Despite improvements over recent years, morbidity and mortality associated with heart failure (HF) are higher in countries in the Central and Eastern Europe and Baltic region than in Western Europe. With the goal of improving the standard of HF care and patient outcomes in the Central and Eastern Europe and Baltic region, this review aimed to identify the main barriers to optimal HF care and potential areas for improvement. This information was used to suggest methods to improve HF management and decrease the burden of HF in the region that can be implemented at the national and regional levels. We performed a literature search to collect information about HF epidemiology in 11 countries in the region (Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, and Slovenia). The prevalence of HF in the region was 1.6-4.7%, and incidence was 3.1-6.0 per 1000 person-years. Owing to the scarcity of published data on HF management in these countries, we also collected insights on local HF care and management practices via two surveys of 11 HF experts representing the 11 countries. Based on the combined results of the literature review and surveys, we created national HF care and management profiles for each country and developed a common patient pathway for HF for the region. We identified five main barriers to optimal HF care: (i) lack of epidemiological data, (ii) low awareness of HF, (iii) lack of national HF strategies, (iv) infrastructure and system gaps, and (v) poor access to novel HF treatments. To overcome these barriers, we propose the following routes to improvement: (i) establish regional and national prospective HF registries for the systematic collection of epidemiological data; (ii) establish education campaigns for the public, patients, caregivers, and healthcare professionals; (iii) establish formal HF strategies to set clear and measurable policy goals and support budget planning; (iv) improve access to quality-of-care centres, multidisciplinary care teams, diagnostic tests, and telemedicine/telemonitoring; and (v) establish national treatment monitoring programmes to develop policies that ensure that adequate proportions of healthcare budgets are reserved for novel therapies. These routes to improvement represent a first step towards improving outcomes in patients with HF in the Central and Eastern Europe and Baltic region by decreasing disparities in HF care within the region and between the region and Western Europe.

1st Department of Internal Diseases Faculty of Medicine Medical University of Varna Varna Bulgaria

2nd Department of Medicine Cardiovascular Medicine General University Hospital and 1st Faculty of Medicine Charles University Prague Czechia

AstraZeneca GCC Dubai United Arab Emirates

AstraZeneca Warsaw Poland

Carol Davila University of Medicine Bucharest Romania

Clinic of Cardiac and Vascular Diseases Faculty of Medicine Vilnius University State Research Institute Centre for Innovative Medicine Vilnius Lithuania

Confido Healthcare Centre Tallinn Estonia

Department of Cardiology University Clinical Centre of Serbia Belgrade Serbia

Department of Cardiovascular Diseases University of Zagreb School of Medicine University Hospital Centre Zagreb Zagreb Croatia

Department of Coronary Disease and Heart Failure Institute of Cardiology Jagiellonian University Medical College Kraków Poland

Department of Nursing and Obstetrics Faculty of Health Sciences Wrocław Medical University Wrocław Poland

Division of Cardiology General Hospital Murska Sobota Murska Sobota Slovenia

Emergency Institute for Cardiovascular Diseases 'Prof Dr C C Iliescu' Bucharest Romania

Faculty of Medicine University of Belgrade Belgrade Serbia

Faculty of Medicine University of Latvia Riga Latvia

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Faculty of Natural Sciences and Mathematics University of Maribor Maribor Slovenia

Heart and Vascular Centre Semmelweis University Budapest Hungary

Institute of Heart Diseases University Hospital Wrocław Poland

Latvian Centre of Cardiology Pauls Stradiņš Clinical University Hospital Riga Latvia

Wrocław Medical University Wrocław Poland

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