SPIDR · Strengthening secondary prevention of ischemic heart disease in rural Ukraine and Bulgaria: the SPIDR Consortium

The SPIDR Consortium aims to improve secondary prevention of ischemic heart disease (IHD) in Eastern Europe. Our particular focus is on underserved and disadvantaged populations in Ukraine and Bulgaria, where the disease burden is among the highest globally. The SPIDR project will co-design, evaluate, and disseminate health system-strengthening strategies that support improved implementation of IHD care interventions recommended by the European Society of Cardiology. This package of care includes interventions that are clinically proven but poorly implemented such as antihypertensives, antiplatelet and lipid-lowering therapy, smoking cessation, exercise-based cardiac rehabilitation, and screening and intervention for co-morbid mental disorders. To design implementation strategies are effective and contextually appropriate, SPIDR will engage stakeholders from across the health system—including patients, caregivers, healthcare workers, and policymakers—in a collaborative co-design process. Evidence-based implementation approaches such as shifting care to primary facilities, task-sharing with non-specialist workers, and supporting patients through mobile messaging, peer support networks, and simplified medication regimens will be tailored to local needs. Importantly, we will integrate mental health screening and intervention into IHD care to reduce fragmentation. The project will assess feasibility, refine strategies, and conduct a full trial to evaluate implementation and effectiveness outcomes. We will evaluate the health impact of our implementation strategies and produce roadmaps to support their sustainability. Our ultimate goal is to reduce health inequities and strengthen IHD care for underserved and disadvantaged populations in the region.