Transforming heart failure care in the Basque Country through value-based integrated care

Issue/problem Heart failure is a major cause of hospitalisation and health system burden in Europe, particularly among older populations. In the Basque Country (Spain), prevalence reaches 6.8% and 16.1% among those aged ≥75. Fragmentation across care levels limits continuity of care, patient experience and efficiency. Integrated, value-based care pathways are needed to improve outcomes and sustainability, with relevance for other European health systems. Description of the practice This implementation study is part of the EU4Health Joint Action JACARDI (2023–2027). An integrated heart failure (HF) care pathway was co-designed and implemented across 13 Integrated Healthcare Organisations in the Basque Country. This initiative involves clinicians, managers, community actors, patients and caregivers. It includes standardised clinical pathways, integration into a unified electronic health record, inclusion of social prescribing and self-management, and patient-centred care training. An evaluation framework based on implementation science and value-based care was developed. Results Preliminary results show: - Implementation across 13 organisations with multidisciplinary engagement. - Coverage of > 35,000 patients within the scope of the HF pathway. - Deployment of standardised pathways and digital integration into electronic records. - Training of healthcare professionals and facilitators. - Establishment of an evaluation framework including patient-reported outcomes and experience measures. - Introduction of a sex and gender perspective to promote more equitable care. Lessons Large-scale implementation of integrated, value-based care is feasible with strong governance, co-design and policy alignment. Implementation science and digital tools support adoption and scalability. Incorporating patient-reported outcomes and a gender perspective strengthens equity. This practice is transferable to other settings aiming to improve chronic care and system efficiency. Key messages • Implementing integrated, value-based care pathways for heart failure can improve coordination, patient-centred care and system efficiency on a large scale. • Incorporating implementation science, digital tools and a gender perspective can improve equity and support the sustainable transformation of chronic care systems.