Heart failure (HF) affects 2–3% of Belgians. Nurse-led HF clinics are proven to improve outcomes, but Belgian hospitals have had no dedicated funding for them. AstraZeneca partnered with Hict to build a financial model helping hospitals assess the cost implications of setting up or expanding an HF clinic.
Heart failure (HF) is a chronic condition affecting approximately 2-3% of the Belgian population and is associated with a reduced quality of life and a high rate of hospitalisations. The positive impact of nurse-led heart failure clinics on patient outcomes, quality of life, and hospital efficiency has been well established in scientific literature.
Despite this evidence, Belgian hospitals face important financial and organisational challenges when considering the implementation or expansion of an HF clinic. Until the end of 2024, no dedicated structural funding existed for HF clinics or HF nurses, meaning that the associated costs were borne entirely by hospitals and/or cardiologists. Although a RIZIV/INAMI pilot project for telemonitoring of HF patients was launched in January 2025, this funding only partially covers the costs and comes with strict eligibility conditions.
Within the context of its commitment to improving outcomes for patients with heart failure, AstraZeneca initiated a collaboration with Hict to develop a financial decision-support model that could objectively assess the financial implications of setting up or expanding a heart failure clinic in Belgian hospitals.
The objective of the project was to develop a flexible and user-friendly financial model that enables cardiologists and hospitals to:
The model was designed as an offline Excel-based tool, allowing hospitals to enter their own data and assumptions while ensuring that all data remain within the hospital.
Hict applied a phased and co-creative approach, combining evidence-based inputs with real-world validation:
Phase 1: Desk research and parameter definition
A structured desk and literature review was conducted to identify relevant clinical, organisational, and financial parameters related to the implementation of HF clinics and HF nurse activities.
Phase 2: Expert input and co-creation
Insights from literature were complemented through an online brainstorming session with three pilot centers and external experts (i.e. a HF nurse and a hospital medical director). This ensured that the model reflected real-world clinical practice and hospital organisation, as well as resulted in relevant outcomes to support decision making in hospitals.
Phase 3: Interviews and model refinement
Follow-up interviews were conducted with pilot centers to further fine-tune model inputs, assumptions, and outputs, ensuring relevance and feasibility across different hospital settings. 5 different perspectives were considered during this phase, to ensure the engagement and feedback from the different stakeholders: cardiologists, (HF) nursing staff, care managers, data team, and the financial directors.
Phase 4: Model development and validation
Based on the collected inputs, Hict developed a first version of the financial model. During development, additional validation was sought from experts in hospital financing and data reporting (i.e.. BFM/BMF and MZG/RHM, experts). The model was iteratively tested and validated with pilot centers to assess usability, completeness, and internal consistency.
Phase 5: Finalisation
A final version of the model was developed, accompanied by a comprehensive user manual explaining input requirements, assumptions, methodology, and interpretation of results. The final tool and manual were presented to all stakeholders involved in the project during an interactive workshop, including hands-on examples
The project resulted in a practical and transparent financial simulation tool that allows Belgian hospitals to:
By making the financial implications of heart failure clinics explicit and customisable, the model supports informed decision-making and facilitates constructive discussions between cardiologists, hospital management, and other stakeholders on the sustainable implementation of HF clinics in Belgium.
Dashboard with dummy data, showing the direct quantitative, direct financial and opportunity outcomes.
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