Development and rollout of a national plan on cardiovascular health. Spain's cardiovascular health strategy (ESCAV).

Abstract

Introduction and objectives: Cardiovascular disease (CVD) remains the leading cause of death in most countries; however, few specific political actions have been implemented to increase cardiovascular health at the national or international level. We aimed to describe the methodology used for the development and initial rollout of Spain's Cardiovascular Health Strategy of the National Health System (ESCAV, Estrategia en Salud Cardiovascular del Sistema Nacional de Salud).

Methods: A multidisciplinary team comprising all relevant stakeholders developed a national strategy to reduce the burden of CVD in Spain. The team used qualitative methodologies to identify and select priorities and design strategic map models.

Results: The strategy was structured within a matrix composed of 6 cross-cutting themes (citizen empowerment; health promotion, prevention, and early CVD detection; comprehensive management of acute and chronic CVD; health care coordination; equity; and knowledge management) and 4 longitudinal lines (ischemic heart disease, heart failure, arrhythmias, and valve disease). These were framed by 3 overarching axes: continuity of care, patient safety, and leveraging of information systems. A total of 27 critical points were selected, leading to the definition of 99 strategic objectives (32 general and 67 specific) and 136 actions through iterative reviews and prioritization. Strategic maps were developed for the overall strategy and for each action line, incorporating 61 indicators to facilitate and monitor the development of the strategy.

Conclusions: ESCAV is one of the most ambitious initiatives to change a nation's cardiovascular health. The steps taken and the methods used to develop this strategy may serve as a valuable reference for other countries seeking to implement similar initiatives. In addition, it may provide an incentive to advance efforts toward establishing a European plan for cardiovascular health.