Abstract The European Society of Cardiology (ESC) develops and updates clinical practice guidelines (CPGs) based on the latest evidence. However, their implementation remains suboptimal, leading to missed opportunities to improve cardiovascular (CV) outcomes. The success of CPG implementation is influenced by four key factors: (i) patient-related barriers, (ii) health care professionals’ engagement, (iii) the clarity and usability of CPGs, and (iv) the health care system and economic context in which care is delivered. To address these challenges, innovative strategies are needed to bridge the gap between CPG recommendations and clinical practice. The ESC has developed several initiatives to improve implementation, including (i) educational programmes, (ii) examinations for cardiologists, (iii) accreditation policies, and (iv) registries. However, persistent gaps indicate that knowledge dissemination alone is insufficient. A more integrated, structured, and equitable approach to quality-of-care improvement is required. Despite the need for evidence-based implementation strategies, only a limited number of high-quality randomized controlled trials have evaluated individual approaches for CV conditions. Strategies such as text messaging, educational interventions, the involvement of non-physician health workers, structured order sheets, and financial incentives have been tested, but their feasibility and effectiveness can vary across health care systems. Future research should explore the potential of artificial intelligence-enhanced technologies to support and scale implementation efforts. This manuscript reviews current evidence on CPG implementation and proposes strategies to enhance the adoption of best practices in CV care.