Essential antiarrhythmic drug accessibility worldwide: A multi-survey study and comprehensive evaluation of access and supply challenges
Antiarrhythmic drugs (AADs) are essential for preventing and/or treating symptoms, preventing a decline in health and even cardiac arrest from cardiac arrhythmias. However, concerns are increasing about their accessibility, both for common arrhythmias (e.g. atrial fibrillation) and for rare diseases (e.g. pediatric arrhythmias, idiopathic ventricular fibrillation, Long QT syndrome or Brugada syndrome and different cardiomyopathies). We aimed to assess insights into current access to AADs worldwide using surveys.
Online surveys were distributed to members of the European Heart Rhythm Association, the Association for European Paediatric and Congenital Cardiology, the European Reference Network GUARD-Heart, and national heart rhythm societies. Responses were obtained from 558 respondents across 80 countries. Among countries included in the main analysis (≥5 respondents; 16 countries within and 7 outside the European Union, in total 298 respondents), only 16-59% of surveyed AADs were considered readily accessible. Accessibility varied substantially by drug. For example, oral flecainide and propranolol were available in 88% of countries, whereas mexiletine solution (e.g. for children with severe Long QT syndrome) was available in only 10%. Marked differences in accessibility were reported both between and within countries, with availability also changing over time. Higher-income countries generally reported better access and a greater number of market authorization holders (i.e. companies that acquired permission to market a drug) than lower-income countries. National societies’ perception was that limited access negatively affected patients’ quality of life (72%) and life expectancy (35%), while 73% expected these challenges to persist or worsen in the coming years.
Conclusion: Physicians worldwide frequently encounter problems accessing guideline-recommended antiarrhythmic drugs for their patients, which putatively impacts on their patients’ quality of life and life expectancy. This highlights systemic vulnerabilities that extend across national and institutional boundaries, urging close collaboration among clinicians, policymakers, manufacturers, and institutions to guarantee timely and equitable treatment for all patients.
Postema PG, Reijnhout ND, Ballacci F, Manders EA, Hoeksema WF, Toniolo M, Tfelt-Hansen J, Penela D, Futyma P, Lane D, Casado-Arroyo R, Sarquella-Brugada G, Blom NA, Wilde AAM, Hollak CEM, Arbelo E. Essential antiarrhythmic drug accessibility worldwide: A multi-survey study and comprehensive evaluation of access and supply challenges. Europace. 2026 Sep 2:euag220. doi: 10.1093/europace/euag220. Epub ahead of print. PMID: 42680576.
Prepared by Pieter Postema and Ruth Biller