Foreword

Cardiovascular disease (CVD) represents a substantial public health burden in Europe and there is a pressing need to implement comprehensive strategies to address this growing epidemic. To this purpose, surveillance remains the primary tool to evaluate the burden of disease, to plan preventive actions at both population and individual levels and to assess efficacy of prevention.

Public health surveillance has been defined as ‘the ongoing, systematic collection, analysis, interpretation and dissemination of data regarding health-related events for use in public health action to reduce mortality and morbidity and to improve health’ (MMWR Recomm Rep 2001; 50:1-35.)

Though CVD has been identified as one of the leading contributors to the global disease burden, the number of reliable and standardised indicators for which CVD data are available on a comparable basis across Europe is currently limited. Mortality data from EUROSTAT, WHO and OECD are only available for groups of diseases such as ischaemic heart disease (IHD) or cerebrovascular accidents (CVA). Hospital discharge data have been published using a variety of codes and classifications. In recent years, thanks to information technology, a substantial volume of data is being recorded on hospital admissions and discharges, medication use, in-patient care utilisation, surgical operations and invasive procedures. These data, provided that they are properly linked and validated, can be important sources of information for achieving better knowledge and more effective interventions, studying disease trends, producing annual reports, orientating preventive actions and making comparisons among countries.

The EUROCISS project, funded by the European Commission, aimed to prioritise the aspects of CVD of major interest in EU countries and to provide a list of recommended indicators and sources of information for monitoring CVD. The main objective was to prepare the Manuals of Operations for the implementation of population-based registers of Acute Myocardial Infarction/Acute Coronary Syndrome (AMI/ACS), stroke and of CVD surveys. These manuals provide simple and comparable tools to support and stimulate implementation of surveillance systems in those countries which lack them but collect routine data such as mortality and hospital discharge records (HDR). They recommend to start from a minimum data set and follow a stepwise procedure, thus providing a standardised model for an efficient implementation of a surveillance system at reasonable cost.

A population-based register is the best data source for the surveillance of AMI/ACS and stroke morbidity and mortality. It considers both fatal and nonfatal events occurring in-and out-of hospital, thus providing estimates of key indicators such as attack and case fatality rates. Population surveys can further supplement the information collected from registers with additional details on socio-demographic characteristics, risk factors, physical/biological measurements and chronic conditions.

Europe is now facing the challenge to implement preventive actions, identify persons in need of treatment, apply the European Guidelines for CVD Prevention in Clinical Practice and verify improving effectiveness. The development, testing and implementation of effective surveillance systems for CVD will produce reliable and comparable indicators, thus enabling policy makers to trace differences within and between countries and to make better decisions on planning and evaluation of prevention programs, healthcare delivery, resource allocation, and research.