JACARDI – Reducing the burden of cardiovascular diseases (CVDs) and diabetes

For the EU Screening Week 2026, during which the European Commission proposed a Council Recommendation on cardiovascular health checks,HaDEA spoke with Benedetta Armocida, coordinator of the Joint Action JACARDI co-funded by the EU4Health programme, about the importance of preventing cardiovascular diseases (CVDs) and diabetes, identifying risks early and ensuring that interventions reach the right people and communities.

In this interview, Dr Armocida discusses the progress made by JACARDI and its pilots, and how the evidence generated by the Joint Action can support future action across the EU.

What are the focus, mission and objectives of JACARDI?

JACARDI was created in the context of the Healthier together – EU non-communicable diseases initiative to address a key public health challenge: cardiovascular diseases and diabetes remain major causes of premature mortality, morbidity and health inequalities in Europe, despite the availability of effective prevention and management strategies.

Under JACARDI, 18 EU countries, Norway, Iceland and Ukraine, are collaborating to reduce the burden of cardiovascular diseases and diabetes, at both individual and health system levels. The European Commission is supporting this Joint Action with €53 million from the EU4Health programme.

A central principle of this collaboration is to address CVDs and diabetes within a common cardiometabolic framework. CVDs and diabetes share many determinants and risk factors, are often coexistent in patients, and are shaped by cumulative exposures across the life course. JACARDI, therefore, takes into consideration the patient’s full life cycle, through the interaction of biological, behavioural, social and environmental factors. This creates important opportunities to connect primary prevention, risk identification, screening and care within more integrated approaches.

JACARDI is examining how interventions can reach populations experiencing barriers to prevention and care, how they can be adapted to different contexts, and which organisational, governance, workforce, data and financing conditions support their integration into health systems.

Regularly checking some vital numbers (blood pressure, blood sugar levels and cholesterol) is key to detecting heart health risks early, in line with the EU Safe Hearts Plan’s objectives. How has JACARDI contributed to the prevention, early detection and screening of cardiovascular diseases and diabetes in Europe?

JACARDI approaches prevention through a life-course perspective, recognising that cardiometabolic risk accumulates over time. Primary prevention therefore starts well before the onset of disease, by supporting healthy behaviours, including health literacy. JACARDI’s interventions strengthen both individual and organisational health literacy by:

• supporting people in understanding health information, recognise risk factors and engage with prevention and healthcare services;
• strengthening the capacity of organisations and health systems to provide accessible, understandable and actionable health information and create environments that enable people to make informed health decisions.

This is closely aligned with the purpose of EU Screening Week and The Know Your Numbers campaign, which highlights the importance of knowing key cardiometabolic indicators. JACARDI contributes to this objective by generating evidence on the pathways needed to ensure that measurement leads to risk assessment, appropriate and integrated referral, prevention and care.

What has the Joint Action shown most progress in until now?

JACARDI is implementing a total of 143 pilots across Europe, including 19 pilots dedicated to screening, which are being implemented in 11 countries. They cover a broad range of delivery environments, both in clinical and non-clinical settings. The target populations span the life course, from children and adolescents to older adults, and include both general population groups and populations requiring tailored outreach, such as migrants and individuals with established or elevated cardiometabolic risk.

The pilots are testing different ways of reaching people and identifying risks. Nine pilots use opportunistic screening and nine use systematic approaches based on age or risk profile. Three pilots use survey methods and thirteen include public awareness-raising activities, with several pilots combining different approaches within the same pathway.

How do you determine the success of a pilot?

From the outset, we have tried to avoid creating isolated “islands of excellence”. A successful pilot is not sufficient if the intervention cannot be integrated into routine services, adapted to different contexts or maintained when external project funding ends.

For this reason, sustainability has been a consideration from day one, since the design of pilot projects. We are looking at organisational capacity, governance, workforce, data, financing, equity and the local context in which interventions are delivered.

The same applies to equity: equity in JACARDI is not treated as an additional consideration at the end of implementation but is operationalised through methodological tools that support critical reflection, context-sensitive data, co-design and inclusive communication. This approach recognises that implementation cannot be separated from the question of who is reached and who is left behind.

Are there any examples from the pilots that you could share with us?

Most certainly. One of the most important developments is that the pilots are generating implementation knowledge alongside intervention-specific results: both assessing whether an intervention works and identifying for whom, in which contexts, under which conditions, and what is needed to sustain or transfer it.

For example:

• in Spain, we have launched a school-based intervention, co-designed with children, families, teachers and health professionals, to promote healthy eating and physical activity among children aged six to twelve years;
• in Czechia and Spain, our pilot teams are developing co-designed approaches to health literacy among adolescents;
• in Hungary, mobile health units are bringing cardiometabolic risk assessment to geographically underserved communities;
• in Romania, community nurses combine risk identification with awareness-raising, referral and behavioural support in rural areas;
• in Belgium, online risk assessment is being linked to coordinated lifestyle interventions;
• in Portugal, a pilot is working with migrant communities through the participatory Ophelia approach to co-design health-literacy interventions that are inclusive, culturally relevant and responsive to people’s needs.

Together these and other pilots provide a diverse European implementation experience around the core question of how people at increased risk of cardiovascular diseases and type 2 diabetes can be identified earlier and connected to appropriate action.

