Changes from report parliamentary committee draft to plenary report

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

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Changed29.84. Highlights the crucial role of strong integrated primary healthcare systems and community-based servicesservices, inincluding cardiovascularhospital diseaseand community pharmacies, in prevention, early detection and long-term risk reduction,reduction of CVD and its interconnected risk factors, particularly in underserved rural and deprived urban areas;

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Removed30. Calls on the Member States to adequately resource primary care infrastructure, multidisciplinary teams and preventive services, and stresses that early detection and preventive care should be financially accessible and, as far as possible, free;

Added85. 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;

Added86. Calls for strengthened collaboration between primary care and cardiovascular specialist services to optimise interventions for the effective prevention and reduction of cardiovascular risk;

Added87. 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;

Added88. 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;

Added89. 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;

Added90. 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;

Added91. 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;

Added92. 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;

Added93. 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;

Added94. 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

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Changed31.95. Stresses that cardiovascular diseasesCVDs frequently coexist with other chronic conditions, including diabetes, obesity, chronic kidney disease, rheumatic and musculoskeletal diseasesdiseases, 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 cardiovascular diseaseCVD 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;

Change 21

Removed32. Underlines that people living with cardiovascular disease and coexisting chronic conditions often experience fragmented and poorly coordinated care, resulting in delayed diagnosis, inconsistent treatment and avoidable complications;

Added96. 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;

Removed33. Stresses the need to strengthen the competencies of healthcare professionals to manage cardiovascular disease in the context of coexisting chronic conditions, including training in comprehensive risk assessment, medication management and shared decision-making;

Added97. 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;

Added98. 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;

Added99. 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;

Added100. 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;

Added101. 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;

Added102. 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;

Added103. 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;

Added104. 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;

Added105. 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;

Added106. 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;

Added107 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;

Added108. 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;

Added109. 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

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Changed34.110. 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 andage, access to healthcare services;services, affordable healthy food, safe and accessible spaces for physical activity, and availability of health promotion and prevention education;

Change 23

Added111. 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

Change 24

Changed35.112. Stresses that cardiovascular diseasesCVDs 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;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 recogniseimprove 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;

Change 25

Removed36. Stresses the urgent need to address the under-representation of women in cardiovascular research and clinical trials; calls for adequate funding for gender-specific cardiovascular research, including research on female-specific risk factors related to pregnancy, menopause and hormonal influences;

Added113. Highlights that women living with diabetes and other metabolic diseases are, on average, diagnosed up to 4.5 years later than men; emphasises that this delay in diagnosis increases women’s risk of cardiovascular mortality by approximately 30 %; stresses that delayed diagnosis results in delayed access to timely and appropriate care, further increasing the risk of cardiovascular complications and exacerbating existing cardiovascular health inequalities among women;

Added114. Calls on the Commission and the Member States to integrate a gender-responsive approach into cardiovascular health policies across prevention, early detection, diagnosis, treatment and rehabilitation, including through targeted awareness campaigns on gender differences in CVDs, on the atypical symptoms that women face in cardiovascular health, and on access to cardiovascular risk assessment for women across the life course; further calls on the Commission and the Member States to institutionalise gender-specific diagnostic protocols; call for the implementation of clinical training for healthcare professionals on gender-specific differences in pathophysiology and treatment response;

Added115. Calls on the Commission and the Member States to integrate female-specific conditions into cardiovascular risk assessment and management as part of standard care for affected women; calls for the monitoring of cardiovascular risk factors exclusive to women, such as early menopause, whether natural or induced, the use of oral contraceptives, prolonged exposure to endogenous oestrogens, polycystic ovary syndrome, endometriosis, gestational diabetes, and hypertensive disorders of pregnancy, all of which should be addressed specifically; underlines that preterm births are also a risk factor for developing CVDs, as they reflect placental insufficiency and indicate endothelial dysfunction; highlights the increased cardiovascular risk in transgender women who have undergone hormone therapy; calls for the systematic integration of reproductive history and life-course factors, including age at menarche, infertility, adverse pregnancy outcomes, breastfeeding history, and the menopause transition, into cardiovascular risk assessment and management as part of standard care for women;

Added116. Calls on the Commission to publish gender-sensitive clinical guidelines and to introduce strengthened requirements for the inclusion of women in publicly funded cardiovascular research; calls on the Commission to include gender-disaggregated data collection, analysis and reporting mandatory in all EU-funded cardiovascular research, programmes and digital health initiatives, with a view to systematically identifying diagnostic gaps and eliminating gender bias in cardiovascular care;

Added117. Stresses that reproductive and maternal health are intrinsically connected to cardiovascular health and calls for a reversal in the chronic underinvestment in research on female-specific conditions, including reproductive, gynaecological and maternal health issues;

Added118. Stresses the urgent need to address the under-representation of women in cardiovascular research and clinical trials through the inclusion of clear strategies to improve gender parity in study design, recruitment and analysis, including gender-disaggregated reporting and adequate representation of women across all age groups and life stages; further demands that all medical device authorisations for interventional cardiology and electrophysiology be based on gender-disaggregated data; calls for adequate funding for gender-specific cardiovascular research, including research on female-specific risk factors related to pregnancy, menopause and hormonal influences; emphasises the need to expand research and prevention strategies on women’s cardiovascular symptomatology, disease progression and treatment responses, including for congenital and pregnancy-related heart conditions, in order to ensure evidence-based, gender-responsive care and to inform the development of novel health technologies;

Added119. Calls on the Member States to ensure the inclusion, within sexual and reproductive healthcare services, of routine screening for infectious diseases causing cardiac disorders for all women of reproductive age, including pregnant women; stresses that such measures contribute to preventing the development of severe cardiac disease and to interrupting the vertical transmission of infections;

