Changes from plenary report to adopted text

59. Recognises long-term exposure to environmental noise from road, rail and air traffic as a significant but under-addressed cardiovascular risk factor; calls for strengthened noise reduction policies in order to reduce harmful noise levels and protect health and well-being across the EU through urban planning, transport regulation and enforcement of current EU legislation; underlines that sufficient funding of nature-based solutions, which can have a positive impact on health, should be considered as part of the One Health perspective;

60. Calls on the Commission and the Member States to address the significant health risks arising from air, soil and water pollution; highlights that methane and ammonia are contributors to harmful air pollution, which is associated with reduced lung function, systemic inflammation and increased cardiovascular morbidity and mortality;

II. Early detection and diagnosis

61. Welcomes the announced Council recommendation on health checks for cardiovascular diseases; stresses that any EU guidance must be evidence-based, effective, focused on the needs of patients, healthcare professionals and carers and the problems they face, and accompanied by clear benchmarks and indicators, and must reduce inequalities and avoid low-value practices; notes that this guidance should be risk-stratified and include integrated referral pathways from primary care to follow-up secondary care for CVD and its comorbidities; highlights, furthermore, that such guidance must include recommendations on implementation, including active cross-border cooperation and quality assurance dispositions, to ensure effective coverage of at-risk populations; calls for the implementation in the Member States of the announced Council recommendation on health checks for cardiovascular diseases, while respecting their competences and emphasises the importance of promoting education and training for healthcare professionals on the early detection of CVD, with appropriate consideration of gender-specific differences;

62. Calls on the Commission to ensure adequate financial support for Member States for the implementation of the Council recommendation on health checks for cardiovascular diseases; stresses that this financial support should be appropriate for and proportional to the scale of the burden of CVDs;

63. Believes that early detection of CVDs should be pursued through an integrated, cross-disease approach that recognises interlinkages between cardiovascular and other NCDs and their shared risk factors; points out that such broad prevention and early detection strategies addressing CVDs and other NCDs can empower patients to better understand and manage their health and can help to prevent premature mortality;

64. Is concerned about the number of misdiagnosed cardiovascular events and calls on the Member States to better train health professionals on possible symptoms, including in emergency services; underlines the importance of national healthcare systems introducing standardised protocols to better detect cardiovascular events; highlights the need for regional and local health infrastructures and hospitals to provide specialised services for cardiovascular events and to ensure that patients can get swift access to such services in order to prevent misdiagnosis and ensure adequate treatment;

65. Stresses that early prevention and detection should prioritise targeted, risk-based approaches supported by validated risk prediction models in primary care, including through screening where appropriate; emphasises the need to focus on risk factors such as tobacco consumption, harmful alcohol consumption, particularly at levels exceeding scientifically established health recommendations, obesity, insufficient physical activity, hypertension, menopause, family history and dyslipidaemia; underlines that individuals living with conditions such as chronic kidney disease, diabetes, obesity, chronic obstructive pulmonary disease, metabolic dysfunction-associated steatotic liver disease and chronic anaemia, as well as women with adverse pregnancy outcomes, should be systematically screened for CVD, while ensuring effective referral systems and long-term follow-up pathways; highlights that CVDs are often detected only after major events such as heart attack or stroke;

66. Underlines that early detection is often missed, especially in underserved and high-risk populations; calls on the Member States to ensure equitable access to diagnostics, paying particular attention to underserved areas and to women;

67. Underlines the essential role of secondary prevention for individuals who have experienced a cardiovascular event, including systematic risk-factor management, medication adherence, lifestyle and mental well-being support and regular clinical review to reduce the risk of recurrence;

68. Draws attention to the substantial underdiagnosis of inherited, genetic and congenital cardiovascular conditions in the EU, including cardiomyopathies, channelopathies, familial hypercholesterolaemia, type 1 diabetes, aortopathies, connective tissue disorders and congenital heart disease; stresses that dyslipidemias such as familial hypercholesterolemia, elevated lipoprotein (a) and hyperglycaemia contribute substantially to cardiovascular risk; calls on the Member States to ensure equitable access to diagnostics and to support early detection of genetic conditions from the school age of children, where there is clear scientific evidence of clinical benefit, while fully respecting ethical principles, informed consent and data protection requirements; stresses that when CVDs with a genetic predisposition are detected, family/cascade screening should be provided;

