EAPC Country of the month - Denmark

Associate Professor Albert Marni Joensen
MD, Specialist in Cardiology, PhD
National CVD Prevention Coordinator (NCPC) for Denmark (-2017)

Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark

(Note: National CVD Prevention Coordinator for Denmark since 2017: Professor Eva Prescott)

This report was prepared by:

• Albert Marni Joensen, MD, PhD, National CVD Prevention Coordinator for Denmark (-2017)
• Magnus T. Jensen, Co-Chair Working Group on Preventive Cardiology and Cardiac Rehabilitation, Danish Society of Cardiology
• Thomas S. G. Sehested, MD
• Kirstine L. Sibilitz, MD Phd
• Susanne Glasius Tischer, MD, Phd
• Ulla Overgaard Andersen, MD, Sc.D
• Soetkin Versteyhe, Master in Pharmaceutical Sciences Phd
• Julia Vishram, MD, Phd
• Gunnar Gislason,MD, Phd, Professor, Scientific Director of the Danish Heart Foundation

Group picture (from left): Magnus T. Jensen, Albert Marni Joensen,
Thomas G. S. Sehested, Kirstine Lærum Sibilitz and Ulla Overgaard Andersen
Individual pictures (from top): Julia Vishram, Soetkin Versteyhe, Susanne Glasius Tischer, Gunnar Gislason

Documents to download

• Full report
• CV and publications Albert Marni Joensen

Health care

The central government outlines health policies and goals for the public health care system. Five counties govern and administer the health care system and the municipalities provide rehabilitation and general health-promoting information.

The Danish healthcare system is tax financed and there is equal access to general practitioners and hospital care at no individual charge, independent of income or participation in the labour market. Medication expenses are partly covered by the counties. Patients who cannot afford the remaining costs can apply for economic help from the municipalities.

Danish costs for health care are approximately equal to the median costs in Europe.

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Risk factors

In 2013, Denmark counted 5.6 million inhabitants and the life expectancy at birth was 78 and 82 years for males and females respectively. During the last decades the age-standardized CVD mortality has decreased substantially. The development 2006 – 2012 is shown in figure 1.  

Figure 1: Temporal trends in cardiovascular mortality. Age-standardized rates per 100,000 and total number of deaths. 

Source: figure drawn based on data extracted from the Danish Heart Foundation. HjerteTal.dk [Internet]. 2015 [cited 2016 Feb 14].

Table 1: The prevalence of major CVD risk factors in Denmark 2013

Source: http://www.sundhedsprofil2010.dk/ (Danish only), *Data from survey Health 2007 

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Main actors

• The central government
• The Danish Health Authority
• The Danish counties
• The Danish municipalities
• The Danish National Institute of Public Health
• The Danish Society of Cardiology
• The Danish Heart Foundation
• General practitioners and personnel in hospitals, municipal rehabilitation, health centers and home care.

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Prevention activities

The Danish Health authorities have released focus areas which are recommendations in specific areas to be implemented across the 98 Danish municipalities for use in public institutions. General guidelines also include requirements for basic knowledge for care providers, teachers, and other professionals. For cardiovascular disease prevention following recommendations and initiatives are included:

• Physical Activity:  60 minutes of moderate to high intensity physical activity per day in age group 5-17 years and 30 min. for adults.
• Tobacco: Total ban on smoking in public areas. Smoking cessation courses with special focus on different groups. Minimum age for buying tobacco and prohibition of advertisements for tobacco products. National campaigns against smoking.
• Alcohol: A maximum weekly consumption of 7 units for women and 14 units for men. Health campaigns for the young and groups at risk.
• Obesity: Prevent obesity in the young by introducing healthy meals and physical activity throughout the educational system.
• Nutrition: The Official Dietary Guidelines were renewed in 2013 focusing on healthy nutrition and physical activity. The goals are supported by initiatives concerning e.g. food-labelling.
• Trans-fat: Denmark was the first country to introduce national rules for industrially produced trans-fat content resulting in a large reduction of trans-fat content in pre-processed food.

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Cardiac Rehabilitation

National guidelines recommend that patients with coronary heart disease (CHD), heart failure (HF), and those after heart valve surgery are systematically referred to cardiac rehabilitation (CR). CR is regarded as a part of the treatment and is financed by the taxpayer-funded system. Initiatives are taken to also include other cardiac patients e.g., atrial fibrillation (AF).

The municipalities are the principal responsible for rehabilitation with close cooperation with the treating hospital. Participation rates in CR for CHD, HF and heart valve surgery patients is above 70%, although only a part of these patients fulfill a complete comprehensive programme.

CR for CHD patients at hospitals is organised as an intersectional programme with a multidisciplinary approach supervised by a cardiologist.

The establishments of HF clinics offering education, control of fluid retention, and medication appear efficient in terms of therapy optimisation and decline in HF related readmissions.

Also, the number of AF clinics is increasing with the purpose to ensure a better treatment, guidance and education for AF patients.

National Treatment Quality Databases have been established to monitor and improve the treatment and rehabilitation for patients with CHD and HF. A similar database for AF patients is following.

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Aims for the future

The Danish Society of Cardiology and The Danish Heart Foundation will continue the work to prevent development of CVD through information, research, and by influencing policy makers. We have identified three areas which require increased focus in the coming years:

1. tobacco smoking, particular in young individuals
2. social inequality in health
3. obesity and diabetes

We propose further structural initiatives to

• reduce tobacco consumption by 25% by 2025, (limit access to tobacco, increase in retail price, and higher legal age of purchasing tobacco).
• implement strategies to address socioeconomic disparities in health.
• facilitate daily physical activity and healthy nutritional choices.

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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.