Cardiovascular Morbidity and Functional Dependency in an Ageing Europe: EU27 Projections to 2050

AIMS: To assess how population ageing and functional health trends could shape the number and proportion of older adults living with cardiovascular disease (CVD) and severe dependency in activities of daily living (ADL) across the EU27 by 2050. METHODS AND RESULTS: A prevalence-based macrosimulation combined Eurostat population projections, Global Burden of Disease 2023 CVD prevalence and trends, and European Health Interview Survey ADL data. Reference assumptions included within-stratum independence between CVD and dependency, constant age-specific ADL rates and no dependency gradient within ages ≥75 years. Decomposition and sensitivity analyses examined demographic, epidemiological and functional contributions; uncertainty propagation was incomplete. From 2021 to 2050, the population aged ≥65 years with CVD was projected to increase from 44.1 to 59.2 million (+34.3%). Modelled co-occurrence with severe ADL dependency, not dependency attributable to CVD, increased from 4.06 to 6.21 million (+53.0%), raising the proportion from 9.2% to 10.5%. Demographic change drove the increase in number, partly offset by declining CVD prevalence. Under reference assumptions, annual relative ADL declines of 0.45% and 1.46% would stabilise the proportion and number, respectively. A post hoc continuation of EHIS declines, using fixed country and sex weights under the same CVD trajectory, instead reduced the number to 3.61 million (-11.1%) and the proportion to 6.1%. CONCLUSION: Severe ADL dependency could increase faster than the older cardiovascular population, but sustained functional improvements could reverse this trajectory. Cardiovascular care planning should account for both population growth and changing functional health.