Report prepared by Ass. Prof Anna Kiessling with the assistance and advise from:
- MD Kristina Hambraeus
- Ass. Prof Claes Held
- MD PhD Anna Norhammar
- Prof Joep Perk
- together with the rest of the National Working Group for Cardiovascular Prevention and Lifestyle, appointed by the Swedish Society of Cardiology
National CVD Prevention Coordinator for Sweden:
MD, PhD, FESC
Cardiologist, Assistant Professor, Senior Lecturer
Karolinska Institutet, Department of Clinical Sciences, Unit of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
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Everyone has equal access to healthcare services under a taxpayer-funded system. The government establishes principles, and the county councils provide healthcare. The municipalities provide care for elderly, people with disabilities and for school health care.
Special demands are put on healthcare due to proportionally one of Europe’s largest elderly populations. Healthcare costs represent 10 % of Sweden’s gross domestic product (GDP). County council and municipal taxes pay for the bulk of these costs. An increasing part of healthcare is financed by county councils but carried out by private care providers. Quality registers are widely used to follow and increase the adherence to guidelines.
People in Sweden are living increasingly longer, with an average life span of 83.5 years for women and 79.5 years for men. Cardiovascular disease is the most common cause of death and among the most frequent sources of disability. Mortality rates have declined substantially. More than half of the decrease between 1986 and 2002 was attributable to reductions of major risk factors; mainly a decrease in serum cholesterol.
Table 1. The prevalence of major CV risk factors (WHO data from 2008)
|Risk factor||Prevalence among adults||Trend over time|
|Physical inactivity||47 %||Decreasing|
|Blood lipids (total cholesterol)||5 mmol/l (mean)||Decreasing|
|Diabetes mellitus||9 %||Increasing|
|Alcohol||7-10 litres/adult > 15 years||Increasing|
Physical inactivity: less than 30 minutes 5 times a week, moderate intensity, or 20 minutes 3 times a week, vigorous intensity
Hypertension: systolic BP > 140 or diastolic BP > 90 or on medication
Diabetes mellitus: fasting blood glucose > 7.0 mmol/L or on medication
Source: WHO statistics (2008): http://apps.who.int/gho/data
Prevention methods and main actors
The main authorities acting in the prevention area are:
The National Board of Health and Welfare
The Swedish Association of Local Authorities and Regions (SALAR)
The Swedish Council on Health Technology Assessment
The Public Health Agency of Sweden
The Swedish Society of Cardiology
The Heart and Lung Foundation
The Swedish National Board of Health and Welfare’s National Guidelines for Methods of Preventing Disease state recommendation on methods of preventing disease by a structured support to patients in their efforts to change unhealthy lifestyle habits. The lifestyle habits included are: tobacco use; hazardous use of alcohol; insufficient physical activity; unhealthy eating habits.
A national project called the Lifestyle project is running to implement them nationally.
Healthy eating habits are discussed widely in Sweden and both evidence based and more populist guidance about different diets is available.
Physical activity on prescription (PAP) is increasingly used to minimise a sedentary lifestyle. It is an individually adjusted written prescription of physical activity including the intensity, duration, and type of activity that the patient should perform to prevent further disease.
All undergraduate programmes leading to a healthcare profession at university level have intended learning outcomes at graduation level including competence in prevention. At residency level there are also compulsory goals on preventive and health promoting competences at both individual patient and group level for all specialties including in cardiology. The Swedish Society of Cardiology, The Swedish Medical Society and other authorities at regional and local levels arrange shorter and longer courses on a regular basis with focus on cardiovascular prevention and on support of healthier lifestyle among patients.
Sweden has no fixed age limits for participation in cardiac rehabilitation, and a well-established countrywide system of cardiac rehabilitation is provided. Most programmes have duration of 2-3 months and include physical activity training, education about healthy food, cardiac risk factors, smoking and the importance of physical activity and stress reduction. The link from organised cardiac rehabilitation to long-term structures to support maintenance of a health life style is increasingly strengthened.
A quality audit is presented yearly on a national basis. SWEDEHEART is a national registry of all patients hospitalised for acute coronary syndrome (ACS). The SEPHIA registry (SEcondary Prevention after Heart Intensive care Admission), forming a part of the SWEDEHEART-registry, provides information on follow up of unselected consecutive patients below the age of 75 up to one year after an acute myocardial infarction. Results from 2012 shows:
- At the second follow-up around 55 % of smokers had quit. Fourteen % of smokers had taken part in smoking cessation programmes.
- The proportion of patients with systolic blood pressure < 140 mmHg was 65 % at the first and second follow-ups, but with differences between hospitals.
- Target level for LDL was achieved by 38 % two months after the myocardial infarction, but with divergence in results between hospitals.
Aims for the future
Future plans include focusing on smoking cessation and physical activity. Further, focus on socioeconomically deprived, mentally ill and minors especially susceptible to marketing of the tobacco and fast food industry. We will see more use of national quality registers in the preventive strategies and new individualised models of cardiac rehabilitation.
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