NEWS

What does “quality” really mean in cardiovascular medicine? At RISE @ ESC Congress 2026, our session on quality metrics and leadership challenged participants to look beyond guidelines and clinical evidence to a more fundamental question: How do we reliably deliver the right care to the right patient at the right time, and know whether it is making a difference?

Led by Dr. Silvia Castelletti, Deputy Editor of European Heart Journal – Quality of Care & Clinical Outcomes, the session explored how evidence, measurement, quality improvement, and leadership can work together to improve cardiovascular outcomes, with a particular focus on women’s health. Dr. Pamela Douglas and Dr. Zainab Samad supported the discussion.

Quality is more than following guidelines

A working definition of quality in medicine is delivering care that is safe, effective, and patient-centered, leading to better heart health and longer lives. But having evidence and guidelines is only the beginning.

As Dr. Pamela Douglas explained, “Many of us think of quality as we have data; we know this drug improves outcomes, reduces events. We have it in guidelines. We now have quality of care. Well, not quite. We need to get to the bedside and the individual patient.”

That means identifying gaps between recommended and actual care, measuring those gaps, designing interventions, and assessing whether they work. Registries can provide the data needed to benchmark performance across institutions and countries, but measurement alone does not improve care. Teams must use this data to understand why gaps exist and redesign systems accordingly.

Dr. Samad emphasized that this is an ongoing process of “continuous system redesign and iteration and adaptation” in which identifying one problem leads to the next cycle of improvement. 

Measuring what matters for women

The discussion highlighted the importance of choosing metrics that capture not only how long people live, but how well they live. Measures such as life expectancy, quality-adjusted life years and disability-free life expectancy offer different perspectives on the impact of cardiovascular care.

These measures also reveal important inequities. Although women live longer than men on average, they spend a greater proportion of their lives in poor health. 

“The three main pillars for health are screening, diagnosis, and treatment,” Dr. Castelletti said. “So, the gender health gap can be solved by solving the under-screening, the underdiagnosis, and the undertreatment.”

The session highlighted that cardiovascular disease accounts for approximately 35% of deaths among women globally, while women can face delays or missed diagnoses and may not receive care that adequately reflects sex-specific considerations.

“[The] women’s health gap equates to 75 million years of life lost; this means seven days per woman per year less. Closing this gap would improve the health and lives of millions of women. [It would] reduce the women’s health burden by 26 million disability-adjusted life years per year globally and boost the global economy by at least $1 trillion annually by 2040. To shift this gender health gap, we need to understand what the contributors to this gap are.” 

From measurement to action

Pregnancy provides a particularly important window for prevention. Cardiovascular disease and hypertensive disorders during pregnancy can have serious consequences for both mother and baby, while pregnancy-related cardiovascular complications can also signal elevated cardiovascular risk later in life.

A clinical case presented during the session illustrated how relatively simple actions – recognizing risk factors, screening for hypertension, educating patients, and ensuring appropriate follow-up – can potentially change outcomes. 

As Dr. Castelletti summarized, addressing the women’s health gap starts with better data on women, generated through registries and studies, and then translating that evidence into clinical practice.

Making quality a culture

Ultimately, quality improvement is not simply a toolkit or a project. It is a culture.

Leaders play an important role in creating that culture. Clinicians and organizations need to understand why change is necessary, have the time and resources to make it happen, and feel empowered to identify problems and test solutions. It also requires psychological safety: recognizing that identifying a problem is not a failure, but the first step toward improving care.

This approach offers an important opportunity. By combining better data with deliberate quality improvement, healthcare systems can address gaps in women’s cardiovascular care while creating more equitable pathways for prevention, diagnosis, and treatment.

The practical takeaway was clear: review the evidence, identify the gap, design the intervention, measure the result, and keep improving. Quality improvement does not always require expensive technology or new treatments. Progress can start with thinking differently, asking the right questions, and ensuring that proven care actually reaches the patient.