascade screening).
  • The EHN calls for a European wide joint action and/or network of Member States, supported by experts, to identify the most effective policies, measures, and programmes for reaching out to and managing high risk individuals for cardiovascular disease and to detect those with specific, highly treatable cardiovascular conditions.

9. WHAT ARE YOUR KEY ACTIVITIES FOR THE REST OF 2021 AND BEYOND?

The main focus is to continue with the EHN’s Strategic Plan 2019-2023. Also, with the upcoming Horizon Europe Programme, the EHN really wants the opportunity to participate and consolidate that CVD must be a vital part of research in Europe.

 

We are also in the EU4Health programme, the EHN will continue to call for increased recognition and concrete steps to help reduce the burden of chronic disease – of which CVD has a major impact.

 

There is also the idea that we must look into strengthening health care systems so that they are more resilient. The EHN has already observed how devasting the pandemic has been for CVD patients. Therefore, we must ensure that responses in the future do not neglect the general healthcare system to guarantee adequate functioning even during times of crisis.

 

The EHN works closely with WHO Europe as they founded the NCD Advisory Council. The EHN is pleased to be part of this Council with the aim to improve the overall NCD situation in Europe and focus on the three key pillars of our Strategic Plan 2019-2023.

10. ARE THERE ANY EVENTS YOU WOULD LIKE TO FLAG IN PARTICULAR, BE THAT VIRTUAL OR WHEN THINGS IMPROVE and we can all meet in person?

That would be very nice! Well, here at EHN we continue our series for the MEP Heart Group but this will be virtual now due to the pandemic. We have a meeting coming up on the Horizon Europe Programme.

 

The EHN is already looking into whether it is possible to work on co-morbidities between cardiology and oncology because we have EHN members that work on cancer at a national level – so, there is a possibility to have a meeting about this soon.

 

We are also in informal talks with other organisations to broaden our working alliances in the field of NCDs and CVDs i.e., EFPIA (European Federation of Pharmaceutical Industries and Associations) and MedTech Europe.

11. HOW IS THE EHN FUNDED?

The EHN is funded via membership contributions and by EU funds.

 

However, most of the contributions are from membership funds, this is because there is keen interest in the EHN from national-level institutions. The EHN has a vast support network that has believed in their work and policy outcomes over the past 25 years.

12. HOW DOES THE EHN COOPERATE WITH WHO EUROPE, THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC) AND OTHER ORGANISATIONS? And what would overarching policy success look like to you?

When you work as part of coalitions you will achieve more.

That is why at the EHN we see the value of creating partnerships with other organisations. For example, with the ESC they provide medical doctors/allied cardiology professionals and our networks within the EHN allow patients to network and shape policy. It is great for EU policymakers to come together in this way and ultimately it results in strong alliance formation.

The EHN has always had a strong working relationship with WHO Europe. WHO Europe has a lot of working groups in the fields of nutrition and physical activity that the EHN has contributed to over the past years.

Again, coalitions work best to create informed and successful EU policy!

“The big vision of EHN is to make CVD history!” Although there are steps before that, here at the EHN we want something as concrete as the ‘Europe’s Beating Cancer Plan: A new EU approach to prevention, treatment and care’ for CVD. Hopefully this will emerge out from our Strategic Plan 2019-2023 and the Horizon Europe programme.

 

There is a need to increase consultation and dialogue between the EU and Member States to work in coalition to decrease the burden of CVD. Although the overall number of CVD is decreasing, it is vital to remember that it remains to be the number one cause of death.

 

Hopefully these recommendations will contribute to a richer and healthier EU!

The big vision of the ehn is to make cvd history!

- Birgit Beger

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