Cardiovascular disease (CVD) remains the leading cause of death and disability in the EU, with significant geographic, gender, and socio-economic disparities in outcomes and care. Despite progress in prevention and treatment, the COVID‑19 pandemic reversed some gains, and most countries still face challenges in early detection, access to acute care, and long-term management. The economic and social burden of CVD is immense, driven by premature mortality, lost productivity, and high healthcare costs, especially in Central and Eastern Europe. While digital health tools, artificial intelligence, and remote monitoring offer promising innovations, their integration into national systems remains limited, and sustained investment in prevention, equitable care, and data infrastructure is essential. Cross-sectoral prevention policies – such as nutrition, tobacco, and physical activity interventions – and a growing emphasis on people‑centred care and rehabilitation are critical levers to reduce the burden of CVD and improve long-term outcomes in Europe.
The State of Cardiovascular Health in the European Union
Abstract
Cardiovascular diseases (CVD) are a complex set of diseases involving a wide array of health services. CVD prevention and care is reflected in all aspects of the healthcare system, including public health programmes and preventive services, primary care, emergency and acute care, as well as rehabilitative and long-term care (Figure 1.1). Each aspect of the health system has an important set of functions that can help reduce the extensive health burden of CVD on society.
The role of public health, and particularly health promotion activities, is to promote healthy lifestyles and reduce the prevalence of risk factors such as obesity, the use of tobacco and related products, and harmful alcohol consumption, as well as improve physical activity and nutrition in the population. These risk factors can lead not only to CVD, but also to other health conditions that increase CVD risk. More broadly, public health and health promotion has a role in addressing wider structural and environmental determinants of health. This includes creating supportive environments, implementing regulatory measures, and reducing socio-economic inequalities that shape lifestyle choices. Primary care services have an important role in promoting healthy lifestyles for individual patients and, in addition, are instrumental in the diagnosis and treatment of risk factors, such as high blood pressure and high cholesterol and delaying the onset of CVD. These services also help patients to manage their CVD effectively, as well as other chronic conditions that can lead to worse CVD outcomes.
Source: Adapted from OECD (2015[1]), Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, https://doi.org/10.1787/9789264233010-en to include additional concepts from the OECD HSPA Framework (2024[2]), Rethinking Health System Performance Assessment: A Renewed Framework, https://doi.org/10.1787/107182c8-en.
In the case of an acute episode such as stroke and heart attack, the emergency and hospital sectors are responsible for providing effective and timely treatment to maximise the likelihood of survival and reduce disability. Following acute care, rehabilitative and primary care, play a vital role in managing CVD and associated complications that may have arisen. Such healthcare services are integral to minimising the morbidity associated with such events. To deliver effective services and programmes along the CVD and diabetes pathway, healthcare systems need to ensure that (1) adequate financial and physical resources are in place, including doctors, nurses, hospital beds and technologies; (2) services and technologies are highly accessible to the people in need of those services – ensuring both financial access, so that cost does not impose unnecessary barriers, and physical access, to ensure that care is timely; (3) the healthcare system delivers high quality care; and (4) equity is embedded across all dimensions of service delivery, ensuring that population groups at greater risk or with disadvantages are not left behind.
The purpose of this report
Building on Health at a Glance: Europe 2024 and the OECD’s portfolio of CVD-related work, this report examines the current status of cardiovascular health in the EU, with the aim of providing evidence which can help to inform potential future initiatives in the EU. The publication will deliver an in-depth situational analysis of CVD trends, including the presence and influence of risk factors, multimorbidity, and health and healthcare pathways and outcomes across the EU. It will also include a mapping of existing policies, as well as the main challenges and opportunities for future action at both Member State and EU levels.
Putting CVD in context
CVD refers to a group of conditions affecting the heart and blood vessels, including coronary heart disease, such as heart attack or acute myocardial infarction (AMI), cardiac arrest, cerebrovascular diseases (including stroke), heart failure, and atherosclerosis (see the glossary section for more information). CVD is closely linked with metabolic conditions (such as hypertension and diabetes), which frequently occur together and increase each other’s risks. For this reason, diabetes and hypertension are also examined with a particular emphasis in this report.
Country coverage in this report
This report focusses on the state of cardiovascular health in EU countries, Iceland and Norway. Information on EU candidate countries and additional G20 OECD countries not in the EU (Australia, Canada, Japan, Republic of Korea, Mexico, Türkiye, the United Kingdom and the United States). This report also maps insights and good practices from other OECD Member States, and includes relevant examples from Colombia, Israel, and Singapore, who provided information through the 2025 OCED Cardiovascular Policy and Data Survey. Austria, Canada, Croatia, Czechia, Estonia, Finland, France, Germany, Iceland, Ireland, Japan, Latvia, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, Türkiye, and the United Kingdom also provided responses to the survey – which is referenced throughout the report.
This report examines how European countries perform in their ability to prevent, manage and treat CVD – and the policies they are undertaking to drive results (Box 1.1). The analysis in this report examines the mechanisms by which countries deliver the programmes and services related to CVD and diabetes, namely health promotion, public health, prevention, primary care and acute care. The following chapters of this report describe the main health sectors and cross-cutting issues involved in CVD prevention and care management. In doing so, the report describes the resources available to prevent disease and deliver care, the accessibility and utilisation of those services, the effectiveness and quality of care delivered, as well as the aptitude of the policy environment to enable positive outcomes.
The decline in mortality from CVD in recent decades has been one of the notable achievements of public health and modern medicine. Over the past 50 years, there have been significant increases in life expectancy in European countries, largely due to advances in preventing and treating CVD and its risk factors (OECD/The King's Fund, 2020[3]). During this period, the development and implementation of preventive public health strategies, and medical advances in managing and treating CVD, have resulted in significant declines in CVD morbidity and mortality. Between 1980 and 2005, CVD mortality rates fell by as much as half in several European countries – though the gains have been slowing in more recent years (OECD/The King's Fund, 2020[3]).
Despite the exceptional advances in preventing and managing CVD, it remains one of the biggest health challenges facing EU countries. It is the leading cause of death in the EU, accounting for one‑in-three of all deaths (1.7 million deaths in 2022) and affecting 62 million people (ESC, 2025[4]). Ischaemic heart disease (IHD) is the largest contributor, responsible for almost one‑third (547 000 deaths) of all deaths from circulatory disease. Cerebrovascular disease (stroke) is the second largest contributor, accounting for just over one‑fifth of all circulatory disease deaths in the EU (350 000 deaths). Although CVD mortality rates are higher in men than in women across EU countries – reducing life expectancy of men more drastically, more women than men die from CVD overall. (ESC, 2025[4]). This is because women, on average, live longer and are more likely to reach older age groups where CVD is the leading cause of death. As a result, CVD accounts for a higher share of total deaths among women than among men.
Trends in CVD mortality reversed in several EU countries during the COVID‑19 pandemic, with the largest increases occurring in countries with already high CVD mortality
Between 2012 and 2022, mortality from circulatory diseases fell in every EU member state, with an average decline of 20% among men and 22% among women. Nevertheless, large differences persist; while countries like France, Denmark or Spain reported rates below 220 deaths per 100 000 population in 2022, Bulgaria, Romania and Latvia still exceeded 800 deaths per 100 000 population. As shown in Figure 1.2, Central and Eastern EU countries experienced smaller reductions compared to Western and Southern European countries, contributing to a persistent – and in some cases widening – regional mortality gap.
2022-2012 change in CVD age‑standardised mortality rates (ASMRs)
Source: Eurostat (hlth_cd_asdr2), 2025.
However, this progress – which was already slowing compared to previous decades – was further disrupted during the COVID‑19 pandemic. Countries with higher pre‑pandemic CVD mortality in 2019 experienced the largest percentage increases in age‑standardised mortality rates (ASMRs) between 2019 and 2021, with rises ranging from 10% to 21% in countries such as Romania, Bulgaria and Latvia. By contrast, countries with already lower pre‑pandemic mortality – mostly in Western and Southern Europe – showed smaller increases or even continued declines. This divergence further widened regional inequalities in CVD mortality across the EU. It should be noted that these trends are influenced not only by changes in CVD outcomes, but also by the direct impact of COVID‑19 mortality, possible disruptions to health services, and other competing risks. For example, between 2019 and 2021, the mortality gap between Bulgaria and France increased from 6‑fold to 7‑fold among men, and from 6‑fold to 8‑fold among women. This pattern, illustrated in Figure 1.3, can be observed by comparing pre‑pandemic mortality levels to the percentage change during the pandemic – underscoring persistent inequalities and the disproportionate impact of recent health crises on countries with higher baseline mortality.
Note: EU27 average is weighted.
Source: Eurostat (hlth_cd_asdr2), 2025.
