EUROASPIRE survey

EUROASPIRE survey
Name	EUROASPIRE survey
Type	Observational cardiovascular risk factor survey
Established	1999
Region	Europe
Coordinators	European Society of Cardiology
Participants	patients with coronary heart disease
Frequency	periodic multicentre cross-sectional surveys

EUROASPIRE survey

The EUROASPIRE survey is a series of multicentre cross‑sectional studies coordinated by the European Society of Cardiology that assess secondary prevention and risk factor control in patients with coronary heart disease across Europe, involving clinical teams from institutions such as National Health Service, Karolinska Institutet, University of Oxford, Hôpital Pitié-Salpêtrière, and Universität Wien. The programme links clinical practice with guideline evaluation and health policy, drawing comparisons with initiatives like the World Health Organization chronic disease programmes, the American Heart Association campaigns, the European Commission public health actions, and registries such as the ORBIT-AF registry.

Overview

EUROASPIRE surveys examine treatment patterns, lifestyle modification, pharmacotherapy adherence, and risk factor prevalence among patients after events such as myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting in centres affiliated with organisations including the European Society of Cardiology, European Heart Network, British Heart Foundation, Deutsche Gesellschaft für Kardiologie, and national cardiology societies in France, Germany, Italy, Spain, and Poland. The project compares findings with international guideline documents from bodies like the European Medicines Agency, the National Institute for Health and Care Excellence, and the American College of Cardiology to inform quality improvement and policy decisions.

History and Objectives

Launched in 1999, the survey series followed the pattern of large-scale cardiovascular epidemiology efforts such as the Framingham Heart Study and the MONICA Project, aiming to measure implementation of secondary prevention after coronary events across diverse health systems represented by countries including United Kingdom, Sweden, Netherlands, Belgium, and Greece. Objectives included evaluating adherence to guidelines from the European Society of Cardiology and comparative analyses with recommendations by the World Health Organization, the European Commission, and national cardiology societies, while influencing policy debates in institutions like the European Parliament and national ministries of health.

Methodology

The surveys used standardized cross‑sectional protocols adapted from clinical research methods promoted by organisations such as the International Society of Hypertension, the Global Initiative for Chronic Obstructive Lung Disease, and the World Health Organization. Data were collected in hospital and outpatient settings after events coded by classifications such as the International Classification of Diseases and adjudicated with criteria similar to those used in trials like SOLVD and HOPE. Participating centres employed risk assessments referencing algorithms from groups like the European Society of Cardiology and used measurements comparable to those in the INTERHEART and INTERSTROKE studies. Statistical analyses relied on methods familiar to researchers from institutions such as Imperial College London, Johns Hopkins University, and Université de Paris.

Key Findings

Across survey iterations, EUROASPIRE documented persistent gaps in control of hypertension and hyperlipidaemia, underuse of evidence‑based therapies including statins, antiplatelet therapy, and beta blockers, and suboptimal implementation of lifestyle advice on smoking cessation, physical activity, and dietary modification. Reports highlighted variations between countries and centres, with performance differences analogous to disparities reported by the Organisation for Economic Co-operation and Development and observed in registries like GRACE and CRUSADE. Findings showed associations between poor risk factor control and adverse outcomes described in landmark trials such as PROVE-IT TIMI 22 and CURE, prompting comparisons with prevention targets set by entities like the European Commission and the World Health Organization.

Impact on Clinical Practice and Policy

EUROASPIRE influenced guideline revisions and quality initiatives by providing evidence used by the European Society of Cardiology, national cardiology societies including the British Cardiovascular Society, and agencies such as the National Institute for Health and Care Excellence to refine secondary prevention recommendations. Data informed public health strategies discussed in forums like the World Health Assembly and inspired regional programmes modelled on successful interventions from trials at centres like Cleveland Clinic, Mayo Clinic, and Mount Sinai Health System. The survey’s benchmarking assisted payers and policymakers in ministries across Spain, Italy, Germany, and Sweden to prioritise preventive cardiology and rehabilitation services comparable to those advocated by the European Heart Network.

Criticism and Limitations

Critiques of the survey note potential selection bias from participating centres that resemble tertiary hospitals in cities such as London, Paris, Rome, and Berlin, limited representativeness for rural populations akin to concerns raised in the Framingham Heart Study debates, and variations in data collection paralleling issues faced by multinational registries like NCD-RisC. Methodological limitations include reliance on cross‑sectional snapshots rather than longitudinal follow‑up like the Framingham Heart Study or randomized evidence from trials such as HPS, and challenges harmonising measurements across disparate health systems including those in Eastern Europe and Central Europe.