EAPC Country of the Month - Spain

February 2015

Report prepared by Regina Dalmau with the assistance and advice from:

Almudena Castro, Cardiologist at the University Hospital la Paz, Cardiac Rehabilitation Unit, Madrid, Spain and Chair person of the Cardiovascular Risk and Cardiac Rehabilitation Section of the Spanish Society of Cardiology

National CVD Prevention Coordinator for Spain:

Dr Regina Dalmau González-Gallarza

Executive Secretary of the Spanish National Committee of Smoking Prevention

contact: email

Important update from Dr Regina Dalmau (June 2018)

Declaration of Madrid 2018 for Health and the advancement of Tobacco Regulation in Spain

In spite of progress having been made, tobacco consumption is still a problem in Spain and one which requires appropriate measures to be taken.

Read the "Declaration of Madrid 2018" (pdf)

Document to download

Health care

The Spanish health care system provides universal coverage and is funded from taxes and predominately operates within the public sector. Provision is free of charge at the point of delivery with the exception of the pharmaceuticals prescribed to people aged under 65, which entails a co-payment estimated according to user incomes.
Health competences have been totally devolved to the regional level since 2002, resulting in 17 regional health ministries with primary jurisdiction over the organisation and delivery of health services within their territory. The National Ministry of Health and Social Policy holds authority over certain strategic areas, such as pharmaceutical legislation, and as a guarantor of the equitable functioning of health services across the country.

Risk factors

As in other societies, cardiovascular disease is the primary cause of death in the Spanish population, accounting for 32% of all deaths. Prevalence studies of cardiovascular risk factors are of great interest to define policies for cardiovascular prevention.

According to a pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century in individuals aged 34-74, the most prevalent cardiovascular risk factors in Spain are:

High blood pressure: 47% in men, 39% in women
Total cholesterol ≥250 mg/dl (43% and 40% respectively)
Tobacco use (33% and 21% respectively)
Diabetes (16% and 11% respectively)

Prevention methods and main actors

The Spanish Society of Cardiology
The Spanish Heart Foundation
The Spanish Society of Family and Community Medicine and its Working Group on Cardiovascular Prevention
The Spanish Interdisciplinary Committee of Cardiovascular Prevention
The Public Health Area of the Ministry of Health
The Spanish National Committee for Smoking Prevention

Prevention activities

The Prevention and Health Promotion Strategy of the Spanish NHS: initiative that tries to facilitate a common framework for health promotion and primary prevention in the course of life. It promotes the participation of individuals and population in order to increase their autonomy and capacity to have greater control over their own health.
The Observatory for the Study of Nutrition and Obesity: strategy of the Spanish NHS (National Health Service) in order to promote the policy development and decision making needed to avoid obesity and to improve children´s dietary situation.
Program on Preventive Activities and Health Promotion (PAPPS) from the Working Group on Cardiovascular Prevention of the Spanish Society of Family and Community Medicine. Every 2 years and after analysing the cardiovascular morbidity and mortality, a document is published setting the evidence-based priorities in cardiovascular prevention in the main areas: hypertension, diabetes, dyslipidaemia and smoking.
The Spanish Society of Cardiology and the Spanish Heart Foundation are involved in many cardiovascular prevention programmes such as:
- Mimocardio: on-going project that tries to emphasise the role of the cardiac patient in improving his cardiovascular prognosis, by understanding the key points in lifestyle correction and risk factor control.
- R-EUReCa (Spanish Registry of Cardiac Rehabilitation Units): tries to clarify the real implementation of cardiac rehabilitation in Spain and to analyse whether the programs cover the care demands of cardiac rehabilitation, and fulfil the minimum quality requirements.

Cardiac Rehabilitation

The situation of cardiac rehabilitation in Spain is very heterogeneous, as shown in the Spanish Registry of Cardiac Rehabilitation Units (R-EUReCa) run by the Spanish Society of Cardiology. Despite the fact that the number of cardiac rehabilitation programs has risen during the last years, there are important geographical differences, and many regions lack any cardiac rehabilitation program. According to a recent study, only 36% of the Spanish cardiac care units have a Cardiac Rehabilitation Program. Moreover, there are also important differences in resources available in the existing programs (staff and facilities).
Main indications for referral to Cardiac Rehabilitation Programmes (CRP) are related to ischemic heart disease, with a growing impact on other settings such as heart failure, cardiac surgery and congenital heart disease. Cardiac rehabilitation and secondary prevention programs are known to improve prognosis and quality of life in many cardiac diseases, and have been proved to be cost-effective.
Therefore, the Spanish Society of Cardiology is making a particular effort in evaluating the real situation of cardiac rehabilitation in Spain and defining the minimal quality standards for a CRP, in order to close the gap between the guidelines and our real practice.

Aims for the future

To implement a common agreed cardiovascular prevention guide, to encourage primary care physicians to implement CV risk in electronic clinical history.
To improve the diagnosis and control of hypertension and hypercholesterolemia.
To reduce the growing prevalence of obesity, sedentarism and diabetes mellitus by promoting a healthy life style from childhood.
To improve the adherence to Mediterranean diet.
To reduce the smoking prevalence, particularly in women and young people.
To achieve a wider implementation of cardiac rehabilitation programs all over the country.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology

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