CVD mortality rates vary six‑fold for men, and seven‑fold for women across EU countries
EU countries show substantial variation in cardiovascular mortality; rates are higher and deaths occur younger in Central and Eastern Europe, with the heaviest CVD burden found in the northeast (Bugiardini, 2023[5]; Cenko et al., 2023[6]). These countries also have the highest overall burden of CVD (in terms of incidence, mortality, and disability-adjusted life years [DALYs]) among people aged 55 and over (Cenko et al., 2023[6]).
In 2022, the EU average age‑standardised mortality rate (ASMR) for circulatory disease was 404 and 283 per 100 000 population for males and females respectively. The rates ranged from 222 per 100 000 males and 135 per 100 000 population females in France to 1 338 per 100 000 males and 890 per 100 000 females in Bulgaria – a six to seven‑fold variation. This large gap is characteristic of a more general geographical pattern across the EU, with higher rates in Central and Eastern European countries. For example, male and female ASMR rates were four times higher in Romania, Latvia and Lithuania than in Norway, Spain and Luxembourg.
In most EU countries, the mortality rate from circulatory diseases is about 26‑60% higher in males than in females (the EU average being 43%). Although CVD mortality rates are higher in males than in females in all EU countries, as in most countries globally, CVD claims a larger number and proportion of total deaths in females than in males (ESC, 2025[4]). Figure 1.4 plots male‑to-female mortality ratios against 2022 AMSRs for IHD and stroke. For IHD, there is a clear negative association (R² = 0.52): where overall IHD mortality is higher, male‑to-female ratios are smaller, implying a narrower gender gap. Countries with low IHD mortality (e.g. France, Cyprus, Spain) show higher ratios – greater excess male mortality – whereas countries with high IHD mortality (e.g. Lithuania, Hungary, the Slovak Republic) show lower ratios. By contrast, stroke shows only a weak positive association (R² = 0.15). Countries with higher stroke mortality tend to have only marginally larger male‑to-female differences (e.g. Bulgaria, Romania, Latvia), while countries with low stroke mortality (e.g. Norway, Greece, the Netherlands) have small gaps. Overall, gender differences in IHD narrow as mortality rises, but for stroke, sex gaps are modest (ratios ≤1.4 across countries) and show little relationship with overall mortality. Reducing male IHD mortality remains a priority across the EU – particularly in Central and Eastern Europe – while persistently high female IHD mortality in some Eastern countries also warrants targeted action.
Note: EU average is weighted.
Source: Eurostat (hlth_cd_asdr2), 2025.
Premature and avoidable mortality from CVD shortens working lives
Premature mortality (deaths below a specified age limit) refers to deaths that occur at a younger age than expected and is often used as a measure of the burden of potentially preventable deaths and for assessing the effectiveness of public health and healthcare systems. It also has consequences for economic costs and the loss of productivity because of working lives cut short. The age limit used differs between data sources; for the Eurostat data discussed here the age limit is 65 years, while some data sources use 70 or 75 years as the upper limit. Because of the small number of premature deaths in countries with smaller populations, the discussion below is limited to EU countries with larger populations. In 2022, the average mortality rate from CVD at ages under 65 for the EU was 61 and 20 per 100 000 population in males and females respectively (Figure 1.5.). There is a 6‑9‑fold variation in male‑mortality between some Central and Eastern European countries (e.g. Bulgaria, Latvia, Romania) and Western European countries (e.g. Norway, the Netherlands, Belgium). The range is more moderate, but still significant, in females (4‑8‑fold).
The excess of male over female mortality rates for CVD is significantly greater at ages under 65 compared to all ages. Between 2012‑2022, premature mortality from CVD fell by an average of 20% in males and 23% in females across the EU, although there were large variations between countries. Premature CVD mortality increased in several EU countries between 2019‑2021, reflecting the impact of the pandemic, with the largest increases observed in some Central and Eastern European countries (Lithuania, Latvia, Romania, Bulgaria) (Cherla et al., 2024[7]).
CVD ASMRs under 65, 2022
Note: EU average is weighted.
Source: Eurostat (hlth_cd_asdr2), 2025.
People living with CVD experience worse outcomes across every dimension of self-reported health and well-being than those with other chronic conditions
CVD is a leading cause of disability and premature death, and the results highlight the broader impact it has on people’s lives beyond clinical outcomes. Across all measured dimensions – well-being, social functioning, physical health, and mental health – people with CVD report significantly worse outcomes than their peers without CVD (Figure 1.6). These findings are consistent with existing literature showing that CVD affects multiple aspects of patients’ lives beyond physical symptoms. Physical limitations caused by CVD – such as fatigue, shortness of breath, and reduced exercise capacity – restrict mobility and hinder participation in social and leisure activities, contributing to feelings of isolation and lower social functioning (Mavaddat et al., 2014[8]). The psychological burden is also substantial: people living with CVD often face increased anxiety and fear of recurrent cardiac events, as well as challenges in adapting to lifestyle changes and long-term medication regimens, all of which can exacerbate depressive symptoms and reduce overall mental health (Borkowski and Borkowska, 2024[9]). Furthermore, multimorbidity is highly prevalent among CVD patients and is strongly associated with poorer self-rated health and lower quality of life, sometimes even more than the presence of CVD alone (Dunlay and Chamberlain, 2016[10]; Skou et al., 2022[11]). Evidence from OECD also highlights that while improved acute care has reduced mortality, many patients continue to struggle with long-term consequences and ongoing disability (OECD, 2015[1]). Using data from the OECD Patient-Reported Indicator Surveys (PaRIS), primary care users with CVD report lower overall well-being (4.5 percentage point [p.p.] difference), reduced social functioning (5.8 p.p. difference), worse physical health and poorer mental health (1.3 p.p. difference) as compared those without. Physical health is where the gap between those with and without CVD is most marked (1.8 p.p. difference).
Note: Data from OECD PaRIS Database, 2024. Includes WHO‑5 Well-Being Index (0‑100 scale) and PROMIS® Global Health measures for social activities, physical health (T-score 16‑68, cutoff 42), and mental health (T-score 21‑68, cutoff 40). Higher scores indicate better outcomes. Italy data are from outpatient specialist visits in selected regions. US data include only those aged 65+. Data are sorted by CVD status. Differences between people with and without CVD are statistically significant (p<0.05) for most countries, with some exceptions.
Source: OECD PaRIS Database, 2024.
The economic burden of CVD in the EU continues to increase
CVD has long been a major contributor to healthcare expenditures and economic losses in the EU. The estimated annual cost of CVD in the EU has surged from EUR 169 billion in 2003 to EUR 282 billion in recent years, reflecting a growing financial strain on healthcare systems (Figure 1.7). This increase is driven not only by direct healthcare expenses but also by rising productivity losses and informal care needs, underscoring the urgency of effective prevention and long-term management strategies. The most recent analysis by Luengo-Fernandez et al., uncover the total economic burden of CVD in the EU at EUR 282 billion annually, amounting to approximately 2% of the region’s gross domestic product (GDP). On a per capita basis, CVD-related costs averaged EUR 630 per EU citizen, varying from EUR 381 in Cyprus to EUR 903 in Germany.1 Notably, health and social care expenditures for CVD represented 11% of total healthcare spending in the EU, with significant variation among member states – from 6% in Denmark to 19% in Hungary (Luengo-Fernandez et al., 2023[12]).
Note: The graph presents and consolidates findings from three separate studies that estimated the financial burden of CVD. percentage of total EU GDP was calculated using Eurostat data and the GDP of EU member states at the time of each study. Figures are presented in nominal terms and are not adjusted for inflation and calculation methods vary between studies. Source: Eurostat( (Leal et al., 2006[13]; Wilkins et al., 2017[14]; Luengo-Fernandez et al., 2023[12]).
Total societal economic burden of CVD exceeds cancer
Comparative analyses indicate that CVD impose a substantial economic burden across the EU, often exceeding the costs associated with other costly diseases such as cancer. In 2021, the total economic burden of cancer in Europe not including informal care costs was estimated at EUR 203 billion (Manzano et al., 2025[15]), which included EUR 134 billion in healthcare expenditures, compared to EUR 155 billion for CVD and EUR 70.4 billion in productivity losses, compared to EUR 48 billion for CVD. The 2021 estimates for cancer exclude the costs of informal care – that is, unpaid support provided by family members or friends. The most recent available data from 2018 indicate that cancer-related informal care costs, adjusted to 2021 euros, amounted to EUR 27 billion, compared to EUR 79 billion for CVD (Manzano et al., 2025[15]; Hofmarcher et al., 2020[16]).
In 2021, the total societal cost of CVD – inclusive of direct healthcare costs and losses related to informal caregiving and productivity – was higher than cancer-related costs in most EU countries. In Sweden and Finland, the societal costs of CVD are double that of cancer. Austria reported a total CVD cost of EUR 8.47 billion per year, compared to EUR 5.67 billion for cancer (Figure 1.8). Similarly, Germany spent EUR 83.4 billion on CVD versus EUR 55.6 billion on cancer,1 while France allocated EUR 38.1 billion to CVD compared to EUR 37.9 billion for cancer.
