Bridging the implementation gap in cardiovascular prevention: a narrative review and call to action

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, yet substantial gaps persist between evidence-based prevention strategies and their real-world implementation. This narrative review aimed to identify and synthesize contemporary models, programmes, and implementation strategies in preventive cardiovascular care, highlighting factors that facilitate or hinder adoption at scale.

Narrative synthesis drawing on searches in MEDLINE (PubMed), Embase, and the Cochrane Library (to July 2025), prioritising systematic reviews, major guideline statements, and large multicentre studies.

Community programmes yield modest but meaningful reductions in blood pressure, lipids, and glucose. Clinical programmes achieve greater individual-level effects but are constrained by limited reach. Key barriers include misaligned incentives, workforce limitations, and persistent inequities. The Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) frameworks remain underutilised. Emerging digital tools and updated cardiovascular risk models offer new opportunities but require pragmatic integration.

Strengthening preventive cardiovascular care requires aligning health-system incentives, integrating implementation science, and leveraging technology to support scalable and equitable prevention models.