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Country of the month - Luxembourg

January 2019

Rehabilitation and Sports Cardiology
Risk Factors and Prevention


beissel-jean-2019.JPGNational CVD Prevention Coordinator for Luxembourg

Jean Beissel, MD, FESC

Former Director Cardiology CHL (Centre hospitalier de Luxembourg)
President of the Luxembourg Society of Cardiology
President of COPIL (Pilot Committee for the “Plan National de lutte contre les maladies Cardio-Neuro-Vasculaires” 

This report has been prepared by Dr Jean Beissel. 

Document to download

Health care structure

Luxembourg, officially the Grand Duchy of Luxembourg, is a small landlocked country in Western Europe. In 2018, Luxembourg had a population of 602000. It has by far the most expensive health system in Europe.

The Luxembourg health care system provides good quality care and has made a major contribution to improving population health. The principle of compulsory social security system is funded by the contributions of insured persons and contributions from the Government.

The life expectancy at birth in Luxembourg is among the highest in Europe. It has increased by more than four years between 2000 and 2015, to 82.4 years. There are at present 78 cardiologists working in the country.

Read the full report

Risk factors

Behavioural risk factors are a major public health issue in Luxembourg. Data from the Institute for Health Metrics and Evaluation (IHME) estimate that slightly over 25% of the overall burden of disease in Luxembourg in 2015 (measured in terms of DALYs) could be attributed to behavioral risk.

Many behavioral risk factors in the country are much more prevalent among populations disadvantaged by income or education.

The rising rates of overweight and obesity among children may present a future challenge. Based on self-reported data (which tend to under-estimate the true prevalence of obesity), close to one in seven adults (15%) in Luxembourg were obese in 2014.

In the ORISCAV-LUX 2007-2008 study for the first time new information on the cardiovascular health of the population was documented. The results highlighted a high frequency of cardiovascular risk factors:

  females males all
Use of tobacco 19,7 24,9 22,3
Hypertension 27,1 41,9 34,5
Obesity 18,7 23 20,9
Physical inactivity 14,9 20,7 17,8
Diabetes 3,5 5,2 4,4
Hyperlipidemia 65,5 74,3 69,9

 

Source: First nationwide survey on cardiovascular risk factors in Grand-Duchy of Luxembourg (ORISCAV-LUX) Ala'a Alkerwi et al BMC Public Health 201010:468 https://doi.org/10.1186/1471-2458-10-468

The second Oriscav-Lux study (2008-2015) with over 1000 adults has shown in preliminary analysis a significant reduction in tobacco use from 22,3% to 14,4%. The high prevalence of hyperlipidemia may be explained by the definition used, at least one of the following: T-Cholesterol>190 mg/dl, TG>150 mg/dl, LDL-C>115 mg/dl , HDL-C ,40 mg/dl for men and 46 mg/dl for women. 

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Main actors & prevention methods

The main actors are:

  • the Government
  • Ligue Medico-sociale
  • SLC Société Luxembourgeoise de cardiologie
  • the Scientific Health Council
  • FLASS (Federation luxembourgeoise des associations de Sport de Santé)
  • Association Luxembourgeoise du Diabète
  • LIH Luxembourg Institute of Health
  • LISER Luxembourg Institute of Economic Research
  • Caisse Médico-chirurgicale and the LRC Luxembourg Resuscitation council.

Among the professional groups engaged in CVD prevention are:

  • cardiologists
  • diabetologists
  • neurologists
  • general practitioners
  • nurses

Hospitals, school medicine and occupational health services are engaged in Prevention activities.

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Prevention activities

Governmental activities are:

  • Tobacco Plan (Min of Health) 2016-2020, including Sustainable smoking cessation assistance and training for professionals.
  • Anti-tobacco law of 2017 strengthening the application of the anti-smoking legislation.
  • Gimb  (Ministry of   Health) National Health plan (Gesond Iessen Mei Beweegen= Eat healthy and Move more)
  • National Cardio-Neuro -Vascular Plan (Ministry of Health) in elaboration with main objective to “reduce morbidity and mortality from cardio-neuro-vascular diseases in Luxembourg"

Activities from organisations:

  • World-Heart Day (Societe Luxembourgeoise de Cardiologie) organised in the Center of Luxembourg City with all the stake-holders of Prevention and Cardiology.
  • Journée du Diabète (ALD) Organised by the  Association luxembourgeoise du  Diabète.
  • Bletz (Stroke and Post Stroke Rehabilitation) Yearly conference on Stroke day with multiple interventions in rehabilitation.
  • Reagis (Luxembourg Resuscitation Council) Prevention and treatment sudden cardiac arrest: “Restart a Heart day” with  CPR Teaching in secondary schools,  companies, rural municipalities, public administrations and others.
  • MMM18 campaign (2018) (The Luxembourg Institute of Health) participation in the campaign world “May Measurement Month” in order to raise awareness of the risks associated with hypertension. 

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Cardiac Rehabilitation

Phase II Cardiac Rehabilitation is performed ambulatory after ACS/MI / Cardiac Surgery/Heart failure by the four Hospital Centres but the number of patients with heart failure enrolled in the program remains small.

Long term cardiac rehabilitation is provided by the Luxembourg Association of Cardiac Sports Groups (ALGSC). Founded in Luxembourg in 1984, this non-profit association is divided in three regional sections: South, Central and North. Its main objective is to inform on the prevention of cardiovascular disease among the general public and patients with cardiovascular disease, and to offer physical activities for heart patients in order to increase their quality of life and prognosis.

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Aims for the future

In Luxembourg as in other countries behavioral risk factors, such as overweight and the use of tobacco and alcohol remain important challenges for the health system and reveal substantial inequalities according to education and income status.

Prevention policies suggest ways to meet the challenge: a comprehensive set of health strategies, targeted health promotion and prevention activities with the aim to address CVD risk through raising awareness and with public health campaigns.

The efficient allocation and use of health care resources could receive higher policy priority as the system is very costly and payment methods do not promote efficiency in service provision.

There is considerable room to do more with regular health system performance assessments, particularly when it comes to the monitoring of inputs, processes, outputs and outcomes. Here setting up appropriate information systems will be key.

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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.