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Diapositiva 1

La innovacin y Sostenibilidad del Sistema Pblico de Salud?

Posicin de La Sociedad Espaola de Cardiologa Jos Ramn Gonzlez JuanateyPresidente de la Sociedad Espaola de CardiologaHospital Clnico Universitario de Santiago de Compostela1

CV mortality and life-spectancy in Spain 1980 a 2009Garca Gonzlez JM, et al. Rev Esp Cardiol 2013. on lineWomen 1980-2009Men 1980-2009Lifestyle changesPreventionHealth system improvementsTreatmentRESEARCHINNOVATIONAgeing populationIncreased disease burden: chronic diseasesHealth & care sector unsustainable: under pressure to reformHealth industry under pressure for innovative solution

Health main challenges1. More than 1/5 of the population of Europe, over 100 million citizens, suffer from chronic diseases (e.g. diabetes 8 to 10%, 15.5% obesity)2. 135 million will be over 65 years in 2050: the average 75-year old citizen has at least 3 chronic conditions and takes 5 medications every day3. Healthcare costs are raising at an alarming rate (e.g. neurological disorders 800 billion, cardiovascular diseases 192 billion each year)90% of common drugs work in only 40% of the patients5-7% of adverse drug reactions lead to hopital admissionsAgeing population and increased health care costsCostly and time consuming development of new treatmentsProbably due to the very way in which drugs are validated, as they are not tested in the elderly and the comorbid patients, most drugs work on less than half the population.Not only they don't work but they also lead to adverse drug reaction in 5 to 7 percent of the patientsThe very type of diseases has dramatically changed in the last 50 rears: they are now chronic and lifelong lasting. Coupling it with the ageing population which are the most concerned with CD and the cost of technology and all the ingredients are present to get a huge health cost burden.

3Health System Financial Restrictions in Spain Budget in Million/Eu

-3.585 millon euros from 2008-6.875 millon euros from 2010-11% from 2010-160 euros per person/yearEl Pais25.2.2014

Comparative data with other NHS

Spain

Change in the share of the population at risk of poverty or social exclusion, EU 27 average and selected countries 2006-2011

Long-term unemployed as a share (%) of the active population, EU 27 average and selected countries 2000-2011Spain

Acceso a recursosSanitarios / Frmacos

CV mortality and life-spectancy in Spain 1980 a 2009Garca Gonzlez JM, et al. Rev Esp Cardiol 2013. on lineWomen 1980-2009Men 1980-2009Lifestyle changesPreventionHealth system improvementsTreatmentRESEARCHINNOVATION8.530 menos muertes0-15000-30000-4500019882005Empeoramiento factores de riesgo +13%Aumento de obesidad +6%Aumento de diabetes +7%

Mejora de factores de riesgo -54%Mejora en la PA -19%Reduccin del tabaco -16%Mejora colesterol -27%Actividad fsica -2%Tratamientos farmacolgico -48%Para IAM -10%Prevencin secundaria -10%Insuficiencia cardiaca -10%Revascularizacin -2%Antihipertensivos -5%Estatinas (p. primaria) -2%Inexplicables -2%Explicacin de la cada en mortalidad CV en Espaa: 1988-2005Estudio IMPACT -2014 (datos presentados en el congreso ESC 2014)

567,2212737TRENDS IN STEMI MANAGEMENT (2000 -2013)5103183,486,29093557,89,4586348

Source: Registre del Codi infart. Departament de Salut. Generalitat de Catalunya, 2010-2013. (*) Year 2013: Preliminary data. www.catcardio.cat. Med Clin (Barc) 2009;133:694Codi InfartIAMEST: Pacients amb diagnstic final a lalta dIAMEST (Q).15STEMI Mortality rate 2010-2012IAMCAT II12003IAMCAT III22006 Codi Infart32010 Codi Infart32011Codi Infart3201230-day mortality11,7 %7,4% 6,8%6,3%6,4%1-year mortalityNANA9,9 %10,4 %8,6 %Catalunya

Codi Infart1. www.catcardio.cat2. Med Clin (Barc) 2009;133:6943. Registre Codi Infart. Departament de Salut. Generalitat de Catalunya, 2010-2012La mortalitat dels pacients atesos lany 2012 s provisional i encara no podem calcular la de 2013. En la taula inferior es pot veure levoluci en diferents anys a Catalunya.16

SEC quality of care virtuose circleStandars of CareINCARDIOMetrics (Registry)RECALCARCertificateCERCARCertificate (Audit)SEC quality of care virtuose circleHospital admission for Cardiac DiseasesRECALCAR 2012Andaluca8,12Aragn6,88Asturias7,42Baleares5,71Canarias7,83Cantabria7,46Castilla y Len6,76Castilla La Mancha7,03Catalua6,35Valenciana8,91Extremadura7,37Galicia6,81Madrid6,48Murcia7,23Navarra7,07Pas Vasco7,09RECALCAR 2012STEMI. Risk-adjusted Mortality

