Health economics and the European Heart Rhythm Association.

The management of healthcare is becoming extremely complex in developed countries, as a result of increasing age of the population and increasing costs of care, coupled with diminishing resources due to global financial crisis. This situation threatens access to appropriate care, and a more or less explicit rationing of some types of treatment may occur in 'real world' clinical practice. This is particularly true for those treatments or interventions with a relatively high up-front cost, such as cardioverter defibrillators, devices for cardiac resynchronization therapy or ablation procedures for atrial fibrillation. The European Heart Rhythm Association (EHRA) is strongly convinced that the skills of electrophysiologists and cardiologists responsible for the management of rhythm disorders have to evolve, also embracing the knowledge of health economics, clinical epidemiology, health-care management and outcome research. These disciplines do not belong to what is considered as the conventional cultural background of physicians, but knowledge of comparative cost effectiveness and of other economic approaches nowadays appears fundamental for a dialogue with a series of stakeholders, such as policy makers, politicians, and administrators, involved in budgeting the activity of hospitals and health-care services, as well as in approaching health technology assessment