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This report was prepared by Dr Iulia Kulcsar and Prof. Dan Gaita with the assistance of:
National CVD Prevention Coordinators for Romania:
Dr Iulia Daniela Kulcsar, MD, PhD, MASTER , FESCSenior Cardiologist, Clinical Cardiology Researcher III Degree
Institute for Emergencies of Cardiovascular Diseases “Prof. Dr. C.C.Iliescu”, Bucharest, Romania
Professor Dan Gaita, MD, PhD, FESCProfessor of CardiologyUniversitatea de Medicina si Farmacie Victor Babes, Departamentul de CardiologieClinica de Cardiologie Preventiva & Recuperare CardiovascularaTimisoara, Romania
Romania is constantly ranked last among the EU countries in terms of health expenditure as a share of gross domestic product [GDP] (around 5%). In terms of total health expenditure in purchasing power parity (PPP)/capita, the value in Romania in 2014 was three times lower than the EU average. Preventive measures have been budgeted yearly with a share up to 3% of the total health budget. The share of total health expenditure spent on outpatient care is one of the lowest in Europe. Family doctors play an important role in diagnosing/detecting early stages of CVD and/or in referring the patients to the CV specialists.
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The global prevalence of major risk factors is:
The main actors in prevention in Romania are:
Among the stakeholders in prevention the following organisations are included:
General practitioners are the main actors of both primary and secondary prevention, but their main role is to detect cardiovascular risk factors in the general population. School doctors are also important for the implementation of a healthy lifestyle during childhood. Secondary prevention is offered to the public by cardiologists, internal medicine specialists, and general practitioners.
At the national level primary prevention is provided by the Ministry of Health through the “National program for the prevention of chronic disease”. National programs are also jointly developed by the Romanian Society of Cardiology (the Working Group for Prevention and Rehabilitation) and the Romanian Heart Foundation. There are two national coordinators for these programs.
The Romanian Heart Foundation made a habit of initiating public campaigns targeting the detection of cardiovascular risk factors and promotion of physical activity, on a yearly basis with the occasion of the World Heart Day. The main radio stations and TV channels are also involved in everyday advertising for a healthy lifestyle (via popular shows like “The Health Pill”). It is also promoting the use of the SCORE risk charts in both primary prevention and cardiology practice.
A RSC initiative is the program for ambulatory monitoring of the blood pressure using the patient’s own mobile phone, etc.
Cardiac rehabilitation (CR) is recommended after cardiovascular surgery and after acute myocardial infarction (MI). In CR programs are also included patients with stable coronary artery disease, peripheral arterial disease, heart failure, arterial hypertension and metabolic syndrome.
In all centres, cardiac rehabilitation consists not only in physical training, but in comprehensive secondary prevention offered by multidisciplinary team (cardiologist, physiotherapist, dietician, +/- psychologist). All patients undergo an initial non-invasive evaluation (clinical assessment, ECG, echocardiography, ABPM and/or Holter monitoring if needed, stress testing, including cardiopulmonary exercise testing). Risk stratification is then performed and an individualized program of physical training is indicated. Overall referral rate is about 10-20%, the compliance is decreased and the drop-out rate is 40-60% , mainly because phase-2 rehabilitation is only partially reimbursed (10 of 36 sessions).
In Covasna there is a special rehabilitation hospital of 700 beds for extended phase-2 rehabilitation and for phase-3 rehabilitation, CR is provided as two or three weeks hospitalisation, once a year and consists in a non-invasive evaluation followed by 10 to 50 sessions of physical training together with other secondary prevention measures. European Guidelines are currently used to guide the CR activity in the dedicated centres.
There is a need for more funding in order to provide effective CVD Prevention Programmes and there is a need for full reimbursement for cardiac rehabilitation - out-patient (after acute MI and stroke, cardio vascular surgery, etc.)
In Romania we aim to decline CVD Mortality with 10% in the next 5 years through legislation and support from the parliament and government. The ongoing programme of the Cardiac Society (October 2014—September2017) is a main effort and considers primary prevention as its main priority.
We will seek close cooperation with the Romanian Health Ministry and Romanian Ministry of Education as there is a need for a national population strategy with specific programmes for each of the four major risk factors.
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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