Over the last few decades, mortality from cardiovascular disease has dropped faster than mortality from other causes. Despite this great success, prospects for making further inroads are threatened by rising levels of obesity and the lack of adherence to recommended treatments.

The last 50 years have witnessed remarkable improvements in cardiovascular disease (CVD) outcomes. Since 1960, CVD mortality rates have fallen by over 60% whereas mortality rates for all other causes fell by 38% in OECD countries. Advances in the prevention and treatment of CVD have outpaced those of many other diseases, and these improvements have contributed to longer and healthier lives.

The mortality rate attributable to CVD has declined substantially in recent decades. Over the 50-year period since 1960, average mortality rates for CVD fell by 61%. CVD mortality rates started to decrease in the 1970s and in the 1980s the rate of decrease accelerated even further. Prior to 1985, CVD accounted for one in every two deaths in OECD countries, but by 2011 this had dropped to around one in every three. The reduction in CVD mortality accounts for 60% of the decline in all-cause mortality. Despite these gains, CVD remains the most common cause of death in most OECD countries.

Cardiovascular disease (CVD) and diabetes are both major drivers of the global burden of disease. They are a complex set of diseases involving a wide array of health sectors that place considerable pressure on health systems across countries. describes the burden of CVD and diabetes across OECD countries and examines trends in mortality and morbidity burdens according to gender and age across countries over time. This chapter summarises recent findings that seek to explain some of these recent trends and then describes the economic burden of CVD and diabetes in terms of direct health care cost.

Lifestyles play an important part in predicting cardiovascular disease (CVD) and diabetes risk, although prevention services have to cope with fewer resources in some countries. Lifestyles help explain variations in CVD and diabetes across OECD countries. looks at the health promotion and public health contribution to maintaining healthy lifestyles in OECD countries. It examines recent trends in obesity, tobacco and alcohol consumption, and physical exercise. This chapter outlines policies that health systems have introduced recently to combat unhealthy lifestyles such as tobacco consumption and high salt intake and to promote physical activities in adults and children in order to reduce overweight and obesity. It also benchmarks OECD countries in relation to their CVD and diabetes lifestyle rankings.

The importance of primary care is increasing in managing cardiovascular disease (CVD) and diabetes. focuses on the role of the primary care system and its ability to diagnose and control common CVD-related risk factors. It examines the strengths and weaknesses of primary care across countries by looking at the resources available, its accessibility, and quality. It includes data on prescribing patterns for diabetic patients and the rates of CVD and diabetes-related hospital admissions that are largely avoidable through proper primary care management. The chapter assesses country performance on the basis of its relative incidence of high blood pressure and cholesterol levels, avoidable hospital admissions, and quality prescribing and diabetes-related complications. It also examines primary care quality initiatives taking place across countries such as integrated and co-ordinated care, strengthening information systems for performance monitoring and pay-for-performance.

Even with the best efforts in cardiovascular disease (CVD) prevention and risk-factor management through primary care, many people will still require immediate medical attention or hospitalisation to treat an acute CVD event or diabetes complication including strokes, heart attacks and cardiac arrests. describes advancement in acute treatment of people with a CVD event, and cross-country variation in available resources and accessibility to timely and specialised treatments for acute CVD episodes and diabetes complications. It examines the use of procedures such as bypass surgery and other coronary interventions and also shows recent trends in acute care quality for stroke and heart attack. It then highlights some of the major reforms that countries have put in place at both national and local levels to improve the full pathway of acute care services by bringing care into line with best practice standards in CVD treatment.

This report has primarily focused on a descriptive analysis of how countries compare with respect to CVD outcomes and health care access, resources and quality. seeks to develop a better understanding of how health system characteristics and policies can influence the relationship between the health system’s inputs and outcomes. It presents the analytical results on how countries have performed in improving the quality of acute care by focusing on 30-day case-fatality rates for both heart attack and stroke. It examines the relationship between the deployment of health care resources such as financial resources and medical equipment and improvements in the quality of acute care. This analysis examines whether this relationship varies across countries. Importantly, it also looks at the role of specific health system characteristics and policies to determine their importance in explaining cross-country variation in the quality of CVD acute care.

Despite the potential for practice guidelines to improve health care outcomes, there is evidence that they are adopted too slowly or are applied inconsistently within and across countries. The lack of adherence to recommended clinical practice can have adverse effects on patient outcomes as well as higher health care costs. reports on the analysis of the European Society of Cardiology’s long-term registry of heart failure. It examines cross-country and within-country variations in recommended heart failure practice and analyses whether the degree of adherence can be explained by health system characteristics and policies across countries.