Estimation of lifetime benefits from the optimization of secondary prevention in patients with established atherosclerotic cardiovascular disease

Cardiovascular disease causes almost four million deaths in Europe, costing the EU €282billion/annum. Future mortality rate improvements will be gained through improving secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events. Wide gaps exist between ASCVD prevention/treatment guidelines and their implementation across Europe. We aim to estimate lifetime benefits available via optimised secondary prevention in patients with ASCVD in Denmark, France, Germany, Italy, Poland, Spain and the UK. A literature review identified ASCVD risk factor prevalence in ASCVD populations in seven countries. The simulation used an analytical framework and the SMART-REACH survival model to derive event probabilities over 1-year, associated with being 'at-risk' and 'risk free'. The effect of modifying four risk-factors in the SMART-REACH model - hypertension, hypercholesterolaemia, diabetes and tobacco smoking - was examined. The impact of improving treatment coverage and smoking cessation from (estimated) 43% to 70% (i.e. 70% of patients reach treatment targets/cease smoking) was analysed. Over 94,359 cardiovascular-event-free life years could be gained/year across seven countries by improving secondary ASCVD prevention: 25,333 years in Germany, 21,144 in Italy, 14,584 in France, 13,324 in the UK, 9,393 in Spain, 9,369 in Poland and 1,212 in Denmark. This is a step in better quantifying the impact of improved secondary ASCVD prevention, giving an indication of the potential of EU and national Cardiovascular Health Plans in cardiovascular survival gains. Countries should incentivise proactive identification of patients at risk and ensure subsequent, timely treatment according to guidelines. Future work should utilise updated data and modelling integrating additional cardiometabolic risk factors.