IPM Take
Cardiovascular disease remains the leading cause of death among women, yet many healthcare systems still diagnose, investigate and treat women using pathways largely designed around evidence generated in men.
The European Society of Cardiology is now proposing a different model: dedicated women’s heart centres bringing together cardiology, obstetrics, endocrinology, imaging, genetics and preventive medicine under one coordinated service.
The science supporting sex-specific cardiovascular care has become increasingly difficult to ignore.
The policy challenge is whether health systems are willing to invest in entirely new referral pathways rather than simply publishing another consensus statement.
Executive Summary
The European Society of Cardiology has published a Clinical Consensus Statement recommending the establishment of specialised women’s heart centres throughout Europe.
Rather than creating separate hospitals, the document proposes multidisciplinary centres integrated within existing cardiovascular services, bringing together expertise in prevention, imaging, pregnancy-related cardiovascular disease, inherited conditions, menopause, cardio-oncology and microvascular disease.
The recommendations respond to growing evidence that women frequently experience delayed diagnosis, atypical symptoms, lower referral rates and poorer outcomes across multiple cardiovascular conditions.
The document also calls for standardised referral criteria, specialist training, data collection and quality indicators to evaluate performance.
While the recommendations are not mandatory, they are likely to influence future national cardiovascular strategies and service planning across Europe.
Why it matters
- Policymakers: The recommendations shift cardiovascular policy beyond treatment guidelines towards redesigning specialist services.
- Hospitals: Existing cardiac services may need new multidisciplinary clinics, referral systems and dedicated expertise.
- Clinicians: Greater awareness of female-specific cardiovascular presentations could reduce diagnostic delay and inappropriate management.
- Patients: Earlier diagnosis and coordinated care could improve outcomes for conditions that disproportionately affect women.
- Health systems: Implementation will require workforce planning, investment and performance measurement rather than simply publishing guidance.
Women continue to experience major gaps in cardiovascular care
Despite major advances in cardiovascular medicine, women remain more likely than men to experience delayed diagnosis, misinterpretation of symptoms and under-recognition of several cardiovascular diseases.
Conditions including ischaemia with non-obstructive coronary arteries (INOCA), spontaneous coronary artery dissection, pregnancy-associated cardiovascular disease and heart disease related to menopause often follow different clinical pathways than those traditionally described in cardiovascular medicine.
Many women also develop cardiovascular disease later in life, frequently alongside diabetes, obesity, chronic kidney disease and other long-term conditions requiring coordinated management rather than isolated specialist care.
These differences have increasingly highlighted the limitations of traditional cardiovascular services that were largely developed around evidence generated from predominantly male populations.
The ESC proposes dedicated women’s heart centres
The new Clinical Consensus Statement recommends establishing specialised women’s heart centres embedded within existing cardiovascular networks.
Rather than functioning as standalone hospitals, these centres would coordinate multidisciplinary expertise across cardiology, maternal medicine, endocrinology, genetics, imaging, rehabilitation, nursing and preventive care.
The proposed model would support comprehensive assessment of women across the life course, from pregnancy through menopause and older age.
The statement also recommends structured referral pathways, standardised diagnostic protocols, specialist education programmes and continuous quality monitoring.
Importantly, the authors argue that these centres should become regional hubs supporting surrounding hospitals rather than concentrating expertise in only a few academic institutions.
This is ultimately an implementation challenge
Scientific understanding of sex differences in cardiovascular disease has advanced considerably over the past decade.
Implementation has not.
Many European health systems still lack dedicated referral pathways for women with complex cardiovascular presentations, while specialist expertise remains concentrated in relatively few centres.
Without commissioning, workforce planning and sustainable funding, dedicated women’s heart centres risk becoming another example of evidence that exists on paper but remains inaccessible in routine care.
The recommendations therefore move the discussion beyond clinical awareness towards service redesign.
Personalised medicine is changing cardiovascular care
The proposal also reflects a broader shift towards more personalised cardiovascular medicine.
Increasing use of genetics, advanced imaging, biomarker testing, cardio-obstetric services and multidisciplinary care means cardiovascular treatment is becoming progressively tailored to individual biological and clinical characteristics.
Women’s heart centres could provide a practical framework for integrating these innovations into routine care rather than introducing them individually across fragmented services.
The approach mirrors broader trends already transforming oncology, where specialised multidisciplinary centres have become central to implementing precision medicine.
The challenge now moves to governments
Unlike regulatory approvals, the consensus statement creates no immediate legal obligation.
Its influence will depend on how national governments, professional societies and hospital systems incorporate the recommendations into future cardiovascular strategies.
Countries with established specialist cardiovascular networks may be able to adapt relatively quickly.
Others may require substantial investment in workforce training, referral infrastructure and service organisation before dedicated women’s heart centres become a reality.
The recommendations therefore represent an important policy signal.
The evidence for sex-specific cardiovascular care continues to strengthen.
The remaining question is whether healthcare systems will redesign services quickly enough for patients to benefit.
