A composite infrastructure readiness score reveals a 34-percentage-point divide between different cardiology systems in Europe: a multinational cross-sectional survey
M Gallego Llorente, L Y Rekker, L C Kieviet, D Breucker, L Tjon, M von Scheidt, G Pasterkamp, M I F J Oerlemans, P van der HarstAbstract
Background
The 2025 EU Safe Hearts Plan and the OECD/European Commission cardiovascular health workstream emphasise interoperable data systems and coordinated care to reduce cross-country disparities. Yet current European benchmarking is largely descriptive and lacks a practice-level composite readiness metric with statistical testing.
Purpose
To develop a practice-level Infrastructure Readiness Score (IRS) for cardiology care and quantify variation across European regions and countries, including whether readiness aligns with national wealth.
Methods
Cross-sectional web-based survey of cardiologists at European leading hospitals (Aug. 2025 – Feb. 2026). Each respondent scored 10 binary organisational items (yes=1, no=0): SOPs, national quality registry, cross-database data linkage, coordinated care pathway, formal GP collaboration, national and regional digital tracking platforms, VBHC process evaluation, between-clinic data infrastructure, and comorbidity scoring. The unweighted sum (0–10) was converted to a percentage IRS. Countries were grouped into four regions: Nordic+Baltic (SE, FI, EE, DK), Western (NL, BE, CH, DE, UK, FR), Southern (IT, ES, GR), and Eastern (PL, CZ). Regional differences were tested with rank-sum tests; item-level comparisons used Fisher's exact test. Results are reported as mean (95% CI).
Results
106 cardiologists from 15 countries completed the survey, representing 76 unique centres. The IRS differed significantly across regions (p<0.001): Nordic+Baltic 81% (95% CI 72–89, n=17), Southern 54% (44–64, n=21), Western 53% (46–61, n=31), and Eastern 37% (17–58, n=7), a 43-percentage-point Nordic–Eastern gap. Nordic+Baltic scored higher than Western, Southern, and Eastern regions (all p<0.001). Country-level results challenged a wealth gradient: Sweden and Estonia led (both 85%), while Switzerland (34%) and Belgium (43%) scored half as much. The gap was driven by digital and data-governance items. National quality registries were reported by 100% of Nordic+Baltic centres versus 54% elsewhere (p<0.001); regional digital platforms by 88% vs 34% (p<0.001); cross-database linkage by 88% vs 42% (p<0.001). Clinical SOP availability was similar (76% vs 78%, p=1.00), as was comorbidity scoring (59% vs 71%, p=0.38). VBHC evaluation remained low (16% overall).
Conclusion
Variation across European cardiology concentrates in digital infrastructure and data governance (registries, platform interoperability, cross-database linkage) while clinical protocol availability is broadly comparable. National wealth did not predict readiness: Estonia outscored Switzerland and Belgium, suggesting that governance design matters more than GDP per capita. As the EU Safe Hearts Plan and EHDS move into implementation, practice-level readiness mapping can guide targeted investment in digital infrastructure rather than additional clinical guidelines.Panel A: GDP vs IRSPanel B: Item-level comparison