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EAPC Country of the month - Croatia

December 2015

Report prepared by:

Prof. Davor Milicic, MD, PhD

National CVD Prevention Coordinator of Croatia

Specialist in Internal Medicine, Specialist in Cardiology
Professor or Internal Medicine and Cardiology, University of Zagreb School of Medicine, Fellow of the Croatian Academy of Sciences and Arts
Contact: email

Documents to download

Health care

Health care in Croatia is fairly developed and accessible to all the citizens regardless of their socioeconomic and employment status. It is financed through the Croatian Health Care Institute which is a central and public health insurance organisation. Croatia is the only European country still having medical specialisation in School and University Medicine, focused primarily on prevention and health care promotion in the young population. However, there is no comprehensive national health prevention programme, although there are relatively many prevention activities led by various institutions, healthcare organisations, societies and foundations. Beside suboptimal preventative medicine, curative medicine in Croatia is at a high level.

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Risk factors

In Croatia the leading risk factors are: smoking, obesity, physical inactivity, hypertension, diabetes and dyslipidaemia. Smoking prevalence in adults is almost 30%. Smoking is still allowed in smokers’ areas in coffee shops and pubs, people smoke in open spaces without restrictions. Obesity is a growing problem in Croatia, including visceral type among men and women. It is mostly due to unhealthy eating habits and lack of regular physical activity. Despite the fact that Croatia is partly a Mediterranean country, there are too much carbohydrates and red meet in a daily diet, and too less fish, fruits and vegetables. Diabetes type 2 is consecutively also increasing. Prevalence of arterial hypertension according to our own data is about 37% and the hypertension control is suboptimal. Dyslipidaemia, particularly within primary prevention is usually not considered properly. 

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Main actors

The Croatian Institute for Public Health is the main stakeholder regarding epidemiology data collection and dissemination. The Institute is placed in Zagreb and works also through its regional and local branches. Zagreb, Split, Rijeka and Osijek have their Public Health Departments which are also involved in data collection and prevention programmes. The Croatian Cardiac Society is the main stakeholder in cardiovascular medicine, being actively involved in cardiovascular prevention as a whole and through its Working Group for Cardiovascular Prevention and Rehabilitation. The Society collaborates closely with the Croatian Heart House – Croatian Heart Foundation, particularly in preventive programmes and numerous health promotion activities. It also collaborates with the Society for Hypertension, as well as for Atherosclerosis.

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Prevention activities

Croatian Heart House/Croatian Heart Foundation initiated a wide national health promotion campaign with the title: “Heart Keepers.” It is the first Croatian national e-campaign which is planned for the entire 2016 and focuses on four main topics: Hypertension, Atrial Fibrillation, Dyslipidaemia and Coronary Heart Disease. The Campaign is carefully designed and aimed to both – medical community, dominantly primary care physicians, and particularly to citizens: school children, university students, employees and retirees. It will be steered by the Croatian Cardiac Society and executed by a professional digital marketing company. It contains: e-learning platform, on-line courses for family physicians with CME credits, mobile application for connecting patients and health care providers, medical call centre etc.

There is also an ongoing campaign on reducing the salt intake among Croatian population as the mean daily salt intake among Croatians is about 10-15 g. The goal is to reduce the salt intake up to 5 g per day. The campaign is conducted by the Croatian Hypertension, Atherosclerosis and Cardiac Societies as well as with the Croatian Academy of Medical Sciences and the Croatian Institute for Public Health. There are several ongoing programmes to raise awareness of the importance of a healthy diet and physical activity, particularly in schools and working places. Croatian Heart House/Foundation conducts together with the Zagreb City Public Health Department a national programme on wide education of cardiopulmonary resuscitation and collecting donations for external automatic cardioverter defibrillators installation in as many as possible public places throughout Croatia.

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Cardiac Rehabilitation

In Zagreb, which is the Croatian capital containing about one fourth of the entire Croatian population, there is a well developed out patient cardiac rehabilitation programme, aimed mostly for patients who suffered from myocardial infarction. The Programme is fully covered by the National Health Insurance. In other parts of Croatia there are no such well structured and comprehensive programmes for rehabilitation of post-infarction patients. Regarding general referral rates for rehabilitation after myocardial infarction the referred percentage generally does not exceed 30%.

Beside few comprehensive stationary rehabilitation institutions, there are two highly specialised rehabilitation centres: University of Rijeka Department for Cardiac Rehabilitation in Opatija (northern Adriatic) and Department for Cardiac Rehabilitation in Krapinske Toplice (north-western Croatia). Those in-hospital rehabilitation departments provide high quality programmes mainly for patients after cardiac surgery. It is fully paid by the National Health Insurance. Referral rates for patients post cardiac surgery are about 60%. For non-cardiosurgical patients, stationary rehabilitation is not covered by the National Health Insurance and therefore realised referral rates are less than 15%. All cardiac rehabilitation programmes in Croatia are well audited. There are also developed programmes for rehabilitation of cerebrovascular patients, mainly those who suffered from stroke. There are few in patient institutions specialized for rehabilitation of stroke survivors.

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Aims for the future

Despite the fact that cardiovascular mortality in Croatia is slowly but persistently decreasing, Croatia is still categorised among the high cardiovascular risk European countries. The main goal for the future should be continuation of a decrease in cardiovascular mortality through tackling the main cardiovascular risk factors and changing unhealthy lifestyles.

Essential prerequisite is a better network of cardiology related scientific societies – Croatian Cardiac Society and others (Hypertension, Atherosclerosis, Family Physicians, School and University Medicine, Epidemiology) together with the Croatian Heart House/Foundation and National and local institutes for Public Health. Even more important is to broadly include patients’ organisations in preventive activities and to mobilise all kinds of media to spread the heart disease prevention messages widely.

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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.