Cardiovascular diseases are the main cause of hospitalisation and death in Spain, with its overall economic impact growing by 20% between 2014 and 2020.

“These diseases are a dormant threat and a problem that could end up going unseen, and there is therefore a need to work towards cardiovascular health,” stressed Jesús Ponce, President of Farmaindustria, at the presentation of the report.

Madrid, 14 June 2023 - In 2021, 326 people per day died of some form of cardiovascular disease (CVD) in Spain, reaching a total of 119,196 total deaths over the course of the year, according to data from the National Statics Institute. This makes cardiovascular diseases the main cause of hospitalisation and death in Spain.

These numbers are proof that addressing these diseases presents a significant challenge which leads to increased costs to health systems. Between 2014 and 2020, costs related to cardiovascular diseases increased by 20% for a total of 7.7 billion euros.

Although life expectancy in Spain is one of the highest in the world and it has the second-lowest standardised mortality rate in the European Union, the impact of cardiovascular diseases is on the rise. This has led to the National Health System approving the Cardiovascular Health Strategy in 2022, a pioneer initiative in Europe that is currently under development.

This initiative served as the basis for the drafting of the report “Towards a Better Cardiovascular Health in Spain”, which resulted from a debate between key actors in the area of cardiovascular diseases including public authorities, academics, clinicians and pharmaceutical industry representatives. The consulting firm PwC was responsible for developing the report – at the behest of Farmaindustria and EFPIA – which promotes a platform for cardiovascular health in Europe.

The report was presented this Wednesday at the Royal Academy of Medicine in Spain (RANME) in a ceremony which was closed by the Minister of Health, José Manuel Miñones. Jesús Ponce, President of Farmaindustria, delivered opening remarks in a symbolic timeframe of four minutes – the time between each cardiovascular-related death in Spain: “These diseases are a dormant threat and a problem that could end up going unseen, and there is therefore a need to work towards cardiovascular health.”

The Minister of Health, congratulated Farmaindustria, EFPIA and PwC on the report and spoke on the Spanish Strategy for Cardiovascular Health. “We must double our efforts and continue emphasising lifestyle-related risk factors,” he stated, at the same time assuring that “the research, development and innovation are axes – along with prevention – of the Ministry’s policies for improving cardiovascular health.”

Healthcare Focused on Acute Cardiovascular Events

To date, healthcare in cardiovascular diseases in Spain – similar to that in the majority of Europe – has focused on treating acute events such as myocardial infarctions or embolisms. In fact, over a third of total healthcare costs related to cardiovascular diseases in 2015 was intended for emergency room visits and hospitalisations, with only one-fourth being directed to the remaining hospital and primary care visits.

An analysis of the situation reveals that there is a lack of prevention programmes and early diagnosis. In Spain, there are an estimated 3 million undiagnosed cases of hypertension, one of the most critical risk factors. Juan Tamargo, Professor of Pharmacology at the Universidad Complutense of Madrid, stated that “70% of the burden of cardiovascular disease lies in preventable risk factors,” and this reveals possible actions that could be taken in this area.

The report also points to a deficit of secondary prevention, which must take place following an acute event, and also shows that only two-thirds of cardiac care units in Spain offer cardiac rehabilitation and that only one in every ten people are aware of their ideal cholesterol levels.

Disparities in Cardiovascular Health

Another characteristic of cardiovascular diseases is that their prevalence varies across Spain, with significant differences ranging from a standardised rate by age profile of 184 deaths per every 100,000 residents in Madrid, to almost double that number in Asturias.

The document shows that, in addition to regional disparities, discrepancies related to level of education and occupation are present and indicate different levels of exposure to risk factors, with rates of cholesterol, hypertension, obesity and diabetes are lower in high-level professionals than in unskilled workers.

Gender is also a risk factor for cardiovascular diseases, with 7,000 more women dying from these diseases in Spain than men each year.

A Transition from Treatment of Acute Events to Prevention

These matters make it clear that there is room for improvement and help us reach the conclusion that healthcare must transition its focus from simply responding to acute events in the hospital setting towards preventative measures in primary healthcare centres.

This change would require improving data collection, something which is currently carried out unevenly across Spain: only six Autonomous Regions have an active CVD registry and of these, only half use these data for purposes other than drafting reports.

The PwC report concludes with three major proposals, one of which is precisely the collection of higher-quality and more accessible data for their integration in electronic clinical records and thus improve healthcare. In this regard, José Ramón González Juanatey, Head of Cardiology Services and Continued Care Unit and Professor of Cardiology at the University Clinical Hospital, emphasised the importance of improving the collecting and measuring of health data and innovate in their organisation: “We cannot continue using traditional models. Digitalised models do not require shifting data to resolve demand.”

Another of the proposed measures is prevention, to which end identification of at-risk individuals is proposed, in addition to the reconfiguration of secondary prevention pathways to allow collaboration among hospitals, primary healthcare centres, and social care centres. The third proposal aims at making progress in more equitable identification of at-risk populations at primary-healthcare level, as well as secondary prevention programmes for vulnerable communities, taking into account patterns of inequality related to gender, at socio-economic and regional levels.

To achieve these objectives, a number of key opportunities are highlighted, such as setting aside specific funding for these diseases which would allow for early-diagnosis programmes to be launched, the strengthening of primary healthcare, and better utilisation of digital technologies and continuity of care among hospitals and healthcare centres.

Cardiovascular diseases are a priority for Farmaindustria and our member companies are committed to addressing them. A significant amount of the clinical trials taking place in Spain focus on these diseases and research continues to focus on new treatment options.

Better cardiovascular health can also help achieve more resilient and equitable health systems, as emphasised by the report “Towards a New Normal: Why It’s Fundamental to Improve Cardiovascular Health” developed by PwC and EFPIA in Europe. This report analyses the impact of COVID in CVDs and proposes measures to improve how this should be addressed, and served as a point of departure for the Spain-specific report presented today.

In addition to the presentation of the report, leading experts in the area of cardiovascular health participated in the ceremony to speak on next steps the National Health System should take in terms of prevention and healthcare. These included: Eduardo Díaz Rubio, President of RANME; Victoria Tzouma, Co-Director of EFPIA’s Cardiovascular Health Platform; Leticia Rodríguez Vadillo, Head Partner for Health-Pharma Retail and Consumer Affairs at PwC, and Héctor Bueno, Cardiologist at University Hospital October 12 and Researcher at the National Cardiovascular Disease Centre of the Carlos III Health Institute.

• Download the report in English Towards a better cardiovascular Health in Spain
• Learn more about El valor del medicamento en la salud cardiovascular