Note: All costs expressed in 2021 euros. For cancer, health & social care, costs are estimated with 2023 data, and informal care and productivity losses with 2018 data.
Source: Hofmarcher et al. (2020[16]), “The cost of cancer in Europe 2018”, https://doi.org/10.1016/j.ejca.2020.01.011; Luengo-Fernandez et al. (2023[12]), “Economic burden of cardiovascular diseases in the European Union: a population-based cost study”, https://doi.org/10.1093/eurheartj/ehad583; Manzano et al. (2025[15]), “Comparator Report on Cancer in Europe 2025 - Disease Burden, Costs and Access to Medicines and Molecular Diagnostics”, IHE report.
This cost differential is largely driven by higher costs of health and social healthcare and informal care associated with CVD. For example, in Nordic countries, higher CVD costs are driven by more intensive formal care and higher productivity losses, while in Eastern Europe, the burden is shaped by higher disease prevalence, earlier onset, and reliance on informal care. In 15 out of the 27 countries, the direct healthcare costs for CVD in 2021 are larger than those of Cancer in 2023 (in 2021 euros), with an average difference of 52%. The differences in informal care costs are even more pronounced: in all EU countries, the economic burden associated with informal care for CVD is nearly 400% higher compared to cancer. This stark contrast reflects not only the differing nature of the two diseases and their impact on morbidity and long-term care needs but also points to a critical challenge in care provision and coverage. The high reliance on informal care in CVD highlights potential gaps in formal support systems and places a considerable burden on families and caregivers.
Cardiovascular conditions are impacted by a range of non-modifiable and modifiable risk factors. Non-modifiable risk factors – such as sex, age, family history, and ethnicity and race – are those inherent individual characteristics that may increase the risk of developing a cardiovascular condition. Modifiable risk factors include clinical and metabolic risks, lifestyle and behavioural risks, and environmental risks, as seen in Figure 1.9. The main causal risk factors are metabolic risks which include high low-density lipoprotein (LDL) cholesterol, high blood pressure, diabetes mellitus, obesity, and mental health problems. Smoking is one of the main behavioural and lifestyle-related risk factors for CVD, alongside unhealthy diet, sedentary lifestyle, harmful use of alcohol and poor sleep quality. Environmental risks include air pollution, extreme heat exposure and occupation, all of which can be modified. These risk factors are shaped by broader social and commercial factors – including education, income, housing conditions, migration status and labour market conditions – which further compound CVD risks among people living in vulnerable situations.
A number of intermediate clinical risk factors are influenced by the same risk factors that also influence cardiovascular disease more directly
Globally, 83% of all deaths due to CVD in 2021 were attributable to modifiable risk factors, while in the EU this figure falls to 76%. Metabolic risk factors are the predominant group, accounting for 70% of CVD deaths globally and 68% in the EU. Behavioural risks are the second largest group, accounting for 42% of the CVD deaths globally and 37% in the EU. Environmental risk factors account 33% of CVD death globally, and 18% in the EU (IHME, 2021[17]). Note that risk factors are not mutually exclusive, a person can be exposed to multiple risk factors at once, therefore the percentages are not summative.
Recent trends in cardiovascular risk factors across Europe reveal several growing public health challenges. Concerningly, many metabolic and clinical risks have been increasing or remain at high levels. Between 2012 and 2022, diabetes prevalence rose by 22% in the EU, reaching 7.8% (WHO Global Health Observatory, 2024[18]), and hypertension increased by 1%, impacting 22% of people living in Europe (EuroStat, 2025[19]). Obesity rates have shown little change between 2017 and 2022 but remain high, affecting around one‑in-seven adults aged 18 and over (15%) (EuroStat, 2025[20]). Depressive symptoms have declined by 9% in older adults, but still impact almost a third (27%) of the EU population aged 45 and over (SHARE-ERIC, 2024[21]). The high exposure to metabolic and clinical risks is, at least in part, driven by population ageing; the proportion of adults aged 65 and over surged by 23% between 2000 and 2024, reaching 22% of the population (EuroStat, 2025[22]).
Lifestyle and behavioural risk factors show mixed progress. Tobacco use has dropped by 16% over the past decade, reaching 18% in 2023 (OECD, 2025[23]), and harmful alcohol consumption declined slightly by 7%, reaching 10 litres per person in 2024 (OECD, 2025[24]). However, vaping surged by 45%, reaching 4% in 2024, raising concerns about emerging nicotine habits (OECD, 2025[25]). In Europe, between 2017 and 2022, vegetable consumption has decreased slightly by 6% and fruit consumption fell by 4% (EuroStat, 2025[26]). In 2022, fruit and vegetable intake stood at 61% and 60% respectively (EuroStat, 2025[26]). Insufficient physical activity decreased by 3%, yet still affects more than one‑quarter of the population (28%) (WHO Global Health Observatory, 2024[27]). Sleep problems among older adults have also declined slightly (by 5%) but remain prevalent at 34% (SHARE-ERIC, 2024[21]). Work-related stress, anxiety, or depression rose by 7%, now impacting 29% of the population, reflecting growing mental health pressures in the workplace (OSH Pulse, 2025[28]). Finally, indicators on exposure to environmental factors also show varied outcomes: exposure to extreme heat has increased by 9% with nearly one‑in-three people (34%) experiencing at least one hot day (>35°C) in Europe (OECD, 2025[29]), while exposure to air pollution dropped significantly by 30%, now at 11 µg/m³ (OECD, 2025[30]).
Note: Data represent EU27 averages for the indicated metrics. Metrics sourced from Eurostat and OSH Pulse are weighted averages, while all other metrics are unweighted. Where the most recent data were unavailable, the closest available year was used as noted. Units of measurement – Diabetes: percentage of adults (≥18) with fasting glucose ≥126 mg/dl or HbA1c ≥6.5%; Hypertension: percentage of adults (≥15) with high blood pressure; Obesity: percentage of adults (≥18) with BMI ≥30 kg/m²; Depressive symptoms: percentage of adults (≥45) reporting ≥4 symptoms on EURO-D scale; Age: percentage of population aged ≥65; Tobacco: percentage of daily smokers (≥15); Vaping: percentage of regular users (≥15); Alcohol: litres per person (≥15); Fruit & vegetables: percentage of population consuming daily; Physical inactivity: percentage of adults (≥18) below WHO activity threshold (<150 min/week moderate or <75 min/week vigorous); Sleep problems: percentage of adults (≥45) reporting trouble sleeping; Work-related stress: percentage of employed (≥16) reporting work-related stress, depression, or anxiety; Extreme heat: percentage of people exposed to ≥1 day >35 °C; Air pollution: mean exposure to PM2.5 (µg/m³). Detailed tables are available in Chapter 3, Table 3.1.
Source: EU averages for Diabetes (WHO Global Health Observatory, 2024), Hypertension (Eurostat hlth_ehis_cd1e, 2021), Obesity & Fruit & Vegetable Consumption (Eurostat ilc_hch10 & ilc_hch11, 2024), Work-related Stress (OSH Pulse, 2025), Depression & Sleep Problems (SHARE‑ERIC, 2024; The Irish Longitudinal Study on Ageing (TILDA) 2025; Healthy Ireland Survey 2024), Tobacco, Vaping, Alcohol, Heat Exposure & Air Pollution (OECD, 2025), Physical Activity (WHO, 2024).
Hypertension has stabilised in most countries – but still impacts a significant proportion of the population
Across the EU, an average of 22% of people 15 years and older report having high blood pressure (Figure 1.11). Over 30% of people report having high blood pressure in Hungary, Latvia and Croatia, while less than 15% report having high blood pressure in Ireland. Differences in gender prevalence tend to become more pronounced among countries with higher levels of high blood pressure overall. In Bulgaria, Lithuania and Latvia, there is an over a 6 p.p. difference between levels of high blood pressure in men and women, with higher levels observed in women.
Note: EU27 average is weighted. 1. non-EU European Economic Area countries. 2. non-EU OECD G20 countries. 3. EU candidate countries.
Source: Eurostat (2021), Persons reporting a chronic disease, by disease, sex, age and educational attainment level (hlth_ehis_cd1e), https://ec.europa.eu/eurostat/web/products-datasets/-/hlth_ehis_cd1e (accessed 8, July 2025).
The prevalence of high blood pressure is age dependent. In the EU, on average, half of the people aged 65 or older have high blood pressure compared to less than 10% in those aged 44 or younger. In younger age groups women tend to have slightly lower prevalences than men, but in the age group 65 and over, this pattern reverse, with higher rates in women than men (Figure 1.12).
EU27 average of people with high blood pressure by age group
Note: EU is the weighted average of the 27 EU countries.
Source: Eurostat (2021), Persons reporting a chronic disease, by disease, sex, age and educational attainment level (hlth_ehis_cd1e), Persons reporting a chronic disease, by disease, sex, age and educational attainment level, https://ec.europa.eu/eurostat/web/products-datasets/-/hlth_ehis_cd1e (accessed 8, July 2025).
