Heart failure (HF) affects an estimated 32 million people in the Asia-Pacific (APAC) region, contributing to nearly 6 million hospital admissions annually. This burden has been exacerbated by the COVID-19 pandemic, which has strained healthcare systems worldwide. In Asia, two-thirds of HF patients also manage at least two other chronic conditions, compounding their health needs and healthcare costs. Furthermore, an increasingly early onset of HF, coupled with multi-morbidities and rapidly aging populations in the APAC region, is driving up hospitalization costs and placing a growing burden on financing systems. The economic impact is substantial: in 2017, HF’s global cost was estimated at USD 346 billion[1], and in 2020, heart disease cost the APAC market USD 46.3 billion.[2] Addressing financing gaps is therefore crucial to build more resilient and sustainable healthcare systems that can effectively manage this escalating burden.
Many APAC countries lack dedicated budgets for cardiovascular (CVD) programs, let alone for HF specifically. In countries like Malaysia, Pakistan, and Singapore, HF is often categorized under broader non-communicable disease (NCD) or CVD budgets.[3],[4],[5] This lack of targeted funding often leads to under-resourced HF initiatives, limiting efforts to effectively reduce the disease burden. A prominent consequence of under-resourcing is the absence of comprehensive national-level HF registries.[6],[7],[8] Such registries are crucial for documenting the HF landscape, tracking trends, and crafting informed policies that are fit-for-purpose to better HF care. However, most APAC countries lack comprehensive HF registries, and if they exist, they often cover only specific regions or sub-populations, without standardized data protocols for consistent updates.
Additionally, high out-of-pocket expenses affect access to essential HF medications. In countries where drug purchasing isn’t centralized or where drug pricing regulations are lax, disparities in drug pricing arise, particularly in private sectors, as seen in India and Myanmar.[9],[10],[11],[12] Without robust financing regulations, patients face financial barriers to accessing essential medications, hindering effective HF management.
Beyond essential medications, slow adoption of advanced HF treatments into national insurance schemes perpetuates access issues. [13],[14],[15] For example, while Indonesia’s national formulary includes angiotensin receptor neprilysin inhibitors (ARNIs), reimbursement rates often fail to cover their cost adequately. As a result, healthcare providers face challenges in prescribing ARNIs, limiting patient access to this advanced treatment.[16],[17] Without adequate integration into insurance schemes, costly yet effective medications remain out of reach for many HF patients.
As HF is a chronic condition that requires long-term care and treatment, it is crucial to ensure that patients can access and receive the care that they need across the entire continuum of care. Sufficient coverage and reimbursement for advanced cardiac care, including cardiac rehabilitation, undeniably influences uptake and adherence to long-term treatment that can significantly reduce complications and re-hospitalizations. Cardiac rehabilitation programs are underutilized in Thailand, Japan, Singapore, India, and the Philippines, partly due to insufficient financial coverage unless they are associated with tertiary care or are considered as an extension of hospitalization.[18],[19] To effectively tackle the growing burden of HF, it is paramount to ensure that national insurance schemes and financial models consider patients’ needs across the entire care continuum. It is only through receiving adequate care at every stage of HF that more resilient patients and healthcare systems can be cultivated, allowing systems to be strengthened in capacity and longevity, and hence, enable them to provide value-based care to more patients.
In conclusion, addressing financial gaps in HF care is essential for creating resilient healthcare systems capable of managing the growing burden of HF across the APAC region. The lack of dedicated funding for HF programs, limited patient awareness, high out-of-pocket costs for medications, and inadequate coverage for advanced treatments all contribute to a cycle of under-treatment and preventable (re)-hospitalizations. By investing in targeted budgets, comprehensive registries, and affordable access to essential medicines and rehabilitation programs, countries in the APAC region can reduce HF’s economic impact and improve patient outcomes. Building a sustainable healthcare system—one that provides support across the entire continuum of care—will not only alleviate pressures on healthcare resources but also ensure long-term health and well-being for millions of HF patients.
