Closing Europe’s Cardiovascular Implementation Gap: A Critical Review of the Safe Hearts Plan and the Cyprus Test Case

Abstract

Cardiovascular disease remains Europe’s leading cause of death and disability despite strong evidence for prevention, risk-factor treatment, early detection, rehabilitation, and secondary prevention. This critical narrative review evaluates the European Safe Hearts Plan as a proposed framework for organising cardiovascular care and policy. Its value will depend on whether European priorities can be converted into national plans, dedicated financing, primary-care risk assessment, specialist pathways, rehabilitation, interoper-able registries, digital governance, and equity monitoring. We synthesise evidence from clinical guidelines, epidemiological and economic studies, screening trials, rehabilitation research, digital-health and artificial intelligence literature, registry initiatives, envi-ronmental cardiovascular evidence, and implementation-science frameworks. The central challenge is not a lack of effective interventions but their uneven organisation across health systems. Established interventions should be standardised and audited, whereas screening technologies, artificial intelligence, precision medicine, and digital follow-up require governed implementation and prospective evaluation. Cyprus is discussed as a bounded test setting because its universal coverage, national scale, developing digital infrastructure, and academic-clinical links could make feasibility, adoption, costs, equity effects, and transferability observable before wider European adaptation. The Plan should ultimately be judged by measurable improvements in cardiovascular delivery, equity, rehabilitation, data quality, and outcomes, rather than by endorsement alone.