Hypertension is the primary risk factor for ischaemic and haemorrhagic stroke – and has been attributed to approximately 60% of cases (Silva et al., 2024[31]). Antihypertensive pharmacologic treatment within the first 24 hours of onset of acute CVD events has been found to reduce mortality in as little as 10 days (Perez, Musini and Wright, 2009[32]; Galea et al., 2025[33]). Meta‑analyses show that blood pressure reduction reduces the risk of stroke by approximately 40%, with even modest reductions of 5 mmHg (Law, Morris and Wald, 2009[34]). Moreover, poorly controlled blood pressure after an initial cerebrovascular event is strongly associated with recurrence and mortality (Lindley, 2018[35]). Hypertension is also a major cause of heart failure and it precedes its onset in up to 91% of patients, particularly in older adults (Vasan et al., 2001[36]). In the EU, countries with the highest prevalence of high blood pressure among people aged 65 and over tend to have higher age‑adjusted mortality rates due to ischaemic heart disease in this age group.
Globally, elevated blood pressure is the leading risk factor for DALYs attributable to non-communicable diseases. In 2019, it was responsible for an estimated 10.8 million deaths and 235 (IHME, 2024[37]). In the EU, ischaemic heart disease and stroke – the two primary outcomes of uncontrolled hypertension – rank among the top causes of DALYs and premature mortality. Over the last two decades, the impact of high systolic blood pressure has led to diverging trends. While the contribution of high blood pressure has reduced in terms of cumulative loss of DALYs, it is leading to a cumulative increase of years lived with disability – demonstrating its contribution to the CVD epidemiological shift from mortality to morbidity.
Depressive symptoms are prevalent, and highly associated with CVD
Mental illness is a leading cause of ill health and disability in Europe, and a key risk factor for CVD. Depression and severe mental illness – including schizophrenia or bipolar disorder – are associated with increased risk of myocardial infarction, stroke, angina and coronary heart disease (Honigberg et al., 2022[38]; Kwapong et al., 2023[39]; Emerging Risk Factors Collaboration, 2020[40]; Nielsen, Banner and Jensen, 2020[41]). This link is partly explained by the physiological changes associated with depression – including elevated cortisol and adrenaline levels that raise the blood pressure, glucose and heart – as well as the higher level of socio-economic disadvantage and the higher prevalence of unhealthy behaviours among people with mental illness – such as smoking, diets high in calories, salt and saturated fats, lack of exercise, and lower medication compliance (Nielsen, Banner and Jensen, 2020[41]; Chaddha et al., 2016[42]; Kwapong et al., 2023[39]; Henking, Reeves and Chrisinger, 2023[43]). Some mental health medicines, especially older antipsychotics or very high doses, can affect the heart. They may cause weight gain and changes in heart rhythm that, in rare cases, can lead to dangerous arrhythmias (Nielsen, Banner and Jensen, 2020[41]).
Depression is widespread in Europe. In 2022, 27% of adults aged 45 and over reported at least four depressive symptoms on the EURO-D scale (Figure 1.13). Mental health problems are common among people with cardiovascular conditions. In 2022, 31% of people with CVD and related clinical risk factors (including high blood pressure, hypertension, high blood cholesterol, diabetes and high blood sugar) reported depressive symptoms, compared to 20% of those without. Previous OECD analysis found that stroke survivors faced a 23% higher risk of depression (Everard et al., 2025[44]). This elevated risk may reflect both the physical and psychological burden of living with CVD. Symptoms such as pain, fatigue and sleep disturbance can limit daily functioning and reduce social participation, contributing to isolation and poorer quality of life. At the same time, fear of disease progression, disability or death can have a direct impact on anxiety and depression (Karami et al., 2023[45]).
Note: Respondents aged 45 and older. The EURO-D depression scale is a composite index of 12 items (depressed mood, pessimism, suicidality, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment and tearfulness). The scale ranges from 0 “not depressed” to 12 “very depressed”. 2011 data (instead of 2012 data) was used for Austria, Belgium, Czechia, Denmark, Estonia, France, Hungary, Italy, the Netherlands, Portugal, Slovenia, Spain and Sweden; and 2013 data (instead of 2012 data) was used for Luxembourg. Data for Ireland is based on The Irish Longitudinal Study on Ageing (TILDA) 2025.
Source: SHARE‑ERIC (2024).
Europe’s ageing population puts people at risk
Older adults are especially vulnerable to CVD. As individuals age, the cardiovascular system undergoes structural and functional changes that increase the likelihood of CVD (Jensen, 2024[46]). These include increased arterial stiffness, reduced elasticity, and reduced capacity of the heart to pump blood efficiently. At the same time, exposure to age‑related risk factors, such as diabetes, obesity, hypertension and hyperlipidaemia, reduced physical activity, cognitive decline and depression, further contribute to the growing burden of CVD in older adults.
The share of older adults is growing, contributing to the rising burden of CVD. Between 2000 and 2024, the percentage of adults aged 65 and over grew from 18% to 22% of the population and are projected to reach 29% by 2050 (Figure 1.14) (EuroStat, 2025[47]; EuroStat, 2025[22]). While all EU countries are ageing, the pace and extent differ. In 2024, Italy, Portugal and Bulgaria had the highest shares of older adults (24%), while Ireland and Luxembourg had the lowest (15%). By 2050, the highest shares of older adults are expected in Greece, Italy, Portugal, Spain, Lithuania, Bulgaria, Croatia, Latvia and Slovenia (over 30%), while the lowest shares are projected in Luxembourg, Malta, Sweden and Iceland (below 23%). This demographic shift is expected to increase the burden of CVD, with estimates suggesting a 90% rise in CVD prevalence in Europe between 2025 and 2050 (Chong et al., 2024[48]).
Note: EU27 average is weighted.1. non-EU European Economic Area countries.
Source: Eurostat (2023), Population on 1 January by age, sex and type of projection (proj_23np), https://ec.europa.eu/eurostat/web/products-datasets/product?code=proj_23np (accessed 8, July 2025); Eurostat (2025), Population on 1 January by age group and sex (demo_pjangroup), https://ec.europa.eu/eurostat/en/web/products-datasets/-/DEMO_PJANGROUP (accessed 8, July 2025).
While middle‑aged and older adults are more likely to experience cardiovascular events, the incidence of CVD is increasing among younger age groups (15‑39 years) (Sun et al., 2023[49]). A key contributor is the high and rising rate of childhood obesity and overweight: in 2022, the average prevalence among children in EU countries was 9% for obesity and 25% for overweight (WHO Global Health Observatory, 2024[50]) . Increased exposure to other CVD risk factors in younger people – such as diabetes, hypertension, poor diet and physical inactivity – also contribute to the growing burden in CVD in young people, especially heart failure (Andersson and Vasan, 2017[51]). These developments underscore the urgency for primary prevention strategies that address cardiovascular risk factors throughout the life course.
Early detection through primary care or screening programmes improves outcomes
Screening for metabolic risk factors and other vascular risk factors (i.e. family history of premature CVD, familial hypercholesterolemia) is key to control underlying conditions such as hypertension, diabetes and dyslipidaemia, which, if not managed, can lead to cardiovascular events with greater complications for patients. Screening through CVD risk assessment also helps primary care identify higher risk patients to provide support on self-management and information on signs of alarm to identify CVD events.
Despite the accessibility of blood pressure screenings, more than 30% of EU adults between the ages of 45 and 54 have not had a measurement in the past year, and about 6% have not had a measurement in the past five years, even though hypertension is a major CVD risk factor. Cholesterol and blood glucose screenings are lacking, with over 10% of adults between the ages of 45 and 54 in the EU not having had a test in the past five years (Eurostat, 2022[52]) (see Chapter 3).
Screening for CVD risk factors in adults over age 40 for men and over age 50 for women – as evidence‑based clinical practice guidelines recommend doing at least every five years if CVD risk is low – is a cost-effective strategy to prevent CVD complications. As Figure 1.15 shows, older age groups – 55 to 64 years and those 65 years and over – report higher screening rates, yet there is room for improvement among adults aged 45 to 54. Among those 45 to 54, men report lower rates (87%) than women (89%) for having had a blood cholesterol measurement in the past five years. Similar results are seen for having had a blood sugar measurement in this age group; men consistently report lower rates (86%) than women (88%). Improving blood cholesterol and blood glucose measurements, particularly among men aged 40 and over, would strengthen CVD risk assessment. These screenings are essential for identifying and managing metabolic risk factors – hypertension, diabetes and dyslipidaemia – thereby enabling timely interventions and supporting self-management in primary care settings. However, screening alone is not sufficient – timely follow-up care, including diagnosis, treatment, and patient support, is essential to translate early detection into improved outcomes.
Percentage of population, by age group, reporting having had a blood cholesterol or blood sugar measured by a health professional in less than 5 years from the time of the survey, 2019
Note: EU27 is the weighted average.