69. Calls for the announced Council recommendation on health checks for CVDs to include clear guidance on comprehensive cardiovascular risk assessments and on providing health checks at an appropriate age to individuals with at least one risk factor, including those with a family history of premature CVD; also calls for clear guidance on systematic monitoring and follow-up of individuals with elevated or abnormal findings, including integrated pathways to care;

70. Stresses that persons with multiple modifiable cardiovascular risk factors should be offered comprehensive and accessible support to change their lifestyle behaviours with the assistance of appropriately trained lifestyle medicine specialists or equivalent healthcare professionals;

III. Treatment, care and rehabilitation

71. Underlines that people living with CVD must have timely and affordable access to high-quality, integrated, evidence-based and guideline-based care along the full disease care pathway, including to treatment control and adherence support, as well as appropriate diagnostics and therapies, irrespective of place of residence; recommends a possible cautious use of treat-to-target management frameworks, while avoiding low-value care and ensuring a person-centred, risk-based approach in line with WHO guidance; stresses that cardiac rehabilitation, occupational rehabilitation, integrated nutritional care, physical rehabilitation and social reintegration are integral components of effective cardiovascular care; notes that, in several Member States, access to rehabilitation services remains limited and emphasises the need to guarantee access to these services to all; stresses the need for dedicated age-appropriate rehabilitation centres;

72. Welcomes the announced Council recommendation on personalised treatment and monitoring of cardiovascular diseases, which will improve the quality and consistency of personalised and integrated care pathways;

73. Calls on the Member States to create comprehensive, standardised national cardiovascular care protocols for long-term care pathways, embedding multi-disease, multidisciplinary team models to enable proactive management of interconnected NCDs, ensure smooth care transitions and deliver truly patient-centred care throughout the continuum of cardiovascular risk, diagnosis, treatment and rehabilitation; stresses that such pathways are essential to ensure continuity of care, reduce avoidable complications and hospital readmissions, and improve long-term outcomes for people living with CVD; stresses the need for more streamlined care pathways for reproductive and maternal health and CVD services; calls for the Member States and local and regional authorities to be supported in expanding access to multidisciplinary rehabilitation services;

74. Stresses the need for care and treatment to incorporate the latest scientific evidence; calls on the Member States to incorporate high-quality, innovative treatments into healthcare strategies and to make such treatments more accessible;

75. Calls on the Commission and the Member States to support wider deployment of and access to cardiopulmonary resuscitation (CPR) training and public awareness programmes, including for children and young people, as an essential component of strengthening CVD emergency preparedness and response; calls for strengthened EU support to improve survival following out-of-hospital cardiac arrest, including mandatory CPR and automated external defibrillator (AED) training in schools and workplaces; calls on the Member States to strengthen policies ensuring wide, visible and 24/7 accessible deployment of AEDs in public spaces and high-traffic settings and calls for the development of national AED mapping and maintenance systems and for the integration of AED location data into emergency dispatch systems;

76. Calls for the strengthening of the cross-border European transplant information system, especially for rare and congenital CVDs;

77. Calls for the creation of a European network of cardiovascular centres of excellence, including stroke and heart units, as specialised, multidisciplinary institutions, operating under the Cross-Border Healthcare Directive; stresses that these centres should act as national and regional hubs to improve access to high-quality, multidisciplinary care, reduce time to treatment and strengthen hospital capacity; emphasises their potential role in promoting common standards and best practices, facilitating access to clinical trials and optimising clinical development; highlights their potential contribution to implementing comprehensive, patient-centred care pathways and allowing for the translation of research into practice through multi-stakeholder collaboration, including public-private partnerships;

78. Emphasises the importance of integrating mental health support as a component of comprehensive physical and psychological rehabilitation for patients living with chronic cardiovascular conditions and for those recovering from serious cardiovascular events;

79. Emphasises that uninterrupted access to safe, effective and affordable medicines and medical devices for CVDs is a prerequisite for continuity of care and favourable health outcomes; stresses that unequal access to essential cardiovascular medicines remains a major barrier to effective treatment and secondary prevention; calls for EU-level action, within the EU’s existing competences, to support affordability, availability and security of supply and underlines the importance of the forthcoming Critical Medicines Act in contributing to addressing those issues;