RECALCAR 2012 Cardiologa IntervencionistaAndaluca8,337,94-0,39Aragn8,137,18-0,95Asturias7,997,55-0,44Baleares7,476,33-1,14Canarias8,037,75-0,28Cantabria8,117,56-0,55Castilla y Len8,087,00-1,08Castilla La Mancha7,287,26-0,02Catalua6,966,66-0,30Valenciana9,578,49-1,08Extremadura7,987,54-0,44Galicia7,647,14-0,50Madrid7,736,61-1,12Murcia7,787,40-0,38Navarra6,066,080,02Pas Vasco8,717,29-1,42Rioja7,347,09-0,25PROMEDIO7,847,31-0,53CCAAMortalidad IAM (%)Evolucin

RECALCAR 2012 STEMI. Risk-adjusted Mortality20112012CCAAAngioplastia primaria / 100.000 habEvolucinAndaluca16517914Aragn24328340Asturias290467177Baleares302275-27Canarias10313532Cantabria254400146Castilla y Len24133897Castilla La Mancha32037454Catalua32736336Valenciana21524328Extremadura21623014Galicia31436753Madrid32035636Murcia34743386Navarra4264260Pas Vasco301294-7Riojandndnd20112012RECALCAR 2012 STEMI.PCI/ mill habCCAA Mortalidad Cir. Bypass total (%)EvolucinAndaluca6,50%6,27%-0,23Aragn7,46%6,84%-0,62Asturias6,01%6,09%0,08Balearesnd3,54%ndCanarias8,00%8,97%0,97Cantabriand1,71%ndCastilla y Len7,69%4,71%-2,98Castilla La Mancha7,29%3,45%-3,84Catalua3,94%4,76%0,82Valenciana5,53%5,08%-0,45Extremadura2,13%4,19%2,06Galicia4,67%3,58%-1,09Madrid6,16%4,98%-1,18Murcia8,96%8,62%-0,34Navarra4,44%1,79%-2,65Pas Vasco3,61%5,02%1,41RiojandndndPROMEDIO5,67%5,00%0,6720112012CCAA Mortalidad Cir. Bypass aislada (%)Nm. CasosAndaluca3,2%588Aragn4,6%130Asturias4,1%196Baleares3,9%206Canarias7,4%95Cantabria0,0%66Castilla y Len2,5%317Castilla La Mancha0,0%79Catalua2,6%680Valenciana3,6%779Extremadura4,6%153Galicia2,5%403Madrid3,5%634Murcia3,1%98Navarra1,3%76Pas Vasco4,2%142RiojandndPROMEDIO3,3%2012

RECALCAR 2012Existe una muy importante variabilidad en indicadores de actividad, productividad y resultados en la comparacin entre hospitales, as como entre la misma tipologa de unidades. Esta variabilidad es mayor que la observada entre Comunidades AutnomasLas diferencias halladas estn manifestando probablemente desigualdades en la calidad de los servicios. Con apropiados mtodos de ajuste se deberan hacer pblicos los indicadores de procesos y resultados de los ServiciosExiste un insuficiente desarrollo de redes asistenciales de unidades del corazn. La regionalizacin de servicios y creacin de redes asistenciales son dos de las principales recomendaciones de este informeLos indicadores muestran que probablemente exista un notable margen de mejora de la calidad asistencial, especialmente en lo referido a la estancia media, reingresos en la insuficiencia cardiaca y mortalidad en la ciruga del injerto aortocoronario, as como en la sistematizacin de la asistencia (gestin por procesos), debindose trabajar sobre las variables que pueden resultar en una mejora de todos los indicadoresTrends in in-hospital mortality rates after isolated CABG surgery in Ontario 1991-2006

Confidential reportingPublicreportingThreepriorities. Role SECExcellent scienceIndustrial leadershipSocietal challengesEuropean Research CouncilFuture and Emerging TechnologiesMarie Skodowska-Curie actionsResearch infrastructuresReserch GrantsLeadership in enabling and industrial technologies Access to risk financeInnovation in SMEsInnova-SECHealth, demographic change and wellbeingFood security, sustainable agriculture and forestry, marine and maritime and inland water research and the BioeconomySecure, clean and efficient energySmart, green and integrated transportClimate action, environment, resource efficiency and raw materialsInclusive, innovative and reflective societiesSecure societiesScience with and for societySpreading excellence and widening participationRECALCAR/INCARDIO

Slide 9 (Proposed funding)The experience with the European Research Council, demonstrates the value of EU level competition for the best individual teams. In a short number of years, the ERC has already supported Nobel prize-winning scientists and ERC grants are widely regarded as a stamp of excellence.Excellent science provides the basis of new technologies. The "Future and Emerging Technologies" scheme will be expanded to support unconventional and pioneering science with the potential to be tomorrow's technologies.Excellent science depends on developing, attracting and retaining talent. Through the "Marie Sklodowska Curie" actions, the EU has developed attractive opportunities for researchers to move across countries and improve their careers at all stages.Finally, top class research requires access to major infrastructures which are often expensive and only located in a few places in EuropeSlide 10 (Priority 2 Industrial leadership)Innovative companies are at the heart of job creation and growth. However, Europe lacks such companies, particularly among small and medium-sized enterprises. Slide 11 (Proposed funding)Key enabling technologies - such as advanced manufacturing, microelectronics, nanotechnology and biotechnology - underpin innovation across many industries and sectors. For Europe to build and maintain a lead in these technologies requires strategic investments.A major barrier to growth is the lack of access to finance for innovative companies. Working with the European Investment Bank, support to venture capital and loan