Implementation of prevention guidelines in primary healthcare: a scientific statement of the European Association of Preventive Cardiology of the ESC, the ESC Council for Cardiology Practice, the Association of Cardiovascular Nursing & Allied Professions of the ESC, WONCA Europe, and EURIPA

Abstract

This scientific statement explores the challenges and opportunities associated with implementing cardiovascular disease (CVD) prevention guidelines in primary healthcare across Europe. It identifies key barriers to adherence, including limited resources, diagnostic complexity, and inconsistencies in care delivery. Emphasis is placed on the use of practical tools such as risk assessment instruments, shared decision-making, and integrated information technology systems to support effective implementation. Particular focus is given to vulnerable populations, including individuals with multi-morbidity, to promote equitable access to prevention and care. As CVD remains the leading global cause of death, a proactive and structured preventive approach in primary care is essential to reduce its burden. Evidence-based interventions-including health monitoring, lifestyle counselling, and pharmacotherapy-play a central role in improving outcomes. While patients at high cardiovascular risk are a major focus, strategies for those at lower risk but without established disease are also needed. Promoting long-term adherence to healthy behaviours from early stages may significantly delay disease onset. However, many patients in Europe still fail to meet key prevention targets, such as optimal levels of cholesterol, blood pressure, and glucose control. Variability in implementation across regions, especially in lower-income countries, underscores the need for practical, user-friendly, and context-adapted guidelines. Coordinated care models involving multiple disciplines and sectors, supported by leadership and digital tools, are critical. The statement also highlights three specific areas of interest for improving CVD prevention in primary care: chronic venous disease, lipoprotein(a) management, and cardiovascular risk in patients with inflammatory rheumatic diseases.

Keywords: Cardiovascular diseases; Evidence-based medicine; Guideline adherence; Health disparities; Multi-morbidity; Patient-centred care; Preventive health services; Primary health care; Risk assessment; Telehealth.