Romania launches cardiovascular strategy aligned with European Safe Hearts Plan

Cardiovascular (CV) and cerebrovascular diseases have prompted the most profound public health crisis of the twenty-first century across the European Union (EU), functioning as the leading cause of mortality, morbidity, and socioeconomic strain. Annually, CV diseases claim approximately 1.7 million lives within the EU and affect over 62 million citizens, generating a staggering macroeconomic burden estimated at €282 billion.1 Romania, in particular, bears a disproportionately high share of this burden, with an age-standardized CV mortality rate per 100 000 of ≥600 (which classifies Romania as a ‘very high-risk’ country), and with deaths due to CV diseases accounting for approximately 57% of all national deaths (50% in men and 63% in women).2 This reaches an annual economic burden of CV diseases in Romania of €6.42 billion.2 In response to these epidemiological realities, a major policy shift occurred at both the European and national levels. EU Council Conclusions on the Improvement of Cardiovascular Health were adopted in December 2024,3 rapidly followed by the European Commission's landmark publication of the ‘Safe Hearts Plan’ in December 2025, which serves as the first comprehensive, EU-wide strategy, dedicated exclusively to CV health.1 Meanwhile, the European Health Data Space (EHDS) Regulation entered into force in March 2025, establishing a revolutionary framework for the primary and secondary use of electronic health data, thereby providing the digital infrastructure necessary to track and optimize patient outcomes across borders.4 Using this European political context, Romania adopted its National Strategy for Combating Cardiovascular and Cerebrovascular Diseases (‘CV strategy’) for 2025–2030 in July 2025,5 launched during a Gala event on 29 September 2025 (World Heart Day). Backed by a budgeted action plan, this strategy targets a 30% reduction in CV mortality,5 which is in alignment with the National Health Strategy 2023–2030, with its main objective of decreasing the preventable mortality by at least 5%.6 Thus, Romania is the fifth country in the EU with such a strategy (after Czechia, Luxembourg, Poland, and Spain),7 but with important particularities, as follows: (i) it incorporates a strategy and an action plan for 6 years; (ii) it is comprehensive, the strategy covering five major directions, while action plan has objectives, areas for action, precise performance indicators, responsible institutions, and proposed budgets; and (iii) it is dedicated to both CV and cerebrovascular diseases. Recognizing the unsustainability of the annual financial burden, the Romanian Ministry of Health, guided by the Expert Committees of Cardiology and Neurology, engineered the CV strategy. Its framework is articulated through two highly detailed core documents: an 85-page strategic document and a 58-page action plan. Financially, implementation of the Action Plan is underwritten by a dedicated budget of approximately €204 million, over its initial six year period (2025–2030). Funding streams are heavily diversified, drawing from the National Health Insurance House, Ministry of Health, state budget, and substantial European injections via the National Recovery and Resilience Plan.5 The operational matrix of the strategy is built upon five foundational pillars, as follows: (i) risk factors, screening, and prevention; (ii) acute and chronic treatment; (iii) rehabilitation; (iv) human resources management; and (v) research, development, and innovation, anchored mainly by the national registries.5 Thus, the Romanian strategy is fully aligned with and, in fact, operationalizes the Safe Hearts Plan, which is also built on three similar key pillars across the entire cardiovascular patient pathway: (i) prevention; (ii) early detection and screening; and (iii) treatment and care, including rehabilitation.1 Romanian CV strategy incorporates also human resources management, since this is a major national problem. Thus, while Romania has 106 cardiologists per million citizens, a figure which is above the ESC median of 95, their distribution is severely skewed.8 Approximately 33% of all cardiologists are concentrated in the capital city of Bucharest, and another 44% are in other major university centres, leaving only 23% distributed in the rest of 32 counties (out of 42).5 This maldistribution leaves vast rural swathes of the country unserved, leading to catastrophic delays in door-to-balloon and door-to-needle times for acute myocardial infarction and stroke.5,9 Historically, primary prevention in Romania suffered from a reactive healthcare culture. A recent epidemiological study showed that assessment of CV risk based on SCORE2/SCORE2-OP is underestimated