Lessons from France: the cardiovascular care continuum as a health model
Cardiovascular diseases follow clinical trajectories that unfold over time. They begin with the accumulation of risk factors, progress through acute episodes of varying intensity, and continue through phases of stability, relapse, or chronicity. Their management requires more than just occasional technical excellence: it demands consistent organizational approach throughout the entire process.
Cardiovascular medicine has reached an extraordinary level of diagnostic and interventional specialization. The current evolutionary step consists of integrating this specialization within a framework that ensures continuity of the process. In this context, the French experience offers an interesting reference point through its territorial organization by care files: networks structured by pathology that articulate prevention, acute phase, rehabilitation and follow-up under a common logic.
This is not an isolated reform, nor is it a model that can be exported without nuance. It is a progressive evolution in the way the cardiovascular process is organized.
From the acute event to the complete journey
For decades, the primary focus in cardiology was on the acute phase: reducing door-to-balloon times, improving interventional technology, and optimizing hospital survival. This progress was decisive and continues to be fundamental.
However, national registries such as FAST-MI (French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction)Active since the 1990s, with longitudinal analyses published in 2012 and 2021, these studies broadened the perspective. Interest began to shift from the hospital stay to the following year, therapeutic adherence, and long-term outcomes.
This shift introduces a structural reflection: value is not concentrated exclusively in the technical act, but in the coherence of the entire journey.
Prevention as the starting point of the continuum
In the French experience, the continuum begins with the structured management of risk factors in outpatient care. doctor It acts as a longitudinal reference, integrating the control of hypertension, dyslipidemia, diabetes and health education.
The recommendations of the High Authority for Health (HAS) They have progressively incorporated coordination between levels of care and secondary prevention after the cardiovascular event as part of the organized process.
Cardiac rehabilitation and structured follow-up after discharge are integrated into the care pathway. Secondary prevention becomes a stabilizing element of the system, reducing recurrences and strengthening continuity of care.
The process evolves; it doesn't restart after each episode.
Heart attack networks as an operational example
The filières infarctus They illustrate this organization in a concrete way:
- Early activation through the SAMU.
- Territorial referral protocols.
- Reference centers with hemodynamics.
- Coordination between hospitals with different technical capabilities.
- Subsequent structured follow-up.
These networks integrate public hospitals, private clinics, and outpatient care within a single territorial framework. Their organization depends not solely on the provider's legal status, but rather on their integration within the healthcare system.
Structured transitions and territorial governance
One of the most consistent lessons learned is the importance of transitions:
- Emergency room → hospitalization.
- Hospital → outpatient care.
- Specialized care → primary care.
- Stable phase → decompensation.
In France, these transitions are formalized through shared protocols, risk stratification, and defined territorial circuits.
The Regional Health Agencies (ARS) They play a central role in this articulation, organizing networks that coordinate diverse mechanisms within the same region. The territory becomes the true planning unit.
An evolution of more than a decade
The cardiovascular continuum approach did not emerge abruptly. It solidified over time:
- 2010–2011Works such as those by Dzau and Braunwald refine the concept of the “cardiovascular continuum”, connecting risk, event and clinical evolution.
- 2012FAST-MI publishes longitudinal analyses that extend the assessment beyond hospital admission.
- 2014–2023The HAS progressively incorporates explicit elements of hospital-primary care coordination and organized secondary prevention.
- 2021: publication of trends 20 years after FAST-MI.
- 2023The European Society of Cardiology reinforces the need for integrated models in cardiovascular disease.
- 2025The European roadmap for cardiovascular health consolidates the continuity of care approach.
The evolution is clear: from the episode to the process, from the hospital as a center to the territory as a network, from the specific reaction to longitudinal planning.
A structural reflection
The French experience does not offer a fixed formula. It offers an organizational orientation:
- The clinical process guides the structure.
- Prevention is integrated naturally.
- Transitions are planned.
- The network is structured territorially.
- The results are evaluated as a complete journey.
The cardiovascular care continuum is not a conceptual label. It is a way of organizing complexity.
When the system is organized around the patient's journey —from prevention to chronicity— organizational coherence becomes architecture.
Cardiovascular continuum and regulation of healthcare pressure
Working within the logic of a cardiovascular care continuum allows us to address an organizational dimension that transcends the clinical act itself: the regulation of healthcare pressure.
Cardiovascular diseases generate demand over time and at multiple points in the healthcare system: risk factor management, acute episodes, hospitalization, outpatient follow-up, rehabilitation, and chronic management. Each phase introduces input and output flows that impact activity, demand, and resource utilization.
When the patient process is analyzed from the beginning—starting with prevention to reduce demand—the system acquires the capacity to:
- Identify where healthcare pressures originate.
- Anticipate demand build-ups.
- Direct patients to the appropriate level of intensity.
- Adjust activity according to the evolutionary stage of the process.
The organized continuum allows prevention to act as an initial modulator of demand, rehabilitation to reduce recurrences, structured follow-up to stabilize, and Primary Care to assume longitudinal control when appropriate.
The consequence is organizational: the pressure is distributed consistently throughout the patient's process.
Working within a continuum of care not only improves clinical consistency. It introduces an organizational architecture that impacts efficiency, activity planning, and structured demand management.
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References and documentation
- Dzau VJ, Braunwald E. The cardiovascular continuum refined: a hypothesis. Circulation. 2010;121(6):695–697.
- Dzau VJ et al. A new paradigm for cardiovascular disease management: the cardiovascular continuum. Am J Cardiol. 2011;108(4 Suppl):S1–S10.
- Puymirat E et al. Changes in one-year mortality in patients with acute myocardial infarction in France (FAST-MI). Circulation. 2012;125:1717–1726.
- Puymirat E et al. Twenty-year trends in acute myocardial infarction in France (FAST-MI 1995–2015). Eur Heart J. 2021.
- High Authority for Health (HAS). Recommendations on chronic heart failure and post-infarction (updates 2014–2023).
- Ministry of Solidarity and Health. National health strategy. 2018; updated 2022.
- European Society of Cardiology – Association of Cardiovascular Nursing and Allied Professions. Integrated care in cardiovascular disease. Eur J Cardiovasc Nurs. 2023.
- European Alliance for Cardiovascular Health. European Cardiovascular Health Plan: The Roadmap. 2025.
