EAPC Digital Roundtable: 2021 CVD Prevention Guidelines, from scientific guidance to clinical practice

Introduction

On 27 January 2022, the EAPC Prevention Implementation Committee (PIC) invited cardiologists from the network of National CVD Prevention Coordinators (NCPCs) and EAPC Young Ambassadors to a 90-minute online meeting. Physicians from 13 of the 16 invited countries with the highest age-corrected cardiovascular mortality participated (see country list below). The Chairperson of the CVD Prevention Guidelines Task Force and some members of the EAPC Board also joined the meeting.

As the meeting was conducted online and well arranged by the EAPC Team, it was a low-cost and environmentally-friendly event, set to minimally interfere with the duties of the participating physicians.

Objective of the meeting

The aim of the meeting was to inquire about progress in the implementation of the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice (1) since the publication in the European Heart Journal in autumn 2021. Each of the 13 cardiologists was asked to give a 5-minute slide presentation on four core questions regarding the implementation of the 2021 guidelines. A standardised format was used in order to enable comparison between the 13 countries.

Four core questions

First question: Have any actions been taken?

On the first question “Have any actions been taken regarding the new guidelines, if so, which ones?” 12/13 countries reported publication in national journals, meetings for cardiologists and other healthcare practitioners. In several countries, separate meetings for primary care physicians were arranged and a wide range of further activities were planned.

Second question: Which obstacles are being encountered?

On the next question “What are at present the main obstacles for implementation of the guidelines?” all reported significant difficulties due to the COVID-19 pandemic. It was obvious that the interest for preventive cardiology was limited among politicians and other decision makers, they had at present a different focus. The high cost of lipid lowering medication, costs not covered by insurance, and lack of time for physicians, especially family doctors, were among the main concerns. Even low health awareness in the general population remained a serious challenge in almost all participating countries with a high premature CVD death toll.

Third question: Which improvements have been made?

The third question “Any improvements since the publication, any further activities planned?” showed that translation of the guidelines has been or will be performed in most countries. Dedicated training sessions for healthcare practitioners are planned. Several colleagues are, or will be, engaged in public health campaigns to promote heart-healthy habits in line with the recommendations of the guidelines. Here, the participants underlined the importance of doctors and other healthcare practitioners being a “role model” for a healthy lifestyle.

Fourth question: How can we inspire other countries?

On the final question, “Can the implementation efforts in your country inspire other countries, if yes, how?” several NCPCs recommended broad media campaigns, especially in which national celebrities, such as persons from sports or entertainment, could be engaged in advocating healthy habits, especially among the young. Here, the use of social media could certainly be strengthened in all participating countries, a still underused resource. If any of the national campaigns turn out to be a success, the participating NCPCs agreed to share them within the NCPC network and publish information via the EAPC webpages.

Conclusion

In the final discussion, a major concern was raised and indeed shared by the participating colleagues from the 13 countries with the highest CVD mortality: “if almost all persons in my country are at high or even at very high risk, the ambitions of the 2021 guidelines may be laudable but the mountain to climb for preventive cardiology, isn’t it just too high?” The NCPCs underlined the need of a stepwise guidance approach adapted to the challenge of their country, if not there is a clear risk of “guideline fatigue”.

A short evaluation showed that the roundtable was highly appreciated by all. There was a general feeling that meetings in this low-cost and “fossil-free” format should be here to stay! Therefore, a second roundtable meeting is being prepared for the 13 countries with the next highest premature CVD mortality and will be conducted by the EAPC Prevention Implementation Committee in the coming months.

Lists

Participating countries

• Azerbaijan
• Belarus
• Bulgaria
• Georgia
• Latvia
• Lithuania
• Montenegro
• North Macedonia
• Romania
• Russian Federation
• Serbia
• Ukraine
• Uzbekistan

National CVD Prevention Coordinators and Young Ambassadors

List of all EAPC National CVD Prevention Coordinators
List of all EAPC Young Ambassadors