80. Stresses that delayed or absent treatment of structural heart disease significantly impairs quality of life and accelerates functional decline, frailty and loss of independence in older people; underlines that timely diagnosis and access to appropriate treatment are essential to preserve autonomy, reduce avoidable hospitalisations and support healthy and active ageing;

81. Stresses the growing threat of health workforce shortages in the Member States and underlines that the uneven distribution of general practitioners (GPs), especially in rural and disadvantaged areas, limits access to prevention and early detection of CVDs; calls for actions to improve the attractiveness of healthcare careers, which could include improved working conditions, adequate wages, training, retention measures and multidisciplinary team-based care, with strong primary care as the backbone; highlights the importance of technology and digital tools in enhancing efficiency, by reducing workload pressures and administrative burdens, and in increasing the attractiveness of healthcare careers; calls on the Commission and the Member States to enhance support mechanisms to improve retention and reverse mobility trends of cardiovascular medical personnel in areas affected by chronic shortages, including through targeted incentives and investments in working conditions, continuous training and attractive career pathways;

82. Underlines the importance of ensuring timely and equitable access to palliative care for people living with advanced CVD; calls for adequate training of healthcare professionals in the principles of palliative care in order to promote dignity, quality of life, and people-centred and gender-sensitive care throughout the life course;

83. Stresses that CVDs cause substantial disability affecting the work and quality of life of patients and their informal carers, as well as the ability of patients to live independently; calls on the Member States to devise care strategies addressing workplace reintegration measures and psychosocial and peer support for patients and their families;

IV. Role of primary care and community-based services in cardiovascular prevention and risk reduction

84. Highlights the crucial role of strong integrated primary healthcare systems and community-based services, including hospital and community pharmacies, in prevention, early detection and long-term risk reduction of CVD and its interconnected risk factors, particularly in underserved rural and deprived urban areas;

85. Calls on the Commission, in cooperation with the Member States, to support targeted pilot actions in high-burden and underserved areas, bringing together primary-care-led, risk-based checks, prevention offered by community services, telemedicine support, mobile diagnostic services and clear referral and follow-up pathways, with a view to evaluating impact and enabling effective models to be scaled up across the EU;

86. Calls for strengthened collaboration between primary care and cardiovascular specialist services to optimise interventions for the effective prevention and reduction of cardiovascular risk;

87. Calls on the Member States to adequately resource primary care infrastructure, multidisciplinary teams and preventive services, including access to essential diagnostic tools and digital infrastructure supporting screening, early detection and follow-up; encourages the Member States to reduce out-of-pocket payments, where appropriate, for essential cardiovascular prevention and care services, as high levels of direct payments by patients may constitute a major barrier to access to cardiovascular prevention and treatment, particularly for low-income households; stresses that early detection and preventive care should be affordable, including for low-income households; highlights the role of primary care in supporting adherence to cardiovascular treatments;

88. Stresses that early detection and prevention largely occur at the primary care level, where GPs are often the first point of contact for patients; highlights that GPs and primary care providers play a key role in assessing lifestyle-related risk factors and in providing evidence-based guidance on the type and frequency of physical activity individuals need to maintain or improve cardiovascular and overall health;

89. Emphasises that secondary prevention is essential for individuals who have experienced a cardiovascular event; highlights that secondary prevention encompasses structured risk-factor management, ensured medication adherence, targeted lifestyle support and regular clinical monitoring to minimise the risk of recurrence;

90. Stresses the importance of strengthening the capacity of primary care providers to carry out brief interventions as part of routine clinical practice for cardiovascular risk reduction, including through the adoption of the Five As approach (ask, assess, advise, assist, arrange), to facilitate behaviour change related to major CVD risk factors;

91. Stresses the critical need for robust intensive care capacity within any EU cardiovascular strategy to manage acute cardiovascular events, such as cardiac arrest, cardiogenic shock and acute heart failure, through embedded regional intensive care unit (ICU) networks; expresses concern regarding the acute ICU staffing shortages, which are a barrier to high-acuity cardiovascular emergency response, and calls for targeted support, including mental health support, enhanced retention strategies and specialised multidisciplinary training, to sustain front-line capacity;

