Optimising the EU Cardiovascular Health Check Protocol
The Case for Systematic Auscultation and ECG for SHD
Summary
Cardiovascular disease remains the leading cause of mortality and disability across Europe, and structural heart diseases such as aortic stenosis and mitral regurgitation affect over 14 million Europeans. Many of these conditions develop silently, with symptoms recognized only late, and early detection remains inconsistent across Member States.
The EU Safe Hearts Plan presents a vital opportunity to establish a standardised, evidence-based Heart Health Check Protocol that integrates cardiac auscultation and ECG alongside blood tests, addressing the silent progression of SHD and helping to reduce health inequalities across Member States.
The paper draws on the 2025 ESC/EACTS guidelines on valvular heart disease and on programmes already running in Europe, from the Madrid region and the NHS Health Check to the JACARDI pilot projects, to show that systematic auscultation in primary care is feasible.
Our recommendations
Include auscultation and ECG in the Health Check Protocol
The EU Safe Hearts Plan must explicitly include cardiac auscultation and ECG within its Health Check Protocol as standard components alongside blood testing.
A standardised health history
Symptoms, risk factors and lifestyle factors collected with a standardised set of tools, for consistency and data comparability across Member States.
Systematic auscultation for people aged 65 and over
Cardiac auscultation every two years for all citizens aged 65+, in the standard valve areas and in multiple positions, with basic standardised training for primary care professionals.
Minimum diagnostic tests
Routine blood tests, including cardiac biomarkers where indicated, and an ECG for patients with symptoms, murmurs or an irregular pulse.