The European Heart Rhythm Association White Book: Information is key

In 2007, the Executive Committee of the European Heart Rhythm Association (EHRA) accepted the idea of initiating a survey on the resources, characteristics, procedures, and implants performed throughout Europe in the field of cardiac arrhythmias. Reliable information was urgently needed to accomplish one of the goals of EHRA - to champion equity of access across Europe to the correct diagnosis and therapy for cardiac arrhythmias. In 2008 the first Edition of the EHRA White Book was published. This was achieved after much work, with the valuable and unconditional help of Biotronik, and the dedication of many people, especially Christian Wolpert. Annual editions have updated the initial data, refined the information, and increased country participation (the most recent edition involved 48 out of the 54 nationalities that comprise the European Society of Cardiology). Health care, together with education, are major drivers of social wellbeing. Increasing quality, reliability, and ease of access to a health system are prominent indicators of progress. However, the continuous development of new technologies and treatments exponentially increases the costs of health, and creates concern among administrators of public resources. Cardiac arrhythmias, due to their negative impact on quality of life and mortality are among the areas that have developed most quickly in recent years. Pacemakers, implantable defibrillators, cardiac resynchronization therapies, sophisticated ablation technologies, etc., have continued to develop, increasing our ability to help treat patients more effectively. Clinical practice guidelines have included a number of important recommendations on the application of these technologies; this has allowed improved survival and quality of life. However, implementation of these recommendations is far from homogeneous. Patients from the countries of Europe have widely different access to these technologies and the effective treatments they provide. The EHRA White Book provides this information and allows its easy dissemination Comparison of results between nations or regions can be a major driver leading to changes within health systems. The EHRA White Book provides each country with the ability to see its own data in an international context. These comparative data can be used to demonstrate shortfalls in resource allocation to national or local authorities. There is widespread variation in the availability of arrhythmia specialists throughout Europe is. In some countries, specialist procedures cannot be performed because of lack of trained electrophysiologists. EHRA plays an important role through the provision of fellowship programs and by allocating economic resources in order to train specialists in countries without sufficient cardiac electrophysiologists. In addition, training programs dedicated to the implementation of diagnostic and therapeutic techniques are available under the guidance of EHRA. Accurate information regarding these shortcomings is required to plan for education. EHRA collates this information and provides it to the cardiology community in the form of the White Book. Evolution of the data over time can be analysed by examining the four consecutive editions of the EHRA White Book. Such an analysis is valuable in allowing any change in the provision of care to be assessed on a multinational scale. EHRA will also be able to evaluate whether the tremendous work of data collection has resulted in real changes to the effective diagnosis and treatment of cardiac arrhythmias, and the appreciation that cardiac arrhythmias are a major concern in cardiovascular medicine in Europe. EHRA must also be congratulated for its leadership in highlighting the importance arrhythmias , and for investing time, effort, and resources in providing accurate information on the reality which to base medical progress. The move to publish the EHRA White Book as a supplement to Europace is an exciting and keenly anticipated development which allows easy access to this essential information.