92. Calls on the Member States to strengthen community-based cardiovascular and emergency response capacity, including access to life-saving equipment, coordination with primary care and emergency services, and the development of local response networks, to reduce inequalities in survival and outcomes of acute cardiovascular events;

93. Calls on the Commission and the Member States to recognise the essential role of civil society health organisations and patient organisations in CVD prevention, awareness-raising, peer support, patient empowerment and policy development; stresses that the continuity, independence and effectiveness of their work rely on adequate, sustainable and transparent public funding;

94. Calls for the role of specially trained healthcare professionals in cardiovascular prevention, early detection and selected treatment tasks to be recognised and supported, as these healthcare professionals can partly compensate for the lack of cardiologists, including in rural areas; calls for the role of voluntary and community-based psychological support for cardiovascular patients to be formally recognised and appropriately supported; recognises the important role of psychological support in helping to address certain cardiovascular risk factors and aiding recovery; emphasises the role of community-led care in tackling social exclusion, low health literacy, stigma and access barriers, which worsen the impacts of CVD on vulnerable groups;

V. Multimorbidity

95. Stresses that CVDs frequently coexist with other chronic conditions, including diabetes, obesity, chronic kidney disease, rheumatic and musculoskeletal diseases, pulmonary conditions including lung and respiratory diseases, metabolic dysfunction-associated steatotic liver disease , skin diseases, obstructive sleep apnoea, anaemia, chronic insomnia, and mental health and reproductive health conditions, as well as cancer and cancer survivorship, which significantly increase cardiovascular risk, complicate treatment and worsen health outcomes; underlines that addressing CVD in isolation is insufficient to reduce morbidity and mortality; stresses that prevention and control of these conditions could constitute a cost-effective way to contribute to the prevention of cardiovascular health problems; recognises the importance of ensuring equitable and timely access to treatment and therapeutic innovation in the area of CVD;

96. Stresses that diabetes significantly increases morbidity, mortality and healthcare costs; underlines that fragmented policy approaches addressing CVD and diabetes in isolation risk undermining prevention, early detection and long-term management outcomes; calls on the Member States to ensure that national cardiovascular health plans include a comprehensive diabetes component, or are clearly aligned with existing national diabetes strategies; stresses that special attention must be paid to children and adolescents diagnosed with type 1 diabetes and, increasingly, type 2, who face a lifelong disease burden and an elevated risk of early cardiovascular complications and mortality; stresses that diabetes and obesity are major drivers of CVD and share common risk factors and biological mechanisms; underlines that effective prevention and management of diabetes and obesity are essential components of CVD prevention and care, including through early detection, long-term management and lifestyle support; stresses that effective obesity and CVD management can be hindered by the lack of awareness of obesity as a chronic disease or a fragmented policy approach to obesity care pathways;

97. Highlights the strong and bidirectional relationship between chronic kidney disease and CVD; stresses that kidney disease is frequently underdiagnosed in people with cardiovascular risk factors and is associated with increased cardiovascular morbidity and mortality; calls for better integration of kidney health into cardiovascular risk assessment and care pathways;

98. Stresses that chronic obstructive pulmonary disease (COPD) is a frequent and serious comorbidity in people living with CVD; stresses that COPD and CVD share major risk factors, such as tobacco use, air pollution and socio-economic disadvantage; underlines that COPD significantly increases cardiovascular morbidity, mortality and hospitalisations;

99. Highlights that aortic diseases, including aortic aneurysms and aortic dissections, are severe and often underdiagnosed cardiovascular conditions closely linked to hypertension, smoking, genetic disorders and ageing; stresses that delayed detection of aortic disease is associated with high mortality and avoidable emergency interventions; calls for improved awareness, timely diagnosis and appropriate referral pathways for aortic disease within cardiovascular prevention, early detection and long-term care strategies;

100. Draws attention to metabolic dysfunction-associated steatotic liver disease as a highly prevalent yet under-recognised comorbidity in people living with CVD, diabetes and obesity; underlines that metabolic dysfunction-associated steatotic liver disease, particularly in the presence of liver fibrosis, is an independent predictor of myocardial infarction, stroke and heart failure, and that in people with type 2 diabetes it can increase cardiovascular risk up to fourfold;

