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Technology and Digital Health in Electrophysiology: A study on value-based healthcare and innovation in cardiology

par Osoro, Lucia
Président du jury Dewachter, Laurence
Promoteur Casado Arroyo, Ruben
Publication Non publié, 2026-05-26

Thèse de doctorat

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Résumé :

Cardiovascular diseases remain the leading cause of morbidity and mortality in Europe, increasing the pressure on healthcare systems and exposing persistent inefficiencies in the organisation, financing and delivery of care. Value-Based Healthcare (VBHC), which seeks to optimise outcomes that matter to patients relative to the resources invested, offers a compelling framework for redesigning cardiovascular care. Despite its conceptual maturity, VBHC implementation across Europe remains fragmented and uneven. At the same time, the rapid emergence of Digital Health Technologies (DHTs), including remote monitoring, artificial intelligence, digital diagnostics and automated patient-reported outcome tools, presents new opportunities to operationalise VBHC, provided that appropriate evaluation and adoption mechanisms are in place.This doctoral thesis examines how digital health can support the transition toward VBHC in cardiology and electrophysiology and analyses the role of Health Technology Assessment (HTA), regulation and procurement systems in shaping the adoption of digital innovation across Europe. Using a mixed-methods approach that combines systematic and scoping reviews, policy and regulatory analysis and multinational qualitative research, the thesis investigates: the current maturity of VBHC implementation in cardiology; the adequacy of existing HTA frameworks for evaluating cardiology technologies, including AI-based solutions; the contribution of DHTs as enablers of VBHC models; and the impact of public procurement practices for devices and electrophysiology consumables on access, equity and value.The findings demonstrate that while DHTs are well aligned with the core requirements of VBHC, particularly in enabling outcome measurement, remote care models and pathway optimisation, their adoption is constrained by heterogeneous HTA methodologies, misaligned procurement practices, regulatory complexity and limited cross-border harmonisation. The thesis proposes a roadmap for modernising the evaluation and adoption of digital cardiology technologies, highlighting the need for harmonised European HTA approaches, systematic integration of real-world evidence and procurement mechanisms that reward long-term value rather than short-term cost.Taken together, the studies support a central conclusion: digital transformation and VBHC must evolve in tandem, supported by regulatory, evaluative and procurement systems capable of translating innovation into measurable clinical value. This thesis contributes empirical evidence, methodological insight and policy-oriented recommendations to inform the future of digital cardiology and value-based transformation across Europe.