Cardiovascular disease is the world's leading cause of death – taking almost 18 million lives per year, and with up to 80% of these deaths occurring in low- and middle-income countries. That is why the Novartis Foundation works with city authorities and other partners to co-design and implement data-driven responses to improve cardiovascular population health and narrow health inequities.

CARDIO4Cities is our cardiovascular population health approach that we built and validated in three cities across three continents. In each city, we help authorities use the power of data to make better decisions for health systems and the population, tap into emerging HealthTech innovations where appropriate, and inform the investment into impactful digital health solutions by global best practices from the Broadband Commission’s roadmaps on virtual health and care, and AI maturity in health.

After just 1-2 years of implementation in the cities of São Paulo (Brazil), Dakar (Senegal) and Ulaanbaatar (Mongolia), the CARDIO4Cities approach dramatically improved hypertension control rates at population level, the prime risk factor for cardiovascular disease, and showed positive effects on stroke and coronary heart disease rates. This increase in control of hypertension could be translated into a reduction of up to 13% of strokes and up to 12% of heart attacks already during implementation.

A paper published in PLOS Global Public Health in April 2023 provides evidence that CARDIO4Cities is a cost-effective approach to alleviate the growing cardiovascular disease burden in cities across the world.

CARDIO4Cities Global Impact

Increased blood pressure control rate¹ ³

3x

in 15 months of implementation

São Paulo

3x

in 19 months of implementation

Dakar

6x

in 21 months of implementation

Ulaanbaatar

Averted strokes and heart attacks during implementation² ³

13%

of strokes

São Paulo

3%

of strokes

Dakar

10%

of strokes

Ulaanbaatar

12%

of heart attacks

São Paulo

3%

of heart attacks

Dakar

10%

of heart attacks

Ulaanbaatar

The research paper also calculates the potential long-term impact that CARDIO4Cities can have on cardiovascular population health in metropolitan areas. In São Paulo for example, and over a ten-year projection, the stroke rate could decrease by up to 10%, and the heart attack rate as well as the mortality related to cardiovascular disease could decrease by up to 8% each, even if no further CARDIO4Cities interventions are implemented. Following these estimations, improving healthcare systems and primary care delivery can constitute a considerable return on investment. Overall, results demonstrate that a reduction of morbidity and mortality related to cardiovascular disease by improving hypertension control at population level is both clinically impactful and broadly economically cost-effective once enough patients are involved.

Image of an elderly patient in Senegal getting its blood pressure measured by a a nurse

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The Novartis Foundation is working with the city authorities of São Paulo and Dakar, to extend the CARDIO4Cities approach from hypertension control toward overall cardiovascular risk reduction in urban populations. Further, as part of CARDIO4Cities, the Novartis Foundation and the Swiss Tropical and Public Health Institute have worked with city authorities in São Paulo to develop a data- and evidence-based tool to help decision-makers assess the impact and cost-effectiveness of interventions before they are implemented. Once validated in São Paulo, the simulator will be adapted to additional locations.

CARDIO4Cities Accelerator

The Novartis Foundation cardiovascular population health approach, CARDIO4Cities, was successfully implemented in three cities across continents. It proved to rapidly improve blood pressure control rates (within one to two years of implementation), resulting in a remarkable reduction of stroke and heart attack rates in a highly cost-effective way. That is why the Novartis Foundation decided to create a new organization to globally replicate CARDIO4Cities and make this simple yet impactful approach available to many more people around the world.

CARDIO4Cities Accelerator Logo

In the context of the World Health Assembly 2023 in Geneva, the Novartis Foundation launched the CARDIO4Cities Accelerator, to globally replicate this scientifically proven population health approach and transform cardiovascular population health. As a neutral broker between city governments, health experts, industry, implementing partners, funders and investors, the Accelerator pledges the global community to direct action and funding toward improving cardiovascular population health and equity. By enabling governments and partners to replicate the CARDIO4Cities approach in their metropolitan area, the Accelerator aims to transform cardiovascular population health in 30 cities around the world within the next three years.

We invite health authorities, private sector players, investors and funders, and civil society to explore the CARDIO4Cities Accelerator and its benefits for local populations around the globe.

A Brazilian physician working in the field of cardiovascular disease is standing on a street in São Paulo

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1 Boch J et al. Implementing a multisector public-private partnership to improve urban hypertension management in low- and middle‑income countries. BMC Public Health 22, 2379 (2022).

2 Reiker T and Des Rosiers S et al. Population health impact and economic evaluation of the CARDIO4Cities approach to improve urban hypertension management. PLOS Global Public Health (2023, in press)

3 All figures rounded