EXECUTIVE SUMMARY…………………………………………………………………………. ES-1
i. Methodology………………………………………………………………………………. ES-1

1. EUROPEAN UNION HEALTHCARE OVERVIEW ……………………………….. 1-1
1.1 GDP and healthcare spending …………………………………………………. 1-1
1.2 Healthcare financing……………………………………………………………….. 1-1
1.3 Healthcare economics …………………………………………………………….. 1-3
1.4 Healthcare facilities and personnel……………………………………………. 1-4
1.5 Ambulatory surgery ………………………………………………………………… 1-5
1.6 Hospital length of stay …………………………………………………………….. 1-6
1.7 Unified healthcare…………………………………………………………………… 1-6
1.8 France, national healthcare profile ……………………………………………. 1-7
1.8.1 Healthcare organization and reform ……………………………. 1-9
1.8.2 Healthcare expenditure …………………………………………… 1-10
1.8.3 Hospital services ……………………………………………………. 1-10
1.9 Germany, national healthcare profile……………………………………….. 1-11
1.9.1 Healthcare organization and reform ………………………….. 1-11
1.9.2 Hospital services ……………………………………………………. 1-14
1.9.3 Funding ………………………………………………………………… 1-14
1.9.4 Electronic health records…………………………………………. 1-15
1.10 Italy, national healthcare profile………………………………………………. 1-16
1.10.1 Healthcare organization and reform ………………………….. 1-16
1.10.2 Funding ………………………………………………………………… 1-18
1.10.3 Hospital services ……………………………………………………. 1-19
1.10.4 Electronic health records…………………………………………. 1-20
1.11 Spain, national healthcare profile ……………………………………………. 1-20
1.11.1 Healthcare organization and reform ………………………….. 1-20
1.11.2 Hospital services ……………………………………………………. 1-23
1.12 United Kingdom, national healthcare profile ……………………………… 1-23
1.12.1 Healthcare organization and reform ………………………….. 1-23
1.12.2 Funding ………………………………………………………………… 1-26
1.12.3 Healthcare expenditure …………………………………………… 1-26
1.12.4 Hospital services ……………………………………………………. 1-26
1.12.5 Effect of Brexit ……………………………………………………….. 1-27
1.13 Bibliography…………………………………………………………………………. 1-28

Exhibit 1-1: Healthcare expenditures as a percentage of GDP, 2016 ……………… 1-2
Exhibit 1-2: France, selected national healthcare statistics ……………………………. 1-8
Exhibit 1-3: Germany, selected national healthcare statistics ………………………. 1-12
Exhibit 1-4: Italy, selected national healthcare statistics………………………………. 1-17
Exhibit 1-5: Spain, selected national healthcare statistics ……………………………. 1-21
Exhibit 1-6: UK, selected national healthcare statistics ……………………………….. 1-24

2. CARDIOVASCULAR AND PERIPHERAL VASCULAR SURGICAL PROCEDURES ……………………………………………………………… 2-1
2.1 Arrhythmias …………………………………………………………………………… 2-2
2.1.1 Atrial fibrillation ………………………………………………………… 2-4
2.1.2 Supraventricular tachycardia……………………………………… 2-4
2.1.3 Ventricular fibrillation ………………………………………………… 2-5
2.1.4 Ventricular tachycardia……………………………………………… 2-5
2.1.5 Cardiac device implantation ………………………………………. 2-5
2.1.5.1 Cardiac resynchronization therapy ……………….. 2-6
2.1.5.2 Pacemakers ……………………………………………… 2-8
2.1.5.3 Implantable cardioverter defibrillators……………. 2-9
2.2 Circulatory disorders……………………………………………………………… 2-16
2.2.1 Coronary artery disease ………………………………………….. 2-16
2.2.2 Myocardial infarction ………………………………………………. 2-16
2.2.3 Angina pectoris………………………………………………………. 2-17
2.2.4 Atherosclerosis………………………………………………………. 2-19
2.2.5 Hypercholesterolemia……………………………………………… 2-19
2.2.6 Coronary artery disease treatment ……………………………. 2-20
2.2.6.1 Coronary artery bypass graft surgery ………….. 2-20
2.2.6.2 Less invasive coronary artery bypass graft techniques……………………………………….. 2-21
2.2.6.3 Percutaneous transluminal coronary angioplasty/coronary stenting…………………….. 2-25
2.2.6.4 Transmyocardial revascularization……………… 2-35
2.2.6.5 Atherectomy ……………………………………………. 2-36
2.3 Myocardial disorders …………………………………………………………….. 2-39
2.3.1 Congenital heart defects………………………………………….. 2-39
2.3.2 Heart failure…………………………………………………………… 2-39
2.3.2.1 Ventricular assist devices………………………….. 2-42
2.3.3 Valvular heart disease…………………………………………….. 2-44
2.3.4 Heart defect and heart valve repair and replacement…… 2-46
2.4 Peripheral artery disease and treatment…………………………………… 2-52
2.4.1 Aortic aneurysm …………………………………………………….. 2-52
2.4.2 Conditions of the other peripheral arteries………………….. 2-57
2.4.3 Femoropopliteal bypass ………………………………………….. 2-61
2.4.4 Percutaneous peripheral revascularization techniques … 2-63
2.4.4.1 Percutaneous transluminal angioplasty……….. 2-64
2.4.5 Thrombectomy and thrombolysis ……………………………… 2-67
2.4.6 Femoropopliteal stenting …………………………………………. 2-68
2.5 Bibliography…………………………………………………………………………. 2-74

Exhibit 2-1: Prevalence of cardiovascular diseases by gender, selected EU countries, 2015……………………………………………………. 2-3
Exhibit 2-2: Implantable cardiac assist devices/catheter ablation, procedure volumes forecast, 2016-21……………………………………… 2-13
Exhibit 2-3: Acute myocardial infarction, admission rates and length of stay ….. 2-18
Exhibit 2-4: Coronary artery bypass graft surgery, procedure volumes forecast, 2016-21 ………………………………………………………………………………. 2-26
Exhibit 2-5: Percutaneous coronary interventions/stenting, procedure volumes forecast, 2016-21 ……………………………………… 2-33
Exhibit 2-6: Coronary atherectomy, procedure volumes forecast, 2016-21…….. 2-38
Exhibit 2-7: Heart failure, admission rates and length of stay……………………….. 2-41
Exhibit 2-8: Heart defect repair, procedure volumes forecast, 2016-21………….. 2-50
Exhibit 2-9: Endovascular aneurysm repair, procedure volumes forecast, 2016-21 ………………………………………………………………………………. 2-58
Exhibit 2-10: Thrombectomy and thrombolysis, procedure volumes forecast, 2016-21 ………………………………………………………………………………. 2-69
Exhibit 2-11: Peripheral artery disease treatment, procedure volumes forecast, 2016-21………………………………………………………………………………. 2-72