Source: Eurostat (2022), Self-reported screening of CVD and diabetes risks by sex, age and educational attainment level (hlth_ehis_pa2e), https://ec.europa.eu/eurostat/web/products-datasets/product?code=hlth_ehis_pa2e (accessed 17 October 2025).
People living with CVD interact with a wide range of settings and levels of the healthcare system, including primary care, emergency responders, hospitals, and rehabilitative care after acute events such as heart attacks or stroke. To decrease the significant burden of CVD in EU, it is essential to provide high quality of care to all people across these different settings.
High quality primary care and support for self-management is the first step for CVD control and management
Health promotion activities can have substantial impacts by reducing risks of CVD occurrence among people without CVD (i.e. primary prevention), particularly those in low socio‑economic groups, and targeting people already living with CVD. However, there are opportunities to better reach people living with CVD with the advice that can help them improve on modifiable risk factors and effectively manage their conditions. Self-management support, in particular, is key to increase the confidence of patients to manage their own health to control clinical and behavioural risk factors and to be able to manage their conditions. Confidence in self-management among people aged 45 and older with CVD varies more than three‑fold across countries – from 23% in Italy, to 73% in the Netherlands, and up to 84% in France (Figure 1.16). CVD patients who are confident to manage their own health report higher levels of well-being and are more likely to assess their general health as good or very good, compared to those who lack such confidence.
Percentage of patients that are confident or very confident (compared to somewhat confident or not confident at all) to manage their own health
Note: 1. non-EU European Economic Area countries. 2. non-EU OECD G20 countries. CVD status is self-reported using the question: “Have you ever been told by a doctor that you have any of the following health conditions?” and answer: “Cardiovascular or heart condition”. Confidence to self-manage; Response to question: “How confident are you that you can manage your own health and well-being?”, response options range from not confident at all (0) to very confident (3). Percentage of patients that are confident or very confident (compared to somewhat confident or not confident at all). Error bars correspond to comparative intervals (84%CI).
Source: OECD PaRIS 2024 Database.
Hospital avoidable admissions can be reduced through better access to high-quality primary care
Congestive heart failure (CHF) and diabetes are common chronic health conditions with potential for severe complications and rapid deterioration. However, these conditions can also be effectively controlled in primary care using evidence‑based management practices. A well-performing primary care system can reduce acute deterioration of people living with chronic conditions related to CVD such as CHF or diabetes, thereby preventing unwanted and costly avoidable hospital admissions (OECD, 2020[53]).
However, the effectiveness of primary care to reduce avoidable admissions related to CVD varies considerably. Hospital admission rates for CHF varied almost over four‑fold across EU countries in 2023, averaging 232 per 100 000 population (Figure 1.17). Portugal and Croatia had the lowest rates, while Poland and Lithuania reported rates over twice the EU average. The average admission rate across EU countries fell by 25% between 2013 and 2023 – and over 30% in Austria, Belgium, Estonia, Iceland, Italy and Portugal. Admissions for CHF increased in several countries over this period, including Iceland, Norway and the Slovak Republic. Steep reductions in hospital admissions between 2019 and 2021 were mainly associated with disruptions in hospital services and reduced care‑seeking during the COVID‑19 pandemic, rather than changes in primary care quality. This highlights the importance of strengthening the accessibility and resilience of primary care.
Note: The EU average is unweighted. 1. Latest data from 2021-2022.
Source: OECD Health Statistics 2025.
Reducing avoidable admissions through improvements in primary care and effective delivery can result in significant potential health system savings and improve patient outcomes. According to OECD estimates, EU countries as a whole would have reduced hospital spending by EUR 45 billion, if all countries could to reduce hospital admissions for CVD to the lowest level in the OECD (see Annex 4.B). Besides cross-country differences, multiple studies also point to disproportionately high avoidable admissions among disadvantaged populations with CVD, so focussing on reducing inequalities in access to effective primary care is crucial to further improve health outcomes and in turn increase cost-saving.
Pre‑hospital emergency care is critical for timely response to acute CVD events, but ambulance response times have yet to recover following COVID‑19
Timely access to acute CVD care starts with help-seeking behaviours of the patient and those around them, who play a critical role recognising the symptoms of potential acute CVD and being confident to call for help from emergency medical service (EMS). Data from countries suggest that on average only three of four stroke patients (76%) arrive to a dedicated stroke centre by EMS; the other quarter of stroke patients continue to arrive by their own means. Evidence from multiple countries shows that women wait longer than men to call for emergency services following the onset of stroke symptoms. The pandemic, however, has negatively impacted ambulance response times in several countries, and average response times have not yet returned to pre‑pandemic levels (Figure 1.18).
Response times presented as percentage change in average response time. Reference year 2019
Note: Ireland, the Netherlands, Sweden, Latvia and Türkiye report median response times, Japan reports the mean. Australian data represents the weighted averages of the medians for each jurisdiction (state or territory). England reports the mean.
Source: 2025 OCED Cardiovascular Policy and Data Survey; Australian Government Productivity Commission (2025[54]), https://www.pc.gov.au/ongoing/report-on-government-services/2025/health/ambulance-services; Nuffield Trust (2024[55]), Ambulance response times, https://www.nuffieldtrust.org.uk/resource/ambulance-response-times.
European countries have been making advancements in expanding access to time‑sensitive treatments for stroke, reflecting improvements in system capacity and co‑ordination. Time to diagnosis and assessment can be improved at every stage in the process – from the call for help through to the decision to treat – and varies widely between countries. Data from 22 EU countries showed that less than 60% of reporting countries provided intravenous thrombolysis (IVT) to more than 15% of their admitted ischaemic stroke patients in 2023. Delivering sophisticated, high-quality acute care equitably across the entire population – following the onset of a disease process that manifests without warning – requires a high degree of integration between the general community, emergency responders, emergency departments (EDs) and the inpatient teams within hospitals.
CVD account for up to 6% of hospital ED visits. Approximately two in five primary care users over the age of 45 living with CVD has used the emergency room in the last year – and they are twice as likely to have gone to an ED as those without CVD. Modern care delivery systems generate large quantities of data that may be used to measure the quality of this care against evidence-based and widely accepted guidelines and targets.
Access to – and outcomes of – hospital and post-acute care varies across countries, and often depend on geography
Hospital avoidable admissions due to congestive heart failure and diabetes are trending down across countries – as are hospital discharges for circulatory diseases – but variation in rates between countries indicate these can be reduced through better access to high quality primary care. Despite downward trends, hospitalisation remains a common occurrence for people living with CVD, reflecting difficulties in managing CVD-related conditions. Among people aged 45 and over attending primary care, one‑in-four people with cardiovascular conditions have been hospitalised in the last year, and those with cardiovascular conditions are twice as likely to be hospitalised than those without CVD-related conditions.
Despite playing a central role in all health systems as a care setting for CVD, hospital access, capacities, and outcomes vary and are not always sufficiently matched to disease burden and demand. In almost all countries in OECD, circulatory diseases are the most common cause for inpatient care, and in 2023, 14% of hospital discharges across Europe were associated with cardiovascular diagnosis requiring planned surgical procedures or acute care after acute CVD events. The share varies two‑fold, ranging between 9% in Ireland to 18% in Latvia and Lithuania. Hospital discharges for circulatory diseases vary over four‑fold in the EU. There are less than 1 000 hospital discharges per 100 000 population in Portugal and Iceland, but exceed 3 000 in Lithuania, Latvia and Germany, and are more than 4 000 in Bulgaria (Figure 1.19).
Source: OECD Health Statistics 2025.
The effectiveness of hospital care varies – and the likelihood of surviving an admission for an acute CVD event varies depending on geography. The 30‑day AMI mortality rate in 2023 ranges over three‑fold between the best and worst performing EU country, and 30‑day mortality following ischaemic stroke varies by a factor of 2.5 (Figure 1.20). In recent years, Europe has seen a growing trend in the use of intravenous thrombolysis (IVT) as a frontline treatment for acute ischaemic stroke. The rate of IVT varies by a magnitude of 20 between European countries – from over 75 per 100 000 population in Latvia and Estonia to below 10 in Ireland and Greece. Furthermore, some countries with high mortality rates due to cerebrovascular disease have notably low rates of use of IVT, including Bulgaria and Romania. Latvia stands out as a country where there is high use of IVT and high cerebrovascular mortality, while Estonia, has lower than average cerebrovascular mortality and high rate of use of IVT.
Note: The EU average is unweighted. 1. Latest data from 2020‑2022. 2. Data do not include deaths outside acute care hospitals.
Source: OECD Health Statistics 2025.
Hospital care for CVD is highly dependent on technology, including imaging and invasive procedures. For example, countries with fewer hospitals implanting implantable cardioverter defibrillators (ICDs) tend to have lower implantation rates. There remain persistent delays in elective, but time sensitive, cardiovascular services. Data from seven OECD countries shows that a significant share of patients face delays exceeding three months for procedures such as coronary angioplasty and coronary artery bypass grafting (CABG) for chronic coronary disease, highlighting potential challenges insuring access and equality of service provision.
