Presentation (CTI)

OBJECTIVES: A best practice is only beneficial as long as it can be translated into systems where it is not yet implemented. However, best practice transferability is often assumed rather than measured. We examined 184 cardiovascular best practice candidates across four pathways and 15 European systems, and how transferable those practices actually are.
METHODS: From the EuroHeartPath best‑practice library (best practice candidates across 60 country‑condition patient pathway pairs spanning coronary artery disease, heart failure, cardiac amyloidosis, and out-of-hospital cardiac arrest, each reconciling survey evidence, guidelines, and desk-research) we classified every candidate on two axes: practice domain (national/regional pathway, specialised-centre network, data/registry infrastructure, early-response ecosystem) and a three-level transferability class: protocol-level (a process or SOP a single site can adopt), network-level (requires reorganising referral relationships), or infrastructure-level (requires a built registry, or complex infrastructure assets). We report proportions with Wilson 95% confidence intervals (CIs), and the intervention-class-by-transferability association (chi-square; Cramér's V).
RESULTS: Most best practices were protocol-level (i.e. adoptable by a new site without new infrastructure requirements) (104/184; 56.5%, 95% CI 49.3-63.5), while 80/184 (43.5%) required network or infrastructure reorganisation. Distribution was highly condition-specific: most out-of-hospital cardiac arrest best practices were infrastructure-bound (27/47); amyloidosis best practices leaned on referral-network reorganisation (12 hub-and-spoke models). Practice domain was strongly associated with transferability class (Cramér's V=0.75; p<0.001): every data/registry (35/35) and early-response (12/12) candidate was infrastructure-dependent, whereas national/regional practices were overwhelmingly protocol-level (73/81).
CONCLUSIONS: Infrastructure- and network-dependent practices such as registries, hub-and-spoke networks and citizen-responder ecosystems, which in literature tend to constitute the highest-leverage cardiovascular interventions, were the least transferable, because they presuppose national infrastructure and governance. For HTA bodies and payers, judging an organisational best practice means assessing what it requires to be implemented elsewhere, and not only the potential impact of the fully-implemented practice.