101. Calls on the Commission to ensure that the upcoming Council recommendation on personalised treatment and monitoring of CVDs provides clear guidance to Member States on the development of integrated prevention and disease management programmes that incorporate diabetes and obesity care, including weight management, within cardiovascular prevention protocols;

102. Stresses that chronic inflammatory skin diseases, including psoriasis, atopic eczema and acne, are associated with an increased risk of cardiovascular and cerebrovascular diseases due to shared systemic inflammatory mechanisms; underlines the importance of integrating cardiovascular risk assessment into dermatology care pathways;

103. Stresses that cardiomyopathies, as a heterogeneous group of often inherited heart muscle diseases, can affect people of all ages and are a significant cause of heart failure, arrhythmias, stroke and sudden cardiac death; stresses that cardiomyopathies remain underdiagnosed and are frequently identified only after serious or life-threatening events;

104. Stresses that rare CVDs affecting children represent a major cause of morbidity; stresses that delayed diagnosis and fragmented care during childhood can lead to preventable complications, disability and premature mortality across the life course; calls on the Commission and the Member States to strengthen early detection, specialised paediatric referral pathways and seamless transition from paediatric to adult care, including through European Reference Networks;

105. Highlights the growing burden of heart failure and other chronic heart diseases linked to population ageing; stresses that early diagnosis, continuity of care and access to multidisciplinary healthcare teams are essential to improve quality of life, reduce avoidable hospitalisations and strengthen long-term disease management;

106. Underlines that people living with CVD and coexisting chronic conditions often experience fragmented and poorly coordinated care, including immunisation services, resulting in delayed diagnosis, inconsistent treatment and avoidable complications;

107 Stresses that, to effectively tackle CVDs and related comorbidities, healthcare systems must move away from siloed approaches towards integrated prevention and care, in order to improve outcomes, optimise resource use and strengthen clinical management through EU funding, cross-country collaboration, training and the exchange of best practice;

108. Stresses the need to strengthen the competencies of healthcare professionals to help them manage CVD in the context of coexisting chronic conditions; calls on the Member States to ensure training in comprehensive risk assessment, medication management and shared decision-making for primary care providers;

109. Calls for the development of integrated, person-centred care pathways for people living with CVD and coexisting chronic conditions, ensuring coordination between primary care, specialised care and community services, and supporting continuity of care over time at Member State and EU level;

VI. Reducing inequalities

110. Stresses that the burden of cardiovascular and other major non-communicable diseases is unevenly distributed among and within Member States, resulting in persistent inequalities in morbidity, mortality and quality of life; underlines that these disparities are closely linked to socio-economic status, geography, gender, age, access to healthcare services, affordable healthy food, safe and accessible spaces for physical activity, and availability of health promotion and prevention education;

111. Calls on the Commission and the Member States, within their respective competences, to make the reduction of cardiovascular health inequalities a measurable objective of EU health policy and therefore welcomes the Commission’s flagship initiative to develop an EU cardiovascular health inequalities dashboard, modelled on the European Cancer Inequalities Registry; stresses that such a dashboard must be based on up-to-date, comparable and disaggregated data provided by Member States, and should go beyond headline health outcomes by systematically monitoring the implementation of measures addressing social and environmental determinants of health, in order to ensure accountability, evidence-based policymaking and transparent tracking of progress in reducing cardiovascular health inequalities across the EU; stresses that the data collected should also be reflected in the State of Health in the EU reports and Country Health Profiles and be considered in the formulation of the European Semester recommendations for Member States; underlines that transparent and standardised reporting will facilitate comparison across Member States and support the EU’s objective of reducing the burden of CVD;

Women’s underdiagnosis and the gender gap

112. Stresses that CVDs in women are frequently underdiagnosed and diagnosed too late or misdiagnosed on account of gender-specific risk factors, persistent gender bias, atypical symptom presentation and outdated diagnostic criteria, with women living with type 1 diabetes facing up to a tenfold higher risk of premature CVD at a younger age; calls for systematic training of healthcare professionals to improve understanding and recognition of gender-specific cardiovascular symptoms and to reduce diagnostic delays that increase morbidity and mortality; underlines the importance of improving the detection and management of congenital heart diseases in women and of strengthening cardiovascular screening and monitoring during pregnancy and the perinatal period in order to identify risks at an early stage;