Systematic review of cardiovascular care delivery across health systems in the Asia–Pacific: a regional roadmap for strengthening cardiovascular care

Background: Achieving universal health coverage in the Asia-Pacific requires stronger, more equitable access to high-quality cardiovascular disease (CVD) services. Yet, despite the region's vast diversity in health systems and resources, there is limited consolidated evidence describing how CVD care is organised, financed, and delivered across Asia-Pacific. Methods: This document synthesises evidence from a systematic review and Global Burden of Disease data, structured using Donabedian's framework. It provides: (1) an overview of health system structures for CVD care across the Asia-Pacific; (2) case studies illustrating how system processes influence CVD prevention and treatment; and (3) country-level assessments of health system performance, spending efficiency, and associated cardiovascular outcomes, alongside forecasts of health expenditure and CVD burden from 2022 to 2050. Findings: Many low-to-middle income countries (LMICs) in the Asia-Pacific face challenges in ensuring accessible, high-quality CVD services without substantial policy action and investment. Fragmented primary and secondary care systems, uneven financing models, and limited quality infrastructure have contributed to stalled improvements in cardiovascular health. In contrast, high-income countries must address rising cardiometabolic multimorbidity in ageing populations, requiring transitions from acute inpatient care to integrated, multidisciplinary community-based models that improve quality while managing costs. Interpretation: These findings underscore the need for tailored, equity-focused strategies that enhance access, quality, and efficiency of CVD care across diverse health system contexts, accelerating progress in a populous yet resource-constrained region. Funding: This Commission is partly supported by funding from SingHealth Duke-National University of Singapore Cardiovascular Sciences Academic Clinical Programme, the National Medical Research Council of Singapore, and the Stafford Fox Foundation.