The use of implantable devices – such as pacemakers and implantable defibrillators – have generally plateaued, but the international variation remains great. The exception is the use of transcatheter aortic valve implantations (TAVI), which have increased in all EU countries and seen expanding populations. Many countries have clinical standards in place in their country for device implantation and follow-up or maintain national or regional registries for post-market surveillance and safety monitoring – such as for tracking device use, complications and reoperation rates. Fewer countries have adopted systems for quality audits, such as professional peer review, compliance checks or have implemented systematic measurement of patient-reported outcomes or experiences related to cardiac implant procedures.
Hospital discharge following an acute cardiovascular event is an important point to ensure the continuation of treatment with medications that prevent recurrence and address underlying conditions. Data on prescribing practices shows that care generally conforms to standards. Almost all (97%) stroke patients receive anticoagulating drugs at discharge in countries that report data, while fewer receive statins (92%) and antihypertensive drugs (82%). Additionally, across countries, most patients were discharged on dual anti-platelet therapy and statins following AMI. However, these prescribing practices need to be sustained – and in most cases there is a steep drop between discharge and prescribing practices more than a year after the event, with 68% to 83% patients in reporting EU countries receiving antihypertensive and 31% to 94% patients receiving antithrombotic prescriptions within 18 months (Figure 1.21).
Source: Data Collection on Integrated Care 2022-2023, and OECD Health Statistics Database 2025.
Post-acute care is an opportunity to reduce medium to long term mortality and morbidity, but effectively co‑ordinating and implementing such care remains a challenge for many countries. Goals include optimising secondary prevention (medication, risk factor change), tertiary prevention, rehabilitation after the acute event, and reintegrating with primary care or with ongoing monitoring and self-management programmes. Data from 14 EU countries shows that, on average, 60% of stroke patients survived without readmission within a year, while 24% were readmitted (5% for stroke‑related causes), and 16% died. For CHF patients, 43% survived without readmission, 33% were readmitted (11% for CHF-related causes), and 24% died within the year.
Digital health technologies are increasingly reshaping the way CVD is prevented, diagnosed, and managed. Tools such as electronic health records (EHRs), clinical decision support systems (CDSS), telemedicine platforms, mobile health apps, and wearable monitoring devices are enabling more proactive, co‑ordinated, and patient-centred care. These technologies can help identify individuals at high risk, monitor chronic conditions in real time, and deliver tailored interventions – where supported by robust data, interoperable infrastructure and appropriate governance frameworks such as those being introduced in the European Health Data Space (EHDS) – potentially reducing avoidable morbidity and mortality. However, while process improvements are well documented, evidence of sustained improvements in long-term cardiovascular outcomes remains variable and context-dependent. A risk is that consumer-facing digital technologies may do little to address health inequalities and may, in fact, exacerbate them.
Electronic health records and data systems enable prevention, early detection and management
EHRs are now the cornerstone of health information infrastructure in most high-income countries, providing a digital platform to store and exchange patient information. While gaps remain, modern EHR systems not only serve as repositories of clinical notes and test results but also integrate a suite of functions – from computerised physician order entry and e‑prescribing to clinical dashboards and data analytics (Slawomirski et al., 2023[56]; Kao, 2022[57]). These can aid good cardiovascular prevention and care. The past decade has seen near-universal EHR adoption in some high-income countries. Countries including Denmark and Estonia have implemented comprehensive, national EHR systems enabling data flow across care settings. The widespread use of EHRs means that most patients with CVD have their histories, medications, and investigations recorded electronically, which in principle could support co‑ordinated prevention and management of CVD. In the EU, the European Health Data Space (EHDS) Regulation establishes common rules for interoperable EHR systems, priority data categories, and patients’ digital access rights, aiming to address some of these gaps over the coming decade.
However, challenges around EHR usability, interoperability, and trust in data governance continue to limit their full potential. Similarly, clinical decision support tools have been shown to improve the delivery of recommended services and treatments, but their effectiveness depends heavily on thoughtful integration into clinical workflows and regular updating of underlying guidelines. Results from the 2025 OECD Cardiovascular Policy and Data Survey suggest that countries may not be positioned to leverage EHR data for prevention, early detection and management of CVD.
Wearable devices and smartwatches show promise but countries report limited use and integration into national health systems
Wearables have seen rapid adoption across high-income countries. Recent market data show that as of 2023, roughly one in three adults in the United States uses some form of wearable health tracker (smartwatch or fitness band) (Dhingra et al., 2023[58]). Global estimates indicate over 400 million people worldwide use smartwatches, with the user base expected to approach half a billion in 2025, and Poland, Germany, France being among the top ten adopters (Kumar, 2025[59]). This popularity stems from the appeal of these devices as consumer electronics for fitness and communication, as well as increasing health awareness. A subset of devices with medical functionalities (e.g. ECG-enabled devices) are classified and regulated as medical devices in the EU, with associated safety and performance requirements. Cardiologists are seeing patients armed with data from their wearable device and health systems have begun pilots to integrate patient-generated wearable data into electronic records for monitoring of conditions like atrial fibrillation or post-operative recovery. The benefits in practice remain unclear. However, these initiatives remain limited in scale, and there is not yet consistent evidence that routine integration of consumer wearable data into clinical workflows improves cardiovascular outcomes.
As consumer wearables become ubiquitous, their influence on CVD care is rising. Even so, countries report limited use and integration of wearables into national CVD health monitoring (Figure 1.22). Only four countries (Czechia, France, Norway and Singapore) report having policies in place to promote the adoption of medical devices such as wearable fitness trackers, home ECG-enabled/ arrhythmia detection devices for CVD prevention and monitoring. Only one of these (France) reports having the data infrastructure to support the transmission of data from wearables to a patient’s EHR. Ensuring that these devices do not exacerbate the “inverse care law” (the observation that more affluent members of society receive more care at the expense of the less affluent and less well) due to inequalities in digital literacy and ability to pay is a central priority, including through the development of data governance frameworks, to prevent further widening digital health divides.
N=19 EU+2 and OECD G20 countries (Austria, Canada, Croatia, Czechia, Estonia, Finland, France, Germany, Iceland, Ireland, Japan, Latvia, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, Türkiye, the United Kingdom). Ireland also indicated “Limitedly” in the question on widespread use of digital and wearable devices.
Source: 2025 OCED Cardiovascular Policy and Data Survey.
Artificial intelligence can support the interpretation of large volumes of data if appropriately deployed
Artificial intelligence (AI) and machine learning offer enhanced capabilities in diagnostics, risk prediction, and personalised treatment. Meanwhile, big data analytics and interoperability efforts are enabling new insights by aggregating vast amounts of cardiovascular health information across populations (Figure 1.23). AI algorithms have shown impressive performance in interpreting medical data relevant to cardiology. While proof-of-concept studies and early deployments show promising performance, robust evidence of sustained, real-world impact on cardiovascular morbidity and mortality at scale remains limited. In medical imaging, for instance, deep learning models can analyse echocardiograms with accuracy approaching that of experienced sonographers. In addition to supporting diagnosis, AI is being used to optimise treatment decisions. For example, machine learning models can predict which heart failure patients are at highest risk of hospitalisation in the next 30 days, helping clinicians prioritise interventions (this is already used in some hospital readmission reduction programmes) (Yu and Son, 2024[60]). AI-based clinical decision support, as an evolution of the rule‑based CDSS discussed earlier, can integrate far more data (genetics, labs, imaging, sensor data) to provide nuanced recommendations – essentially an advanced form of CDSS. Regulators have been approving AI-enabled software in cardiology. As of December 2024, over 1 000 AI or machine learning medical algorithms have been approved by the US FDA, and CVD is among the top specialties for these AI tools (Grant et al., 2024[61]; Singh et al., 2025[62]).2
Source: Authors based on information from Poterucha et al. (2025[63]), “Detecting structural heart disease from electrocardiograms using AI”, https://doi.org/10.1038/s41586-025-09227-0; Singh et al. (2024[64]), “Artificial intelligence for cardiovascular disease risk assessment in personalised framework: a scoping review”, https://doi.org/10.1016/j.eclinm.2024.102660; Chowdhury et al. (2025[65]), “The Heart of Transformation: Exploring Artificial Intelligence in Cardiovascular Disease”, https://doi.org/10.3390/biomedicines13020427.
Despite the promise, AI and big data introduce challenges including data bias, algorithm transparency, data privacy, and the risk of over-reliance. Ensuring equitable access and building clinician trust are essential for responsible adoption. Ultimately, these technologies can support a more proactive, personalised model of cardiovascular care – but only if implemented with careful attention to evidence, ethics, and inclusivity. The EU Artificial Intelligence Act, which entered into force in 2024 and will apply progressively over the following years, aims to boost innovation and protect individuals against potential harms, will have important implications for the healthcare sector (EU AI Act, 2024[66]).
