European hospitals can now stress-test their cardiac care for the next crisis

Cardiovascular diseases kill more Europeans than any other cause. That fact didn't change during COVID-19 - but access to cardiac care did. Across the continent, heart attack patients delayed seeking help, catheterization labs were repurposed, and follow-up appointments evaporated. The pandemic exposed a vulnerability that cardiologists had long suspected but never quantified: many cardiovascular care pathways simply weren't built to withstand systemic disruption.

The RESIL-Card tool, launched on the European Day for Prevention of Cardiovascular Risk, is an attempt to fix that - not by building better hospitals, but by helping the ones that exist understand where they would break.

A self-assessment, not a mandate

Available free at wecareabouthearts.org, the tool is a structured online questionnaire that guides cardiovascular care teams through a four-step process. Teams assess their preparedness across multiple dimensions of care delivery, identify strengths and gaps, and receive tailored recommendations with examples of best practices from across Europe.

It is not a regulatory requirement. No hospital is obligated to use it. The tool is designed as a voluntary self-assessment that multidisciplinary teams - cardiologists, nurses, administrators, and ideally patient representatives - complete together.

Professor William Wijns, research professor in interventional cardiology at the University of Galway and coordinator of the We CARE - RESIL-Card initiative, described the tool as a practical way for healthcare teams to ensure patients continue receiving lifesaving care when it matters most.

Built from pandemic lessons

The tool emerged from the We CARE initiative, launched in May 2021 by PCR and Stent - Save a Life! in direct response to COVID-19's impact on cardiac care. It was developed through an EU4Health-funded project involving cardiovascular experts, public health specialists, patient organizations, and policy stakeholders from multiple European countries.

The development process combined literature reviews of existing preparedness frameworks with stakeholder consultations and co-creation workshops. Clinicians, patient advocates, and health system experts contributed throughout iterative testing and validation phases. Professor Niek Klazinga of Amsterdam University Medical Centre noted that the result combines scientific rigor with practical usability.

The emphasis on real-world input matters. Preparedness tools that look good on paper but don't reflect how hospitals actually operate tend to gather dust. The RESIL-Card team's bet is that co-creation with frontline providers will produce something teams actually use.

What the tool measures

The assessment covers the ability of cardiovascular services to maintain continuity during disruption - whether that disruption comes from a pandemic, a geopolitical crisis, a natural disaster, or a surge in demand that overwhelms capacity. Teams evaluate their coordination across services and clinical disciplines, their crisis-response protocols, and their ability to sustain diagnosis, treatment, and follow-up under stress.

Based on responses, the tool generates tailored recommendations and benchmarks drawn from European best practices. These can then inform strategic planning at the department or institutional level.

For patients, the value proposition is straightforward: hospitals that have identified their vulnerabilities before a crisis hits are better positioned to keep care running when one arrives. Teresa Glynn of Global Heart Hub emphasized that for people living with cardiovascular disease, continuity of care is not optional.

Limitations worth noting

The tool is new and untested at scale. Rachel Kenna, Ireland's Chief Nursing Officer, acknowledged that it has not yet been deployed in an Irish setting while expressing interest in its potential. Self-assessments are inherently limited by the honesty and completeness of respondents. And a preparedness evaluation is only as useful as the follow-through it generates - identifying gaps means nothing if institutions lack the resources or political will to address them.

The tool also addresses only cardiovascular care, not broader hospital resilience. A cardiac unit that scores well on RESIL-Card could still be paralyzed by failures in emergency departments, supply chains, or staffing that fall outside the assessment's scope.

Still, as a first step toward systematic resilience evaluation in European cardiac care, it fills a gap that the pandemic made painfully visible. The next question is whether hospitals will actually use it - and whether the insights it generates will translate into real changes in how care is organized, staffed, and sustained when the next disruption arrives.