PERFORMANCE AND SYSTEMIC CHALLENGES IN THE MANAGEMENT OF CARDIOVASCULAR DISEASES IN GREECE: A DELPHI CONSENSUS STUDY
Author(s)
Themistoklis Paraskevas, MD1, Michalis Papapanou, MD2, Angelos Stergios, MSc3, Georgios Cheilas, PhD3, Ioannis Boletis, MD, PhD4, Dafni Kaitelidou, PhD5, Panos Kanavos, PhD6, Evangelos Liberopoulos, MD, PhD7, Lefteris Marinos, MSc8, Kostas Mathioudakis, MSc9, Athanasios Pallidis, BSc10, Dimitrios Paraskevis, PhD11, STAVROS TERZAKIS, Dipl. Eng.12, Eleftherios Thiraios, MD, PhD13, Konstantinos G. Toutouzas, MD, PhD14, Vasiliki - Rafaela Vakouftsi, BSc15, George Veliotes, MD16, Kostas Athanasakis, PhD17.
1Department of Nephrology, University Hospital of Patras, Patras, Greece, 2Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece, 3Novartis, Athens, Greece, 4Onaseio Hospital, Athens, Greece, 5National and Kapodistrian University of Athens, Athens, Greece, 6London School of Economics and Political Science, London, United Kingdom, 7First Department of Propedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece, 8Federation of Pharmacists' Cooperatives of Greece, Athens, Greece, 9IDIKA SA - e-Government Center for Social Security Services, Athens, Greece, 10LDL Greece, Athens, Greece, 11Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece, 12Greek Carers Network EPIONI, Athens, Greece, 13National Agency for Quality Assurance in Health (AQAH S.A.), Athens, Greece, 14First Propaedeutic Department of Surgery, ‘’Hippocrateion” General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 15Greek Patients’ Association, Athens, Greece, 16Interamerican Hellenic Insurance Company, Athens, Greece, 17National School of Public Health, Athens, Greece.
1Department of Nephrology, University Hospital of Patras, Patras, Greece, 2Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece, 3Novartis, Athens, Greece, 4Onaseio Hospital, Athens, Greece, 5National and Kapodistrian University of Athens, Athens, Greece, 6London School of Economics and Political Science, London, United Kingdom, 7First Department of Propedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece, 8Federation of Pharmacists' Cooperatives of Greece, Athens, Greece, 9IDIKA SA - e-Government Center for Social Security Services, Athens, Greece, 10LDL Greece, Athens, Greece, 11Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece, 12Greek Carers Network EPIONI, Athens, Greece, 13National Agency for Quality Assurance in Health (AQAH S.A.), Athens, Greece, 14First Propaedeutic Department of Surgery, ‘’Hippocrateion” General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 15Greek Patients’ Association, Athens, Greece, 16Interamerican Hellenic Insurance Company, Athens, Greece, 17National School of Public Health, Athens, Greece.
OBJECTIVES: Cardiovascular diseases (CVD) continue to place a significant burden on public health in Greece. This study explored expert perceptions of the healthcare system performance and systemic gaps in the prevention, diagnosis, and management of CVD.
METHODS: A two-round Delphi process was conducted with 18 multidisciplinary experts involved in CVD management. Consensus was defined a priori as >66.7% agreement. Second-round results are presented. Quantitative responses were analyzed descriptively, while open-ended responses underwent thematic analysis.
RESULTS: Experts consistently described cardiovascular care in Greece as clinically adequate but systemically fragmented. Seventy-two percent disagreed that primary healthcare effectively supports early diagnosis and follow-up, and 78% reported poor coordination between primary and secondary care. Although 67% of experts agreed that cardiovascular care follows evidence-based guidelines, implementation was uneven across regions and care settings. Current care delivery was considered insufficient to effectively address multimorbidity, reflecting weak continuity of care and longitudinal management. Prevention capacity was limited, with 67% rating national screening programs as ineffective and 72% reporting insufficient resources. Pronounced geographic and socioeconomic inequalities were identified, with 94% reporting quality differences across healthcare units. Experts highlighted persistent governance and information system gaps, with 66% reporting inadequate structured data collection, 78% stating that existing data are not effectively used for policymaking, and 72% indicating the absence of a coherent national CVD strategy. Qualitative analysis highlighted recurring issues, namely, fragmented care pathways with poor care continuity, limited rehabilitation services, geographic disparities, and weak intersectoral collaboration. Prevention emerged as a critical deficiency, reflecting insufficient system‑wide action on lifestyle‑related risk factors at the population level.
CONCLUSIONS: Experts described a system characterized by clinical adequacy but fragmentation in care delivery and inequalities, reflecting a reactive rather than proactive approach. Major axes of a future national action plan should include strengthening primary care, improving governance and reducing geographic and socioeconomic inequalities.
METHODS: A two-round Delphi process was conducted with 18 multidisciplinary experts involved in CVD management. Consensus was defined a priori as >66.7% agreement. Second-round results are presented. Quantitative responses were analyzed descriptively, while open-ended responses underwent thematic analysis.
RESULTS: Experts consistently described cardiovascular care in Greece as clinically adequate but systemically fragmented. Seventy-two percent disagreed that primary healthcare effectively supports early diagnosis and follow-up, and 78% reported poor coordination between primary and secondary care. Although 67% of experts agreed that cardiovascular care follows evidence-based guidelines, implementation was uneven across regions and care settings. Current care delivery was considered insufficient to effectively address multimorbidity, reflecting weak continuity of care and longitudinal management. Prevention capacity was limited, with 67% rating national screening programs as ineffective and 72% reporting insufficient resources. Pronounced geographic and socioeconomic inequalities were identified, with 94% reporting quality differences across healthcare units. Experts highlighted persistent governance and information system gaps, with 66% reporting inadequate structured data collection, 78% stating that existing data are not effectively used for policymaking, and 72% indicating the absence of a coherent national CVD strategy. Qualitative analysis highlighted recurring issues, namely, fragmented care pathways with poor care continuity, limited rehabilitation services, geographic disparities, and weak intersectoral collaboration. Prevention emerged as a critical deficiency, reflecting insufficient system‑wide action on lifestyle‑related risk factors at the population level.
CONCLUSIONS: Experts described a system characterized by clinical adequacy but fragmentation in care delivery and inequalities, reflecting a reactive rather than proactive approach. Major axes of a future national action plan should include strengthening primary care, improving governance and reducing geographic and socioeconomic inequalities.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD27
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Study Approaches
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)