Leveraging health data is key to maximising the benefits of existing and new technologies that aim to manage and prevent CVD
A range of routinely collected health data can be leveraged to improve CVD prevention and management both directly, and by underpinning the digital technologies outlined above. Each data source – including EHRs, registries, administrative datasets, mortality data and (increasingly) alternative sources like patient-generated information – provides unique value for guiding interventions as well as research and policy. However, it is by linking these data, and making them interoperable across jurisdictions and sectors, that their value can be substantially increased, and be harnessed to develop and refine potentially game‑changing technologies to prevent and manage CVD.
EHR systems were discussed above mainly in terms of directly improving patient care and outcomes, such as identifying high-risk patients and improving care co‑ordination. But because EHRs contain longitudinal patient data from routine clinical encounters, offering a comprehensive view of individual health histories, their data can be put to work in several productive ways. They provide a rich source of information for research on CVD prevention, treatments and outcomes that can enable large‑scale analysis of real-world evidence – although caveats do apply (Davidson et al., 2020[67]). Seven of the 19 participating countries in the 2025 OECD Cardiovascular Policy and Data Survey reported using EHRs to CVD burden and outcomes (Croatia, Estonia, France, the Netherlands, Norway, Türkiye and the United Kingdom). For comparison, 17 countries report using administrative datasets and mortality data for this purpose (Figure 1.24). This suggests that countries may not be positioned to leverage EHR data for CVD management and research. The recently adopted EHDS Regulation aims to address some of these barriers by defining common standards, governance structures and rights for primary and secondary use of electronic health data across the EU.
Note: N=19 EU+2 and OECD G20 countries (Austria, Canada, Croatia, Czechia, Estonia, Finland, France, Germany, Iceland, Ireland, Japan, Latvia, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, Türkiye, the United Kingdom).
Source: 2025 OECD Cardiovascular Policy and Data Survey.
Improving interoperability would allow for richer analytics – such as calculating survival rates or identifying high-risk patients before adverse events occur. Cross-border data integration in Europe is also key, as it enables pooled analyses, enhances statistical power, and facilitates benchmarking. Initiatives like the European Society of Cardiology’s (ESC) EuroHeart aim to standardise cardiovascular data across countries to improve policy and practice. The Joint Action on CARdiovascular diseases and Diabetes (JACARDI) is also developing a conceptual framework that defines the key information needed to assess CVDs and diabetes across the EU (risk factors, disease‑related conditions, and medical, social, or structural modifiers), structured by settings, dimensions, and domains. However, data silos, incompatible standards, lack of unique patient identifiers, and varying privacy regulations still remain substantial barriers. Achieving health data interoperability requires co‑ordinated action on several fronts. Technical barriers include differing data formats and the absence of a shared patient identifier across the EU. Legal and ethical hurdles stem from varying interpretations of General Data Protection Regulation (GDPR), inconsistent consent rules, and public trust concerns. In the EU, the newly adopted European Health Data Space (EHDS) Regulation establishes common rules for primary and secondary use of electronic health data. It creates Health Data Access Bodies, defines common standards and safeguards (including secure processing environments and permitted and prohibited secondary uses), and provides greater legal clarity while complementing the GDPR.
National policies and international actions are evolving to address multimorbidity and the challenges of an ageing population
Across Europe, countries are implementing a wide range of strategies to address the growing burden of chronic diseases, notably CVD (Table 1.1.). In some countries, these efforts are embedded within broader national frameworks, including National Health Plans, National CVD control plans and non-communicable diseases (NCDs) prevention and/or management programmes. Hybrid models combining prevention and disease‑specific strategies within acute care services are in place in some countries. Other countries implemented disease‑specific national control plans, such as for diabetes and stroke or disease management programmes. Disease management programmes are the process of care co‑ordination of patients suffering from specific chronic conditions during their care transitions. It has been proposed as a model to optimise care for patients with complex health needs (Sochalski et al., 2009[68]). Figure 1.25 illustrates how comprehensively national CVD policies address various components of the cardiovascular care pathway. While most countries include elements such as prevention, early detection, and diagnosis and treatment in their national plans, critical areas such as tackling inequalities and promoting patient-centredness are the least frequently covered.
Note: Response to question “If your country has national CVD policies, does it address the following aspects?” N=20 EU+2 and OECD G20 countries (Austria, Canada, Croatia, Czechia, Estonia, Finland, France, Germany, Iceland, Ireland, Japan, Latvia, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, Türkiye, the United Kingdom).
Source: 2025 OECD Cardiovascular Policy and Data Survey.
Note: Disease management programmes are the process of care co‑ordination of patients suffering from specific chronic conditions during their care transitions, which has been proposed as a model to optimise care for patients with complex health needs (Sochalski et al., 2009[68]).
Source: 2025 OECD Cardiovascular Policy and Data Survey, (ESO, 2023[69]; IDF Europe, n.d.[70]; Amgen, 2025[71]; Romanian Ministry of Health, 2025[72]; PWC, 2025[73]; Italian Ministry of Health, 2025[74]; Spanish Ministry of Health, 2022[75]; Bulgarian Ministry of Health, 2021[76]; French Ministry of Solidarity and Health, 2018[77]; Sweden Ministry of Health and Social Affairs, 2025[78]).
The EU has a key role in supporting Member States action on cardiovascular health. EU-level actions to reduce circulatory disease mortality have focussed on regulatory measures and health initiatives, including stricter tobacco control, clear food labeling, limits on trans fats, and joint actions on chronic disease prevention and healthy ageing. The Healthier Together NCD initiative, for example, supports EU countries in tackling non-communicable diseases through shared best practices, funding opportunities, and collaborative actions to improve prevention, care, and health outcomes. The 2024 EU Council Conclusions on Improving Cardiovascular Health calls on Member States to strengthen prevention, early detection, and equitable access to high-quality cardiovascular care, while promoting research, innovation, and cross-sector collaboration (see Chapter 6). These actions and political commitments – among others – are working to address key drivers of CVD through prevention and management, reflecting strong recognition and leadership in tackling CVD and the broader NCD burden as major societal challenges.
The 2030 Agenda for Sustainable Development identifies NCDs as a major obstacle to sustainable development. World leaders committed to cutting premature NCD mortality by one‑third by 2030 through prevention and treatment (SDG target 3.4). The WHO leads global efforts to co‑ordinate and promote actions towards this goal. In 2019, the World Health Assembly extended the WHO Global Action Plan for the Prevention and Control of NCDs (2013‑2020) to 2030 and requested an Implementation Roadmap (2023‑2030) to speed up progress. The Roadmap guides actions to meet nine global targets for NCD prevention and management.
Cross-sectoral prevention policies amplify their impact beyond cardiovascular health
The substantial burden of CVD on European societies and healthcare systems calls for the prioritisation of prevention policies across the life course, supported and sustained by empowering citizens to make healthy choices. The environments in which people live, work, and age play a critical role in shaping health outcomes, requiring prevention efforts and co‑ordinated cross-sectoral actions. CVD prevention is increasingly framed as a cross-sectoral priority, with growing recognition of the health co-benefits of policies on diet, tobacco, air pollution, and physical activity. However, there is variation in the implementation of the key policy actions that can reduce the unequal burden of CVD.
In recent years, several international and regional policy frameworks have been developed to help governments translate evidence into effective, scalable interventions, namely the NOURISHING and MOVING frameworks (World Cancer Research Fund) and MPOWER (World Health Organization). They offer practical tools to navigate complex policy environments, enhance accountability, and foster multisectoral collaboration. Crucially, they shift attention from individual choices to structural factors, supporting healthier environments and advancing health equity.
Diet and nutrition policy continues to evolve, with increasing uptake of structural measures such as, reducing trans fats in food sugar-sweetened beverage taxes, and healthy food procurement policies in public institutions like schools. These approaches have shown encouraging results, helping to reduce sugar intake, support product reformulation, and improve dietary quality, particularly for children and groups at higher risk of poor nutrition. The NOURISHING framework provides governments with a useful structure for designing, implementing, and monitoring evidence‑informed actions across the food environment, food system, and behaviour-change communication. Voluntary industry agreements – such as those setting targets for salt or sugar reduction – can be effective, but only when targets are ambitious, progress is independently monitored, and actions are rigorously evaluated. In addition, comprehensive marketing restrictions aimed at reducing children’s exposure to unhealthy food advertising are not yet extensively applied across Europe, even though available evidence suggests they can contribute positively to improving children’s diets.
