Secondary prevention of heart attack and stroke

HPP consulted experts from 11 countries to develop a consensus report and country profiles exploring prevention of recurrent heart attacks and strokes among high‑risk groups.

Secondary prevention of heart attack and stroke


Heart attack and stroke are the leading causes of death across much of Europe. Both are acute events linked to cardiovascular disease, which itself accounts for the largest proportion of healthcare spending in some countries. As such, these events pose a major threat to the sustainability of our health systems.

Thanks to advances in care, more people now survive heart attacks and strokes than ever before. But most of these people remain at high risk of a subsequent cardiovascular event. Secondary prevention involves intensive efforts to prevent a second or subsequent heart attack or stroke. Proven models have been shown to reduce risk of a repeat heart attack by up to 30% or a repeat stroke by up to 60%.

Key models of cardiovascular disease prevention for high-risk groups are typically judged as cost-effective. Reducing repeat events can help to ensure societal productivity by enabling people to remain in the workforce for longer. Moreover, secondary prevention programmes have been shown to be highly effective at improving participants’ quality of life.

Despite this, across Europe, we are failing to reduce the risk of recurrent heart attack and stroke, with significant evidence of little improvement in risk factor reduction and lack of strategic action in the past decade. Governments must develop cardiovascular disease strategies that recognise the major role of repeat events and invest in proven models of secondary prevention.

Country profiles and summaries

Secondary prevention of heart attack and stroke

Country profiles

These reports offer an in-depth look at the policy priorities in secondary prevention of heart attack and stroke in each country.

Austria Belgium Germany Italy The Netherlands Poland Romania Spain
Secondary prevention of heart attack and stroke

Country summaries

These four-page summaries offer a quick guide to the current situation and opportunities for improvement in each country.

Belgium Germany Italy The Netherlands Poland Romania Spain

What we’ve achieved

As part of a multi-year project investigating secondary prevention of heart attack and stroke, HPP developed one of the most comprehensive policy analyses yet undertaken of this issue in Europe – a consensus report based on interviews and consultation with more than 30 experts as well as an analysis of European data and research. The project focused on 11 countries: Austria, Belgium, France, Germany, Greece, Italy, the Netherlands, Poland, Romania, Spain and the UK.

The report explores the evidence around secondary prevention of heart attack and stroke, and highlights gaps in quality care across Europe. It identifies five policy priorities for action, and provides real-world examples of best practice. The executive summary and call to action have also been published in a separate summary document.

This work is intended to provide a powerful, evidence-based narrative for policy and system transformation in secondary prevention of cardiovascular disease, at a time of significant pandemic-related disruptions and growing impetus among advocates for more effective policies to compensate for many years of neglect.

The consensus report was developed alongside national-level reports for each of the 11 countries. These country profiles are accompanied by four-page summaries highlighting the current situation and opportunities for improvement in each country. These documents were developed for use at the national level, and several have been made available in the public domain.

Key partners and stakeholders

Advisory panel

  • Professor Theodora Benedek, Professor of Cardiology, University of Medicine, Pharmacy, Sciences and Technology Tirgu Mures, Romania; President, Cardiology Committee of the Romanian Ministry of Health
  • Dr Carlos Brotons, General Practitioner, Sardenya Primary Health Care Center-Biomedical Research Institute Sant Pau, Barcelona, Spain
  • Dr Valeria Caso, Neurologist, University of Perugia Stroke Unit, Italy; Former president, European Stroke Organisation
  • Dr Christina Chrysohoou, Cardiologist, Director, Greek National Health Service, University Hospital Athens, Greece; Board member, Hellenic Society of Cardiology
  • Professor Donna Fitzsimons, Board member, ESC (Lead Patient Involvement); School of Nursing and Midwifery, Queen’s University Belfast, UK
  • Professor Piotr Jankowski, Cardiologist; Jagiellonian University, Kraków, Poland
  • Neil Johnson, Founder, Global Heart Hub; Chief Executive, Croi, West of Ireland Cardiac & Stroke Foundation and National Institute for Prevention and Cardiovascular Health, Ireland
  • Professor Kornelia Kotseva, Professor of Cardiology, National Institute for Prevention and Cardiovascular Health, National University of Ireland – Galway, Ireland
  • Professor Dafin Muresanu, President, European Federation of NeuroRehabilitation Societies; Director, Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Romania
  • Dr Dimitri Richter, Chair, ESC Council for Cardiology Practice; author, 2019 ESC/EAS lipid guidelines, Euroclinic, Athens, Greece
  • Maria Teresa San Saturnino Peciña, President, Cardioalianza, Spain
  • Professor Peter Siostrzonek, President, Austrian Society of Cardiology, Austria
  • Stefan Strilciuc, Executive Director, RoNeuro Institute for Neurological Research, Romania
  • Professor Philippe Van de Borne, Professor of Cardiology, Erasme Hospital, Brussels; Université Libre de Bruxelles, Brussels, Belgium
  • Professor Heinz Völler, Cardiologist, Klinik am See, European Association of Preventive Cardiology; Department of Cardiology, University of Potsdam, Germany

Additional national-level experts


  • Professor Stefan Kiechl, President, Austrian Stroke Society
  • Professor Andreas Zirlik, Head of Cardiology Department, LKH-University Hospital Graz


  • Professor Johan de Sutter, EAPC National CVD Prevention Coordinator for Belgium, Maria Middelares General Hospital, Ghent University
  • Professor Peter Sinnaeve, Professor of Cardiology, Universitair Ziekenhuis Leuve


  • Philippe Thébault, President, Alliance de Coeur


  • Professor Bernhard Schwaab, President, German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR) and Guth Klinikgruppe
  • Professor Andreas M. Zeiher, President, German Society of Cardiology


  • Professor Konstantinos Tsioufis, Chair-elect, EAPC Cardiac Rehabilitation Section, Centre of Rehabilitation Research, University of Potsdam
  • Dr Kostas Vemmos, President, Hellenic Stroke Organisation University of Athens


  • Dr Damiano Parretti, Head of Cardiovascular Diseases, Società Italiana di Medicina Generale (SIMG)
  • Professor Carlo Gandolfo, Professor of Neurology, Genoa University; Member of the scientific committee of ALICe Italia Onlus
  • Professor Pasquale Perrone Filardi, Associate Professor of Cardiology, Director, School of Cardiology, Federico II University Hospital, Naples
  • Professor Aldo Pietro Maggioni, Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence
  • Dr Simona Giampaoli, Former Director, Department of Cardiovascular and Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy

The Netherlands

  • Dr Arend Mosterd, Cardiologist, Meander Medical Centre, Amersfoort
  • Dr Petra van de Pol, Cardiologist, Program Director NVVC Connect, Utrecht
  • Professor Jaap W Deckers, Professor of Cardiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam


  • Dr Adam Kozierkiewicz, Consultant, JASPERS, European Investment Bank


  • Dr Christina Tiu, President, Romanian Society of Neurology; Associate Professor, University of Medicine and Pharmacy ‘Carol Davilaʼ, Bucharest
  • Professor Dragoș Vinereanu, President-elect, Romanian Society of Cardiology;
  • Professor of Cardiology, Emergency Hospital of Bucharest


  • Dr Manuel Anguita, Former President, Spanish Society of Cardiology


  • Dr Patrick Doherty, Chair of Cardiovascular Health, Department of Health Sciences, Director, York University; Director, British Heart Foundation
  • Professor Mike Hannay, Managing Director, East Midlands Academic Health Science Network (AHSN)

Project funding

This project was initiated and funded by Amgen (Europe) GmbH.