Dion Nicole Seow, Consultant, ACCESS Health International
[1]A Call for Cohesive Action: Redefining Cardiovascular Care in the Asia-Pacific 2 [Internet]. Available from: https://apac-cvd.org/wp-content/uploads/2024/02/Redefining-Cardiovascular-Care-Report_final.pdf
[2]The Cost of Inaction in Asia-Pacific | Singapore Heart Foundation [Internet]. www.myheart.org.sg. Available from: https://www.myheart.org.sg/heart-news/the-cost-of-inaction-secondary-prevention-of-cardiovascular-disease-in-asia-pacific/
[3]Siew Chin Ong, Joo Zheng Low. Financial burden of heart failure in Malaysia: A perspective from the public healthcare system. PLOS ONE [Internet]. 2023 Jul 5;18(7):e0288035–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10321615/#pone.0288035.ref001
[4]Government of Pakistan. Non-Communicable Diseases & Mental Health National Action Framework [Internet]. 2021. Available from: https://www.iccp-portal.org/system/files/plans/National%20Action%20Framework%20for%20Non%20Communicable%20Disease%20and%20Mental%20Health%202021-30.pdf
[5]Ministry of Health. White Paper on Healthier SG [Internet]. 2022. Available from: https://file.go.gov.sg/healthiersg-whitepaper-pdf.pdf
[6]Heart Failure: Symptoms & Treatments | SingHealth [Internet]. www.singhealth.com.sg. Available from: https://www.singhealth.com.sg/patient-care/conditions-treatments/heart-failure
[7]Sivadasanpillai Harikrishnan, Koshy L, Sanjay Ganapathi, Panniyammakal Jeemon, Kumar RK, Roy A, et al. Charting a roadmap for heart failure research in India: Insights from a qualitative survey. The Indian Journal of Medical Research. 2023 Jan 1;158(2):182–2.
[8]Expert interviews
[9]Singh A, Chauhan S, Devasia T, Karkala YR, Paramasivam G, Shetty PN, et al. Financial burden of heart failure in a developing country: cost analysis from Manipal Heart Failure Registry, India. Journal of Public Health. 2019 Dec 11
[10]Expert interviews
[11]Zin Mar Win, Mao W, Traill T, Zarni Lynn Kyaw, Pyone Yadanar Paing, Osondu Ogbuoji, et al. Cost-effectiveness and budget impact analysis of screening and preventive interventions for cardiovascular disease in Myanmar: an economic modelling study. The Lancet regional health Southeast Asia. 2024 Jul 1;26:100394–4.
[12]National Strategic Plan for Prevention and Control of NCDs (2017-2021) [Internet]. Medbox.org. 2017. Available from: https://www.medbox.org/document/national-strategic-plan-for-prevention-and-control-of-ncds-2017-2021#GO
[13]Expert interviews
[14]Thevongsa P. Extending Social Health Protection in Viet Nam: Accelerating progress towards Universal Health Coverage [Internet]. International Labour Organization; 2021. Available from: https://www.social-protection.org/gimi/Media.action;jsessionid=XfN7Ja8ZA1NS3UbHkYMWyB3mrtdf-4tGMtIaKBfAZs7x-rjp3XYe!-765179005?id=18736
[15]สำนักงานหลักประกันสุขภาพแห่งชาติ (สปสช.) [Internet]. www.nhso.go.th. Available from: https://www.nhso.go.th/
[16]Peran Sacubitril/Valsartan dalam Penanganan Gagal Jantung: Tinjauan Terkini [Internet]. Kiera Clinic. 2023 [cited 2024 Nov 7]. Available from: https://www.kieraclinic.com/artikel-kesehatan/mengenal-arni-harapan-baru-pasien-gagal-jantung#/
[17]Te. Proposal to widen access to empagliflozin for chronic heart failure [Internet]. Pharmac | Te Pātaka Whaioranga | NZ Government. Pharmac | Te Pātaka Whaioranga | NZ Government; 2022. Available from: https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/proposal-to-widen-access-to-empagliflozin-for-chronic-heart-failure
[18]Turk-Adawi K, Supervia M, Lopez-Jimenez F, Pesah E, Ding R, Britto RR, et al. Cardiac Rehabilitation Availability and Density around the Globe. EClinicalMedicine [Internet]. 2019 Aug;13:31–45. Available from: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2819%2930100-2
[19]Expert interviews