EAPC Country of the Month - Portugal

Report prepared by Prof. Evangelista Rocha with assistance and advice from:

• Dr. Rui Cruz Ferreira, MD, Director of the National Programme for Cerebro-Cardiovascular Diseases, Directorate-General of Health
• Dr. Ana Abreu, MD, Coordinator of the Working Group on Exercise Physiology and Cardiac Rehabilitation - Author of the contents of cardiac rehabilitation, Portuguese Society of Cardiology.
• Dr. Rui Portugal, MD, Executive Director of the National Health Plan, Directorate- General of Health
• Prof. Paulo Nogueira, Statistician, Director of the Directorate of Analysis and Information, Directorate-General of Health
• Prof. Ana Timóteo, MD, Working Group on Exercise Physiology and Cardiac Rehabilitation, Portuguese Society of Cardiology

National CVD Prevention Coordinator for Portugal (-2017):

Evangelista Rocha
MD, PhD

Cardiologist at the Armed Forces Hospital (Lisbon)
Assistant Professor at the Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon.

(Note: National CVD Prevention Coordinator for Portugal since 2017: Professor Ana Abreu)

Documents to download

• Full report
• CV and Publications E.Rocha

Health care

The Portuguese health system consists of three systems:

• the universal National Health Service (NHS)
• public and private subsystems
• voluntary private health insurance

Public health insurance coverage for a core set of services is 100% but 20.0% of the total population have double coverage through private insurance. It includes the various levels of prevention: health promotion, disease prevention, diagnosis, treatment and rehabilitation.

Total health expenditure is 9.5% of gross domestic product (GDP). Spending on inpatient care and outpatient care accounts for the major part of health expenditure, while 6% goes towards public health and prevention services and administration.

Risk factors

The average life expectancy at birth in Portugal in 2012 was 80.6 years (overall), lower in males (77.3 years) than in females (83.6 years), which is slightly above the EU28 average (respectively, 79.2, 76.1 and 82.2).

The trend in mortality is towards a marked and progressive decrease in deaths from cardiovascular disease (CVD). Between 1990 and 2012, proportional CVD mortality decreased from 42% to 30.2%.

Prevalence of risk factors in Portugal:

Main actors & prevention methods

The main actors are:

• Ministry of Health – Directorate-General of Health
• Central Administration of the Health System
• National Authority of Medicines and Health Products
• Executive Council of the Groups of Primary Care Centres
• Portuguese Society of Cardiology and its Working Groups
• Portuguese Foundation of Cardiology
• Decision-makers
• Health professionals (general practitioners, cardiologists, nurses, etc.)
• Citizens

Prevention activities

Ongoing activities focus on health promotion and screening healthy individuals who may be at risk as well as those with existing conditions, to modify them in a comprehensive approach to the cardiovascular continuum by lifestyle changes and drug treatment as well as interventions to reduce mortality and morbidity in patients with acute coronary syndromes.

National priority health programmes to promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases (NCD): tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol:

• National Programme for Diabetes
• National Programme for Smoking Prevention and Control
• National Programme for Promotion of Healthy Eating
• National Programme for Cerebro-Cardiovascular Diseases

"Heart Month": Every May there is a campaign on television, radio, cinemas, posters, billboards, and various websites to publicise the importance of caring for the heart. It includes meetings, workshops, conferences, talks, cardiovascular screenings and sporting events.

World Heart Day, World No Tobacco Day: The Portuguese Foundation of Cardiology and the Portuguese Society of Cardiology work with local authorities to develop initiatives under the theme set by international organisations.

“e_COR”: This study set out to determine the prevalence of major cardiovascular risk factors in the Portuguese population, including genetic characteristics.

“Stent for Life”: Public campaign as part of the international “Stent for Life” initiative to raise public awareness of the symptoms of myocardial infarction (MI) and of the need for rapid transport to a percutaneous coronary intervention (PCI)-capable hospital.

Cardiac Rehabilitation

The recent 2014 survey performed by the Working Group on Exercise Physiology and Cardiac Rehabilitation (GEFERC) of the Portuguese Society of Cardiology (SPC) shows that 10% of MI patients are now being rehabilitated, compared to 3% in 2009.

Other clinical conditions, like coronary artery bypass grafting
(CABG) and heart failure, are also more often being treated by cardiac rehabilitation (CR), corresponding to 40% of all rehabilitated patients. There are currently 22 centres (12 public and 10 private), all with a multidisciplinary team.  

Obstacles to CR include:

• small number and uneven geographical distribution of CR centres
• financial constraints
• lack of legislative support for work absenteeism
• poor patient motivation
• inadequate referral by physicians

In order to overcome these obstacles, GEFERC has carried out several actions:

• Joint document with the Coordinator for Cardiovascular Disease of the Ministry of Health publication
• Production of a film on cardiovascular disease prevention and CR
• Publication of a CR book
• protocol between GEFERC and the Portuguese Association of Interventional Cardiology (APIC) agreement
• Production of an educational programme for children and parents
• annual exercise activities for cardiac patients, extended to the general population organisation
• annual GEFERC meetings for health professionals organisation
• rehabilitation/prevention campaigns in the media

Aims for the future

• to implement four national priority programmes incorporating new recommendations  
• to comply with the new Directive 2014/40/EU on tobacco products and to give strong support for smoking cessation
• to accept the Diabetes Challenge proposed by the Calouste Gulbenkian Foundation.
• to increase the number and improve geographical distribution of CR centres in order to get more cardiac patients rehabilitated.
  
  

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