Why is this data gathered from these experiences and pilots important?

These experiences reinforce an important public health principle: screening is a health-system process. Measurement creates an opportunity for risk identification. Risk assessment helps determine the appropriate response, while referral and follow-up connect early detection with prevention, diagnosis and care.

The evidence gathered by JACARDI also helps us understand where important gaps remain.

For example, a JACARDI scoping review identified substantial gaps in the European evidence base on cardiovascular and diabetes risk in these populations, with no eligible publications identified for 69% of the EU countries and associated countries included in the review. When populations are insufficiently represented in data and evidence, it becomes more difficult to design prevention strategies that respond to their needs or to monitor whether interventions are reducing inequalities. Closing these evidence gaps is therefore an important part of strengthening prevention.

• The Italian Health Examination Survey – CUORE Project, which contributes to JACARDI as a population-based pilot, provides a particularly relevant example in the context of the Know Your Numbers campaign. Their survey combines standardised measurements with information reported by individuals, enabling the assessment of both objectively measured and self-reported prevalence of risk conditions, as well as awareness of personal health status.

Preliminary findings from the 2023–2025 wave showed substantial awareness gaps: around half of people with raised blood pressure were unaware of their condition, with an even higher proportion among younger men. Important gaps were also observed for elevated blood glucose and cholesterol. This underlines the importance of health checks, and the proposal for a Council recommendation on cardiovascular health checks.

Alongside the pilots, JACARDI has also developed a short practical guide for screening individuals at increased risk of cardiovascular diseases and type 2 diabetes. The guide brings together approaches for risk identification, assessment, population segmentation and screening, helping to translate implementation experience into practical resources.

Across the JACARDI screening portfolio, the emerging implementation evidence is therefore helping us understand how different models can reach populations, identify cardiometabolic risk and connect people with appropriate pathways for prevention and care.

Are there any particular challenges that the project has faced during its implementation?

For a Joint Action of this scale, one of the main challenges has been implementing common objectives across health systems, organisations and populations that differ substantially in their structures, resources and needs, while operating in a continuously evolving policy environment.

We have, therefore, approached implementation as a continuous learning and reflection process, with the flexibility to adapt interventions and delivery models as evidence, local context, health-system conditions and policy priorities evolve.

One way of describing this approach is through our “four As” methodological principles: adapt, adopt, abandon and add. These are not sequential steps, but four ways in which an intervention can evolve as implementation generates new knowledge:

• An intervention can be adapted to the characteristics of a population or organisational context;
• Existing effective practices can be adopted and embedded within new settings;
• Approaches that prove unsuitable can be discontinued;
• New components can be introduced as implementation generates additional knowledge.

This has been particularly relevant to the evolution of the European cardiovascular policy landscape. JACARDI started before the development and adoption of the Safe Hearts Plan. It created an opportunity to further strengthen the connection between JACARDI’s implementation work and the EU’s priorities for cardiovascular prevention and early detection.

JACARDI’s work will be showcased at the upcoming event ‘Delivering on the Safe Hearts Plan: the impact of EU-funded projects’ on 24 November.

What are you looking forward to regarding JACARDI’s upcoming milestones? As the pilots are progressing towards completion, the focus is increasingly shifting from implementation at individual sites to understanding what can be learned across countries, populations and health-system contexts.

More broadly, all 143 pilots will be systematically assessed to identify common implementation mechanisms, contextual factors, barriers and enabling conditions, together with the factors that support sustainability and transferability.

Building on this, JACARDI will translate its evidence and implementation learning into actionable recommendations for health systems and policymakers.

At the same time, JACARDI is strengthening the science-to-policy interface. Fifty trainers from 18 European countries have already been trained, with this capacity being cascaded to 300 professionals involved in the pilot projects. This creates an important bridge between evidence generation and its use in practice, supporting professionals to interpret evidence, communicate it and apply it in decision-making.

The timing of this work is particularly relevant. EU Screening Week creates a European moment around a very concrete public health message: know your numbers and act on them. JACARDI’s contribution is to build the implementation evidence around that message: how to measure cardiometabolic risk, identify people who may benefit from further assessment, reach populations equitably, connect findings to prevention and care, and build sustainable pathways within health systems.

Ultimately, the legacy we aim to create is a stronger European capacity to prevent cardiovascular diseases and diabetes, identify risk earlier and translate evidence into action across the life course.

Relevant links

Healthier together – EU non-communicable diseases initiative

Commission policy on cardiovascular health

Proposal for a Council recommendation on health checks

Questions and answers on the proposed Recommendation on cardiovascular health checks

Safe Hearts Plan

Know Your Numbers campaign

EU Screening Week 2026

Showcase event ‘Delivering on the Safe Hearts Plan: the impact of EU-funded projects’

Background

EU4Health is the fourth and largest of the EU health programmes. The EU4Health programme goes beyond an ambitious response to the COVID-19 crisis to address the resilience of European healthcare systems. The programme provides funding to national authorities, health organisations and other bodies through grants and public procurement, contributing to a healthier Europe.

HaDEA manages the vast majority of the total EU4Health budget and implements the programme by managing calls for proposals and tenders from 2021 to 2027.