Tobacco control is among the most developed policy areas, with widespread adoption of effective measures contributing to declining smoking rates and reductions in CVD. Many countries have implemented legislation on smoke- and aerosol-free environments, cessation support, and youth-focussed restrictions, with growing interest in flavour bans and tobacco-free generation laws. The Tobacco Products Directive 2014/40/EU and the Tobacco Advertising Directive 2003/33/EC regulate key aspects of the manufacture, presentation, sale, advertising and sponsorship of tobacco and related products. The implementation of these measures has contributed to reductions in smoking prevalence and, consequently, declines in cardiovascular disease. While individual policies – such as taxation, smoking restrictions, and health warnings – are effective on their own, the most impactful approach is implementing them simultaneously (Akter et al., 2024[79]). Other measures, such as flavour bans and free or discounted nicotine replacement therapy, also show positive impacts on quit rates, with flavour bans reducing e‑cigarette consumption. Progress at national level, however, varies. In more than a third of countries, cigarette affordability has increased, while the uptake of advertising bans and mass media campaigns differs across the region, and enforcement of newer measures remains uneven. Rising youth vaping and dual use present emerging challenges, with regulatory approaches to e‑cigarettes showing considerable diversity. The MPOWER framework provides countries with a structured, evidence‑based set of measures to support the implementation of comprehensive tobacco control policies and reduce tobacco-related harm.
Physical activity is widely recognised in national policies, with many countries implementing campaigns, school-based programmes, and infrastructure investments. Promising practices include active travel schemes, physical education in schools and workplace initiatives; however, their implementation is inconsistent. People living in vulnerable situations – such as children, older adults, and disadvantaged populations – remain under-targeted, and cross-sector co‑ordination with areas like transport and urban planning is often limited. The MOVING framework is a policy tool to support physical activity promotion and support governments in the development and assessment of strategies (Oldridge-Turner et al., 2022[80]). It focusses on six key areas: mass media campaigns, opportunities for physical activity in schools, volunteer and community programmes, infrastructure and urban design, national guidelines, and governance. In addition, the Health4EUkids Joint Action fosters collaboration among EU Member States to promote healthy lifestyles and physical activity in children through integrated, evidence‑based approaches across both the health and education sectors (Health4EUkids, 2025[81]).
Countries across Europe have overall advanced policies to tackle harmful alcohol consumption based on key European and International frameworks, though there are differences among countries. Specifically, the European Framework for Action on Alcohol 2022‑2025 sets out six key priority areas: pricing policies, marketing restrictions, availability controls, health information and labelling, health services’ response, and community action (WHO, 2022[82]). The WHO’s SAFER initiative highlights a set of cost-effective actions that can support countries in further reducing alcohol-related harm. At the same time, environmental factors including air pollution, extreme weather events and climate‑related stressors are being more and more recognised as important contributors to cardiovascular risk. Measures such as low-emission zones and policies that promote active transport present promising co-benefits for health and the environment. However, only a limited number of countries currently incorporate environmental risks in a systematic way into their national cardiovascular plans.
Improvements in health literacy and preventative care could prevent and reduce treatment delays
Preventive care and risk detection play an important role in cardiovascular health, with programmes like health checks and high-risk prevention initiatives demonstrating effectiveness in identifying and managing cardiovascular risk factors, particularly in underserved populations. These approaches are generally cost-effective and scalable, but challenges remain in reaching the people living in vulnerable situations and sustaining long-term engagement. Behavioural insights offer valuable tools to enhance adherence and design more effective interventions, but their application remains fragmented and limited across Europe.
Low health literacy hinders behavioural change and timely care‑seeking – while it can be improved through context-specific education, few countries target people living in vulnerable situations. High health literacy has potential to improve outcomes for acute cardiac events, and survival after out-of-hospital cardiac arrest depends on public training and automated external defibrillator (AED) availability, which vary across Europe. National cardiopulmonary resuscitation policies and AED registries have improved outcomes in some countries. Addressing equity is essential in CV care, as women, some ethnic groups, smokers, and people with diabetes face delays and treatment gaps (Anand et al., 2025[83]; Cabrera and Johnson, 2025[84]). A full-pathway approach and regional networks can help reduce these disparities. JACARDI (11/2023‑2010/27) applies the “4Cs” framework as a structured approach to integrate the principle of equity and diversity into the implementation of 142 national-level pilot projects, which entails “Critical reflection”, “Context and data”, “Co-design”, “inclusive and accessible Communications”. Enhancing health systems ability to meet the needs of individuals from varied backgrounds requires ongoing self-reflection, recognising power imbalances, and ensuring commitment to respectful partnerships with diverse communities, to ensure that services are inclusive and equitable.
Health systems interventions – particularly related to co‑ordination and people‑centredness – are essential for improving outcomes both in acute instances and over the long-term
Improving outcomes in cardiovascular and cerebrovascular care requires a co‑ordinated approach across the care continuum – from early detection to post-acute support. Early heart failure detection and referral require public and professional awareness, primary care diagnostic tools, and clear referral pathways. Multidisciplinary programmes with and home‑ or clinic-based follow-up and self-management are key to reducing mortality and hospitalisations. Dedicated stroke teams and networks help standardise care and reduce regional disparities in stroke treatment. Mobile Stroke Units improve outcomes and are cost-effective, especially in densely populated areas; they are already in use in countries like France, Germany and Norway. Post-acute stroke care remains limited and needs expansion, being crucial to improve outcomes.
People‑centred care integrates medical treatment with individual preferences, promotes co-production, shared decision making, and prioritises overall well-being. People‑centred cardiovascular care improves patient experiences and outcomes yet lacks widespread adoption. In the 2025 OECD Cardiovascular Policy and Data Survey, eight of the EU27+2 countries reported that citizen or patient representatives were involved in developing policies related to access and quality of CV care. However, only four European countries reported citizen or patient representatives participating as co-designers. A few countries are investing in health literacy programmes to support self-care and shared decision making. Enhancing patients’ quality of life requires strong investments in discharge planning, self-management and rehabilitation. Early supported discharge accelerates the hospital discharge from hospital by offering specialised multidisciplinary care at home. Few countries have fully implemented early discharge protocols after stroke, acute coronary syndrome and heart procedures. Home‑based care has significant potential for development across the region and could support the implementation of these innovations across the region.
Strengthening governance structures by breaking down silos across administrative systems in health and social care is one key aspect. Financial incentives to healthcare providers have been associated with measures of enhanced access and increased quality of care (Flodgren et al., 2011[85]; Heider and Mang, 2020[86]). Furthermore, primary care‑oriented health systems, with General Practitioners (GPs) as gatekeepers, stronger financial incentives directed to GPs and better care continuity, have been associated with lower avoidable hospitalisations in a previous OECD analysis (OECD/The Health Foundation, 2025[87]). Various European countries are strengthening governance models, changing legal frameworks and piloting the systematic collection of integrated cardiovascular care indicators to enhance cardiovascular care integration (Table 1.2).
|
Country |
Strengthening governance models |
Changes in legal framework |
Systematic collection of integrated CV care indicators |
|---|---|---|---|
|
Austria |
In development |
In development |
In development |
|
Croatia |
N/A |
N/A |
N/A |
|
Czechia |
N/A |
N/A |
N/A |
|
Estonia |
In development |
In development |
In development |
|
Finland |
N/A |
N/A |
N/A |
|
France |
In development |
In development |
Fully implemented |
|
Germany |
N/A |
N/A |
Fully implemented |
|
Ireland |
In development |
N/A |
In development |
|
Latvia |
In development |
In development |
In development |
|
Luxembourg |
In development |
In development |
In development |
|
Netherlands |
In development |
In development |
In development |
|
Slovenia |
N/A |
N/A |
N/A |
|
Sweden |
In development |
Fully implemented |
N/A |
|
Iceland |
N/A |
N/A |
N/A |
|
Norway |
In development |
In development |
In development |
|
Canada |
N/A |
N/A |
N/A |
|
Japan |
Not implemented |
Not implemented |
Not implemented |
|
Türkiye |
N/A |
N/A |
N/A |
|
United Kingdom |
In development |
Fully implemented |
In development |
Note: N=19 EU+2 and OECD G20 countries (Austria, Canada, Croatia, Czechia, Estonia, Finland, France, Germany, Iceland, Ireland,
Japan, Latvia, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, Türkiye, the United Kingdom). N/A: information not available.
Source: 2025 OECD Cardiovascular Policy and Data Survey.
CVD is the leading cause of death and disability in the EU, with persistent and widening inequalities across regions, genders, and socio-economic groups. While decades of progress in prevention and treatment have contributed to declining mortality, these gains have slowed – and in some countries reversed – particularly following the COVID‑19 pandemic. Central and Eastern European EU countries continue to bear a disproportionate burden, with higher premature mortality, lower treatment coverage, and greater reliance on informal care. The growing prevalence of metabolic and behavioural risk factors, compounded by population ageing and rising multimorbidity, underscore the urgency of co‑ordinated, system-wide responses.
To address these challenges, scaling up proven, cost-effective interventions across the full continuum of care – from prevention and early detection to acute treatment, rehabilitation, and long-term management – will be crucial for EU countries. Strengthening primary care, improving medication adherence, expanding access to rehabilitation, and investing in digital health infrastructure are critical levers for improving outcomes. Equally important is the need to address disparities, integrate patient-centred approaches, and leverage data for real-time monitoring and international benchmarking. A renewed commitment to equity, resilience, and cross-sector collaboration will be essential to reduce the burden of CVD and improve cardiovascular health for all people living in Europe.
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