National CVD Prevention Coordinator for Cyprus
Lambros Kypris, MD, MA
Cardiologist/Intensivist
Private Cardiologist – CardioHealth Cardiology Center
This report has been prepared by Dr. Lambros Kypris with the assistance of Dr. George Georgiou former president of the Cyprus Society of Cardiology.
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Health care structure
The health system in Cyprus is comprised of two healthcare delivery systems of similar size: the public and the private sectors. The public health system is highly centralized and exclusively financed by the state budget. The private system is practically completely separate from the public health system and mostly financed by out-of-pocket payments and private health insurance. Since joining the EU in 2004, each year Cyprus has allocated less of its government budget to health (7.1% of total public expenditure in 2015) than any other EU Member State. As of 2015, total health spending per capita was EUR 1592, which is below the expenditure levels before the financial crisis and well below the EU average. As a result, Cyprus’ health system is largely financed through out-of-pocket expenditures (49% in 2012). Implementation of the new Health Care System, concerning primary care, is anticipated to begin in June of 2019.
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Risk factors
Cardiovascular disease remains the main cause of death (36% among women and 34% among men). In 2014 the prevalence of diabetes was 8.9% in males and 6.7% in females (7.8% in total). The percentage of adults who are daily smokers in Cyprus remains well above the EU average (25.2% in Cyprus versus 21% for the EU average). Obesity is a significant health problem in Cyprus. 15.6% of the adult population is obese, while more than 25% of adolescents aged 12 to 17 in Cyprus is overweight or obese. According to estimates generated by WHO, 59.9% of the Cypriot population aged 15 years and over is insufficiently active. The prevalence of hypertension in the Cypriot population is 31.2% in males and 21.3% in females (26% total), while the prevalence of dyslipidaemia is estimated at 14%.
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Main actors & prevention methods
The main actors of CVD prevention in Cyprus are:
- the Cyprus Ministry of Health
- the Cyprus Society of Cardiology
- primary care physicians
- cardiac centres of the private and public sectors
Primary cardiovascular prevention is primarily provided by general practitioners (mainly of the public health system), internal medicine specialists and cardiologists, while secondary prevention is mainly provided by cardiologists and internal medicine specialists both in the private and public health systems. In addition, primary prevention programs for CVD disease are provided by school health services.
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Prevention activities
The Cyprus Society of Cardiology is the main body responsible for the organisation of the "World Heart Day" and "Heart failure awareness day" in Cyprus. Similar campaigns are also carried out by other organisations such as the Cyprus Society of Hypertension (World Hypertension day), the Cyprus Pulmonary Society (World No Tobacco Day) and the Cyprus Diabetes Association (World Diabetes Day).
The prevention projects regarding the prevention of CVD are mainly focused on diabetes, tobacco control measures and the promotion of a healthy lifestyle among children and adolescents.
The Diabetes strategic plan is coordinated by the Ministry of Health and it is based on 5 pillars:
- prevention and health promotion
- diagnosis and treatment
- rehabilitation services
- research and documentation
- dabetes registry
The national strategy for tobacco control falls under the umbrella of the Cyprus Ministry of Health. Since January 2010 smoking is forbidden in recreational areas, closed public places, and health care establishments. The Research and Educational Institute of Child Health represents Cyprus in the European Research Program IDEFICS. The program has a total duration of 5 years and aims at changing dietary habits in preschool and school aged children. There are 3 medical schools (two in private universities and one in a public university) in Cyprus, where the different aspects in the field of CVD prevention are included in the curricula of the medical universities. A postgraduate program in family medicine is being offered at the University of Nicosia.
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Cardiac Rehabilitation
Cardiovascular Rehabilitation (CR) is not well established in Cyprus due to the lack of specialised centers, specialised programs and organised multidisciplinary teams.
A multidisciplinary approach considered to stabilise, slow, or even promote regression of CVD is the key component for a successful CR. Unfortunately this approach needs a lot of efforts in order to become a reality in our country.
To address the inadequate availability of CR in Cyprus, coordinated efforts through a National Program of prevention and control of cardiovascular diseases are required. This National program should embrace actions for the initiation of rehabilitation programs.
At this time CR referral is provided sporadically by cardiologists of the private sector. The absence of an expert multidisciplinary team for CR, to be provided free of charge in the public health system, is one of the main barriers to the establishment of a successful CR program. The cardiologist is the main doctor who is responsible for the baseline assessment of the patients as well as for the coordination of the patient’s follow up and the linkage with other experts such as dietitians, physiotherapists etc.
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Aims for the future
The principal actions for the 5 next years are:
- Assessment of the main obstacles to CVD prevention on different levels
- Improvement of the health monitoring unit
- Strengthening of the institution of the national coordinator
- Educating of general practitioners in the field of CVD
- Proper establishment of cardiac rehabilitation
- Organisation of campaigns for raising public awareness on CVD
- Establishment of national guidelines for the prevention and treatment of CVD.
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Note: 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.
Our mission: To reduce the burden of cardiovascular disease.