Social and regional inequalities

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Changed37.120. Stresses that action to reduce cardiovascular diseaseand other related NCDs must explicitly address social and regional inequalities, such as disparities between urban and rural areas, including medical deserts, and disparities among vulnerable and marginalised groupsgroups, such as people living in poverty, migrantspeople who have lived in areas where infectious diseases that lead to cardiovascular pathologies are endemic and people in precarious employment; calls for targeted, community-based and primary-care-led interventionsinterventions, to ensure equitable access to prevention, early detection and care;care, including through measures that improve access to affordable healthy food, safe and accessible environments for physical activity, and targeted health and prevention education; highlights that limited health insurance coverage may prevent vulnerable groups from accessing cardiovascular prevention and treatment;

Change 27

Removed38. Calls for EU cohesion and structural funds to be used strategically to reduce cardiovascular health inequalities, including through investment in prevention programmes, healthcare infrastructure and health workforce capacity in disadvantaged regions;

Added121. Stresses that solidarity between Member States is essential to addressing CVD, particularly in the context of cross-border healthcare and health workforce mobility; calls on the Member States to strengthen the effective implementation of the EU framework on cross-border healthcare, in order to enable patients to access treatments and surgical interventions in other Member States when such care cannot be provided in a timely manner in the Member State in which they live;

RemovedVII. Digital health, data and artificial intelligence

Added122. Calls for cooperation with candidate and potential candidate countries to support the development of interoperable cardiovascular and cardiac arrest surveillance systems, registries and training standards, in line with EU data protection rules and recognised European and international scientific frameworks, with a view to improving preparedness, comparability and long-term integration into EU health initiatives;

Removed39. Supports digital tools and telemedicine where they complement face-to-face care and strengthen continuity and empowerment; stresses the need to avoid digital exclusion;

Added123. Calls for EU funding to be used strategically to reduce cardiovascular health inequalities, including through investment in prevention programmes, such as immunisation and healthcare screening infrastructure and health workforce capacity in disadvantaged areas, and to strengthen primary care and rehabilitation capacity, particularly in communities such as those in rural or deprived regions; stresses that reducing cardiovascular inequalities also depends on Member States’ administrative capacity to design and deliver investments; calls for strengthened technical assistance, best practice exchange and better access to EU funding for areas with persistent health and infrastructure gaps;

Removed40. Calls for strong public governance and safeguards for digital health and artificial intelligence, including transparency, accountability, clinical validation and measures to prevent bias and commercial exploitation;

Added124. Calls for the Commission to establish an EU mission on CVD prevention and inequalities, which should bring together a dedicated EU-level task force of public authorities, scientific experts, civil society and relevant industry actors, coordinated with relevant EU bodies, in order to support Member States with data, foster structured dialogue, share evidence and provide evidence-based recommendations in order to promote the development and implementation of effective and accountable measures to improve cardiovascular health and close inequality gaps;

Removed41. Calls for interoperable registries and improved surveillance, leveraging the European Health Data Space for monitoring, quality improvement and research, with a view to ensuring common standards and equitable participation across all Member States;

AddedVII. Digital health, data and AI

Added125. Supports the responsible use of digital tools, telemedicine, wearable devices and data-driven solutions in cardiovascular prevention, early detection, diagnosis, care and rehabilitation, where they complement face-to-face care; stresses that digitalisation should strengthen continuity of care, clinical decision-making and patient empowerment, while fully respecting patients’ rights, including informed consent, privacy, data protection and equitable access to care, and must not increase fragmentation of services or shift responsibility away from healthcare systems; recognises the potential of digital tools and AI in enhancing access to care in rural or remote areas; highlights the role of accessible, affordable and user-friendly medical devices and remote monitoring tools in secondary prevention; stresses the need to enhance digital and health literacy among the population and to avoid digital exclusion, ensuring that no patient is disadvantaged by their age, socio-economic status or digital skills; highlights the potential of integrated digital health solutions, including patient-centred tools and applications, to complement prevention, monitoring and long-term management of CVDs, while safeguarding patient autonomy and choice; notes that experiences from EU-supported digital cancer care and survivorship projects can help to demonstrate synergies, scalability and patient empowerment across disease areas;

Added126. Calls for the Member States to consider how digital tools and AI can appropriately and safely enhance the quality of national healthcare systems; calls for EU funding measures to be leveraged, where appropriate, to support the use of such tools; stresses that the main challenge in digital and AI-based cardiovascular innovation lies not in the lack of technologies, but in the persistent gap between pilot projects and real-world implementation, as well as in ensuring their ethical use; calls on the Commission and the Member States to prioritise the careful, evidence-based integration of proven and validated digital solutions into routine care pathways, workforce training and healthcare system workflows; calls, in particular, on the Commission and the Member States to support the facilitation and uptake of portable and remote monitoring devices and AI-enabled tools in CVD prevention, early detection and management where they demonstrate clear clinical benefit and respect for patient safety and rights; highlights that digital and innovative technologies, including AI, can enhance personalised care, improve early diagnosis, reduce health inequalities and strengthen patient-centred cardiovascular healthcare;

Added127. Recognises the potential contribution of modern precision medicine to combating CVD through individually tailored prevention, diagnosis and treatment, based on the unique genetic circumstances of each individual;

Added128. Calls on the Commission and the Member States to strengthen the digital competencies of healthcare professionals by integrating dedicated training in digital cardiology, including AI-assisted diagnostics, simulation-based learning and digital literacy programmes, into both initial medical education and continuous professional development; highlights that equipping the cardiovascular workforce with these skills is essential to ensure the safe, effective and ethical deployment of emerging digital and AI-driven tools in clinical practice;