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National CVD Prevention Coordinator for Luxembourg
Jean Beissel, MD, FESC
Former Director Cardiology CHL (Centre hospitalier de Luxembourg)President of the Luxembourg Society of CardiologyPresident 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.
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.
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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:
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.
The main actors are:
Among the professional groups engaged in CVD prevention are:
Hospitals, school medicine and occupational health services are engaged in Prevention activities.
Governmental activities are:
Activities from organisations:
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.
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.
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.
Our mission: To reduce the burden of cardiovascular disease
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