Cardiovascular disease (CVD) remains the leading cause of death in most countries; however, few specific political actions have been implemented to improve cardiovascular health at both national and international levels. We aimed to describe the methodology used for the development and initial rollout of Spain's Cardiovascular Health Strategy of the National Health System (ESCAV, Estrategia en Salud Cardiovascular del Sistema Nacional de Salud).

A multidisciplinary team comprising diverse stakeholders developed a national strategy to reduce the burden of CVD in Spain. The team used qualitative methodologies to identify and select priorities and design strategic map models.

The strategy was structured around a matrix with 6 cross-cutting themes (citizen empowerment; health promotion, prevention, and early CVD detection; comprehensive management of acute and chronic CVD; health care coordination; equity; and knowledge management) and 4 longitudinal lines (ischemic heart disease, heart failure, arrhythmias, and valve disease). The framework was further supported by 3 overarching axes: continuity of care, patient safety, and leveraging of information systems. A total of 27 critical points were selected, leading to the definition of 99 strategic objectives (32 general and 67 specific) and 136 actions through iterative reviews and prioritization. Strategic maps were developed for the overall strategy and for each action line, incorporating 61 indicators to facilitate and monitor the development of the strategy.

ESCAV represents one of the most ambitious initiatives aimed at transforming a nation's cardiovascular health. The methods and steps undertaken in this process could serve as a valuable reference for other countries seeking to establish similar initiatives. Furthermore, it may act as a catalyst to advance efforts toward establishing a European plan for cardiovascular health.