Spanish Cardiovascular Health Strategy (ESCAV): an inspiration for Europe


The approval of the ESCAV in 2022 entailed an important milestone in the cardiovascular health policy framework in Spain, providing a favourable ground for the Ministry of Health to prioritize cardiovascular health with concrete actions in coordination with the Autonomous Communities. The strategy brings a change of paradigm on the approach to cardiovascular health, covering 4 diseases: ischemic heart disease, heart failure, heart valve disease (a key form of structural heart disease) and arrhythmias. This experience should inspire action in other European countries as the first strategy that covers early detection of SHD specifically.

The new Spanish Cardiovascular Health Strategy (ESCAV), published in 2022, was developed with the collaboration and participation of patient representatives, health professionals, scientific societies, researchers and Autonomous Communities, as a continuity and extension of the Ischemic Heart Disease Strategy of 2007.

The Strategy, divided into several sections, including disease-specific ones, incorporates a total of 130 specific actions to be implemented. The main goals of the Strategy focus on improving health outcomes, equity and sustainability of the NHS, greater autonomy and empowerment of the agents involved, improvement of processes, availability of resources and knowledge management.

Amongst these actions, the Strategy includes a specific chapter on heart valve disease, setting out as a critical point the promotion of early diagnosis and detection of prevalent forms of HVD. In this regard, the Strategy includes three specific objectives: i) to propose the systematic performance of cardiac auscultation in the population over 65 years of age; ii) to analyse the evidence of echocardioscopy by non-cardiologists in primary hospital care to identify patients with possible heart valve disease; and iii) to design protocols for the referral to hospital care of patients with suspected valve disease and for follow-up in primary care.

Furthermore, in line with these objectives, the strategy includes a series of specific actions, which are: i) to improve health professionals’ knowledge of the factors involved in the development of heart valve diseases; ii) to encourage systematic cardiac auscultation in people over 65 years old in primary care (creation of a check button in the clinical history); iii) to analyse the evidence for performing echocardioscopy in primary care to identify patients with possible heart valve disease; iv) to define common and homogeneous criteria for the referral and follow-up of patients with heart valve disease; and vi) to conduct information and training sessions for primary care health professionals on the updated protocol.

The Spanish Ministry of health has recognised through this action that cardiovascular diseases must be a political priority, since they are “the main cause of mortality and the second cause of hospitalization” in Spain – leading also the statistics at European level.

As Spanish authorities focus now on making sure that all 130 actions are implemented timely – with the involvement of the regions, as shared during a public event in the Ministry of Health on the 29th of March –, the Strategy itself must already serve as a basis for inspiration and further action in other countries.

All European governments, in their own capacities, can now look at the ESCAV as a prime example of a multi-level strategy which, counting on the participation of all relevant stakeholders, includes not only cross-cutting actions but specific ones that tackle the main cardiovascular diseases associated to age. Among these, having a specific chapter dedicated to heart valve diseases (key form of Structural Heart Disease) is particularly relevant, as it allows to include specific recommendations on early detection and secondary prevention, which are essential to tackle them.

In essence, the Spanish Strategy of Cardiovascular Health is the first national plan that specifically tackles early detection of SHD. In the context of increased European cooperation on non-communicable diseases, this example should be reviewed in detail by other health authorities and can be used as an inspiration to ensure that early detection of SHD is soon a reality everywhere in Europe.