by the physicians in almost 70% of patients, with a low control rate of blood pressure and LDL-cholesterol (of 28.5% and 6.5%, respectively).10 CV strategy mandates sweeping preventive reforms by: implementation of standardized digital risk calculators (SCORE2 and SCORE2-OP), integrated directly into the electronic health record software; establishment of at least 20 regional prevention centres (covering at least half of the counties). The main objective of the strategy,5,6 reduction of preventable mortality, is based on the expansion of interventional cardiology and electrophysiology, since Romania performs less than half the volume of elective coronary angioplasties or electrophysiology performed in comparable countries of the region (Czechia, Poland, or Hungary).8 Thus, the CV strategy establishes aggressive targets for 2030: increase by at least 50% of the number of procedures from the existing programmes; implementation of new programmes dedicated to novel/complex procedures; reduction of time from symptoms-to-intervention by at least 20% for both acute coronary syndrome and stroke. Current infrastructure is woefully inadequate, with fewer than 10% of eligible Romanian patients accessing cardiac rehabilitation.5,6 CV strategy restructures this paradigm, aiming for: increase by at least 15% of the number of rehabilitation centres; more than 70% of patients benefit from dedicated rehabilitation, also via digital telemonitoring. One of the most transformative components of the strategy is its reliance on digital infrastructure. The CV strategy mandates the transition to: robust clinical registries (national Registry of high-risk patients, and CV registries, part of the EuroHeart project);9 dedicated centres of excellence (CE) in cardiovascular research (i.e. Search-Vasc CE, recently launched, with a budget of over 18 million Euro for 5 years). These digitalization efforts are intrinsically linked to the EHDS.4 Because the EHDS Regulation legally requires that all electronic health record systems adopt the harmonized EEHRxF by 2026, Romania's newly minted registries will be inherently interoperable on a continental scale. By 2029, Romanian researchers will be able to access massive, anonymized datasets via HealthData@EU, enabling highly complex, cross-border epidemiological studies (Figure 1). Under the CV strategy and EHDS frameworks, patient data flow seamlessly from primary care screening through acute care (USTACC = ICCU, and stroke units) into specialized rehabilitation. Anonymized data will be subsequently pooled into the HealthData@EU Infrastructure for policy planning and research Main areas of the action plan focus on: implementation of cardiology 24/7 on-call for more than 80% of the district general hospitals; increase by at least 20% of the number of dedicated ICCU and stroke units; increase by at least 10% of the number of cardiologists; national plan for attracting cardiologists in the underprivileged areas. Romanian Strategy for Combating Cardiovascular and Cerebrovascular Diseases provides a practical template for other European Union member states. By merging cardiovascular and cerebrovascular policies into a unified governance framework, the CV strategy addresses systemic access gaps, aiming to significantly reduce CV and preventable mortalities. Expert Committee of Cardiology: Dan Dobreanu, Ovidiu Chioncel, Şerban Mihai Bălănescu, Gheorghe Andrei Dan, Daniel Florin Lighezan, Diana Ţînţ, Dana Pop, Bogdan Alexandru Popescu, Dan Gaiţă, Cristian Stătescu, Călin Florin Pop, Radu Gabriel Vătăşescu, Silviu Ionel Dumitrescu, Dan Alexandru Dărăbanţiu, Ioana Şuş. Expert Committee of Neurology: Bogdan Ovidiu Popescu, Cristina Tiu, Rodica Bălaşa, Mihaela Adriana Simu, Dragoş Cătălin Jianu, Carmen Adella Sîrbu, Cristina Aura Panea, loana Raluca Mîndruţă, Florina Anca Antochi, Tudor Dimitrie Lupescu, Dan Andrei Mitrea. Working Groups of the Romanian Society of Cardiology: Dan Gaiţă, Iulia Kulcsar, Dan Dobreanu, Ovidiu Chioncel, Dana Pop, Ştefan Buşnatu, Ruxandra Jurcuţ, Adrian Mereuţă, Bogdan Alexandru Popescu. Working Groups of the Romanian Society of Neurology: Cristina Tiu, Elena Oana Terecoasă, Radu Alexandru Răzvan, Vitalie Văcăraş, Bogdan Ovidiu Popescu, Dragoş Cătălin Jianu, Adina Dora Stan, Hanna Maria Dragoş, Raluca Badea, Anamaria Truţă. D.V. has received research grants from AstraZeneca, Boehringer Ingelheim, Bayer, Amgen, NovoNordisk, Lilly, and Novartis; consulting fees from Amgen, Sanofi, Boehringer Ingelheim, and Servier; payment for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Terapia, Zentiva, AstraZeneca, and Egis; and support for attending meetings and/or travel from Servier, Sanofi, and NovoNordisk. D.M. and S.S. report serving as an unpaid honorary advisor to the Romanian health minister.