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Cross-border aspects of access to primary angioplasty


The Patients’ Rights Directive in Cross-border Healthcare aims to encourage cooperation between national health authorities in access to diagnosis and delivery of high-quality, accessible and cost-effective healthcare. The establishment of hospital networks ensuring non-stop 24/7 coverage of primary angioplasty could be implemented in cross-border settings to reduce time to treatment, whilst also contributing to a more rational use of resources.

Professor John Martin explains the case for cross-border cooperation in acute coronary care settings


The October 2013 deadline for the transposition of the Patients’ Rights Directive on Cross-border Healthcare into national legislation provided a timely opportunity to look at the current extent of cross border collaboration for treating STEMI patients. Structured interviews were carried out with interventional cardiologists in ten countries across Europe. The Member States studied were Austria, Greece, Latvia, Lithuania, Northern Ireland, Poland, Portugal, Slovenia, Spain, and Sweden. The survey provides a snapshot of the current situation regarding formal cross-border arrangements for STEMI patients in those countries, and is not intended to be an exhaustive account of STEMI management in border areas in Europe.

The study was commissioned by DG SANCO as part of the Commission’s on-going work in cross border cooperation in the field of healthcare.

The study revealed a surprising absence of collaborative agreements, or lack of implementation of existing bilateral agreements for this critical condition– at least, based on the best knowledge of the experts interviewed. The findings also suggest that despite the ESC guidelines, there are continuing, major variations in treatment utilization. A significant proportion of eligible patients are not receiving any treatment at all, and an estimated 40-50% of European STEMI patients are not currently treated with primary angioplasty. Given the prevalence of acute heart attacks as a cause of death and morbidity in the EU this situation needs to be urgently addressed.

Other key findings: The most commonly mentioned challenges in the treatment of STEMI patients across borders were differing reimbursement systems, the need for joint training programs for healthcare professionals, consistent data registries and the organisation of Emergency Medical Systems (EMS). In relation to the last point, the use of the 112 European emergency number is a key area where more action is required to encourage its use. And although there is anecdotal evidence of border populations that might benefit from greater collaboration, there is a little data about which criteria or variables should be used to identify priority areas for action.

Finally, while the cardiologists interviewed were overwhelmingly open to the idea of greater collaboration, many drew attention to the longstanding need to overcome challenges and barriers between regions in their own countries to implement best practice. Many felt that political action at national and EU level would be helpful in overcoming internal as well as cross-border barriers to collaboration.

Read the full report here


On 3 June 2013, the European Critical Care Foundation in alliance with Stent for Life Initiative briefed the European Commission's Committee on the Cross-border Healthcare Directive. Click here to find out more about the briefing.


The case for cross-border collaboration: a pilot project to improve access to primary angioplasty to treat acute heart attack patients across borders between Italy, Slovenia and Croatia


The ongoing implementation of the cross-border healthcare directive provided a timely opportunity to examine more closely the issues influencing delivery of timely reperfusion to eligible patients with severe heart diseases, focusing on one particular border region within Europe. Co-hosted by the Friuli Venezia Giulia region, and with the generous support of the Progetto Mattone Internazionale, ECCF collaborated with the University hospital of Trieste, to develop a pilot project for collaboration across borders between Italy, Croatia and Slovenia, beginning with a multi-stakeholder workshop.


Bringing together cardiologists, politicians and public health experts, the objectives of the workshop were to:


  • Discuss key issues impeding cooperation across borders at present
  • Identify solutions and areas of consensus to address barriers to optimal acute care in the cross-border region
  • Establish a working group to develop a protocol for the region.


Ultimately, the pilot project might be replicable to other cross-border settings both regional/internal and national/cross-border. This would increase patient access to best treatment, reduce patient mortality and morbidity and therefore improve outcomes for individuals and healthcare systems.


See a summary of the meeting outcomes

Fast facts

  • For each 30 minute delay from symptom onset to treatment, the relative risk of 1 year mortality increases by approximately 7.5%.

  • Implementing pPCI networks have been shown to decrease STEMI mortality.

  • A key barrier to timely access to treatment is the failure to call an ambulance as soon as heart attack symptoms are observed. Public campaigns affect decision-making processes and increase the likelihood of achieving new behaviours. Withdrawal of public awareness campaigns has been associated with a decline in beneficial effects.



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