The number of patients with heart failure in Bulgaria is rising rapidly, while access to adequate care and treatment remains severely limited, according to a report by the Bulgarian Society of Cardiology and the Association of Active Patients.

Data obtained from the National Health Insurance Fund for 2024 show that 62,800 people have been diagnosed with heart failure in a country of 6.37 million. Within just one year, the number of patients increased by 2,600.

As the data show, one in four patients of working age (18–64 years) has lost the physical ability to work.

The report states that to monitor their treatment and physical condition, Bulgarian patients often have to pay out of pocket for expensive tests.

“The cost is unaffordable for many, and as a result, some patients delay check-ups until they end up in the emergency department,” the document warns.

Growing prevalence, soaring costs

While the number of people affected by heart failure continues to rise, the condition is increasingly affecting younger patients, Nikolay Nedyalkov, researcher at the Association of Active Patients, pointed out.

“We need a plan to tackle this pandemic of heart failure that includes accessible diagnostics, therapy and support. Otherwise, we will continue treating in hospitals what we could prevent in outpatient care,” he added.

Registered consultations and hospitalisations reached 73,608 in 2024, a 4.4% increase in just one year. The rise is particularly sharp among working-age patients – their hospitalisations grew from 46,785 in 2023 to 52,969 in 2024, an increase of nearly 13%.

According to the report, some patients are forced to co-pay for medicines, around €13 per month for sacubitril/valsartan, an ARNI (angiotensin receptor–neprilysin inhibitor). Many diagnostic tests are also often paid for directly by patients, despite Bulgaria having a solidarity-based health insurance system funded by a universal health tax.

Socioeconomic inequalities

Qualitative data from patient interviews reveal that a significant percentage link their deteriorating condition to a past Covid-19 infection. Hypertension, diabetes, kidney and vascular diseases are commonly reported comorbidities, while many patients highlight severe limitations in work capacity and daily activities following diagnosis.

Geographical disparities also create obstacles. For many patients, getting a diagnosis requires travelling to regional or university centres. Transport, accommodation, time and absence from work are borne entirely by patients.

“The social pressure is enormous. Patients with low incomes often have to choose between buying medicines and paying their bills. Some stop therapy, others adjust doses on their own. The result is deterioration, repeat hospitalisations and even higher costs for the system,” the report states.

The cardiology society and patient groups recommend that the state cover the full cost of medicines and diagnostic tests, as well as establish specialised outpatient clinics for people with heart failure.

Bulgaria falling behind

The large-scale report “Health at a Glance 2024” by the European Commission and the Organisation for Economic Co-operation and Development shows a decline in mortality from cardiovascular diseases in all EU member states, with one notable exception – Bulgaria.

Between 2011 and 2021, mortality from circulatory diseases decreased by nearly 20% in the European Union. The reductions ranged from 3% in Romania to 48% in Malta. In Bulgaria, however, mortality from circulatory diseases increased from 1,182 per 100,000 people in 2011 to 1,211 per 100,000 people in 2021.

Eurostat data, published at the end of September, show that the South Central region of Bulgaria has the highest mortality rate from cardiovascular diseases among all regions in the European Union. Over 66 per cent of all deaths are due to diseases of the heart and blood vessels, which is twice the EU average (32%).

The country, one of the poorest in the EU, continues to have high levels of preventable mortality, and is among the leading ones in risk habits such as smoking, alcohol consumption and lack of healthy physical activity. Bulgaria is also among the most affected by the shortage and ageing of medical specialists.

Bulgaria still lacks an effective system for preventing cardiovascular diseases, as in 2024, fewer than 60% of citizens underwent the annual preventive check-ups funded by the state.

[VA, BM]