The democratization of life-saving cardiac exams

We are experiencing a landmark moment in the way we diagnose cardiovascular disease in Portugal. For the first time this year, two of the most important and advanced tests in modern cardiology— the coronary calcium score and coronary CT angiography —are now available under the agreement with the National Health Service (SNS). This decision represents a concrete advance for public health and, above all, a decisive step toward ensuring equitable access to early diagnosis of the leading cause of death in the Western world: coronary heart disease.

For too long, these tests were out of reach for many Portuguese people. They were private sector exams, with significant costs, and, in practice, accessible only to those who could afford them. The result was a clear imbalance: many patients were deprived of early diagnosis, more assertive therapeutic decisions, and, ultimately, the possibility of preventing a heart attack before it was too late.

This change corrects a silent injustice and brings Portugal into line with what has been happening for several years in countries like the United Kingdom and Germany, where cardiovascular prevention is not seen as a luxury, but rather as a clear priority of public health policies. The scientific evidence supporting this decision is robust and irrefutable. Large-scale international studies, such as SCOT-HEART and PROMISE, have unequivocally demonstrated that coronary CT angiography not only identifies but also reliably excludes coronary artery disease, with a direct impact on reducing events such as heart attacks and sudden deaths. We are, therefore, talking about science transformed into concrete benefits for patients.

Ultimately, the essence of this change is simple yet powerful: more people will now have access, quickly and at no additional cost, to tests that can literally change the course of their lives. The calcium score, for example, is an incredibly useful test for those who have no symptoms but carry risk factors such as diabetes, high cholesterol, or a family history of heart disease. It allows a clear and objective understanding of whether preventive measures are needed before any symptoms appear. On the other hand, coronary angiography (CT) is an extraordinary tool for those already presenting signs or complaints, such as chest pain or questionable results on conventional tests, allowing for an accurate diagnosis and often avoiding unnecessary invasive exams.

But beyond the technical aspect, the true impact of this measure is measured in peace of mind and the lives that can be saved. The anxiety of those living with doubt, the fear of those waiting months for an answer, or the anguish of those facing symptoms without a clear diagnosis—all of this can now be combated more effectively. Early diagnosis means better treatment and, often, means avoiding the worst.

It's important to understand that we're not just talking about technological advances or system modernization. We're talking about dignity in access to healthcare, social justice, and the collective responsibility to ensure everyone has the same opportunities to protect their heart.

This decision is, therefore, profoundly appropriate and should be seen as a clear sign that we are moving in the right direction. Naturally, it will now be up to everyone—professionals, institutions, and decision-makers—to ensure that this access is effective, swift, and truly serving those who need it most.

As a physician and clinical director, I fully understand the value of these exams. But more than that, I understand the impact they have on people's lives. I know what it means to be able to look someone in the eye and confidently tell them there's no reason to worry. Or, conversely, to know that early detection of an obstruction allows for preventive action, saving that life from a seemingly unlikely heart attack.

This is how we build a fairer, more humane, and more efficient healthcare system. Not just by treating the disease, but by preventing it before it even manifests. And this, more than a clinical achievement, is a social victory.

The texts in this section reflect the authors' personal opinions. They do not represent VISÃO nor reflect its editorial position.