Building a cardiovascular disease observatory in primary care in Crete, Greece: design, implementation, and lessons learned for interdisciplinary digital surveillance

Background Cardiovascular disease (CVD) remains the leading cause of mortality in Greece. Primary care is the appropriate setting for surveillance of risk factors and morbidity at the community level, with the nursing workforce being central to CVD care. However, CVD-specialist nurses are seldom embedded differentially in Greek primary care. In this context, the School of Medicine of the University of Crete and the Region of Crete launched a regional initiative to design and pilot a CVD observatory aimed at supporting digitally enabled, multidisciplinary primary care. Aim The aim of this work is to describe the design and implementation of the Cardiovascular Disease Observatory in Primary Health Care (CVD-PHC Observatory) of Crete; to reflect on the barriers, facilitators, and practical lessons that emerged during its development; and analyse the design priorities that need to be met for future efforts to meaningfully involve the nursing workforce. Programmatic elements The initiative comprised five sequential phases: (i) co-design of a structured CVD data collection instrument covering sociodemographic, behavioural, clinical, laboratory, biomarker, imaging, and treatment variables; (ii) development of a stand-alone digital recording platform with role-based access for data administrators and field recorders, supporting both real-time and asynchronous entry; (iii) recruitment and training of primary care practices across the four prefectures of Crete; (iv) 3-month pilot deployment, followed by structured feedback; and (v) subsequent 12-month deployment across the same sentinel network. Lessons learned The platform was technically feasible and usable, with 600 patient records entered during the 12-month deployment. However, its long-term value was constrained by the lack of interoperability with national e-prescription and electronic health record systems, by the burden of duplicate data entry, and by the disruption of the COVID-19 pandemic. As no CVD nurses were embedded in the participating sites, deployment was delivered by general practitioners. Thus, the manuscript reports lessons learned for future interdisciplinary efforts rather than a nursing intervention. The initiative offers transferable assets for digital CVD surveillance, interoperability, and the meaningful inclusion on cardiovascular nursing in regional health observatories elsewhere in southern Europe.