The short report on CVD prevention in Urkaine was prepared by:
Professor Volodymyr Kovalenko, FESC
President of Ukrainian Association for preventive Cardiology and rehabilitation
Director of National Scientific center ‘Institute of cardiology’, Kiev, Ukraine
Professor Elena Nesukay, FESC
National CVD Prevention Coordinator for Ukraine
Head of expert center for myocarditis and cardiomyopathies National Scientific center ‘Institute of cardiology’, Kiev, Ukraine
The structure of health care in Ukraine has three levels: national, region and sub-regional (local).
- The national level resorts under the Ministry of Health Care in Ukraine, this includes national health care facilities of different kinds.
- The regional level is administrated by regional state administrations. This includes state ambulatories and hospitals but even facilities such as regional hospitals, diagnostic centers etc.
- The local level is in the hands of the department state administration: these are mainly local medical facilities which are the responsibility of the city councils.
Medical care in Ukraine is provided both at state owned health facilities and at private institutions. Private care accounts for less than 1 % of the total care in Ukraine. Primary care is delivered by general practitioners. According government policy medical care is free of charge both in national and local establishments. There are six cardiologist per 100 000 inhabitants.
Currently the situation in Ukraine health care system is rapidly changing: an alteration of the primary and secondary levels of the health care system is being conducted.
The cardiovascular disease (CVD) mortality level in Ukraine is 772,1 per 100 000 for men and 440,9 per 100 000 for women. This accounts for 68,0 % of the total mortality in the country.
Main CVD risk factors
The staff of the Laboratory of population researches of SI “National Scientific Center “M.D. Strazhesko Institute of Cardiology” NAMS of Ukraine conducts epidemiological analysis since 35 years. These surveys have been standardised. Some results of these surveys are given: 855 men aged 18-64 were examined in 2014-2015. The findings of this survey were compared with the results of the studies conducted earlier: 1980 (1255 men), 2000 (1025 men), 2005 (998 men) and 2010 (1009 men).
We have observed an increase of men with low physical activity (from 19,7 to 38,6 %, p<0,01). The prevalence of hypertension has not changed (30,6 – 27,6 %) and the prevalence of overweight and smoking diminished (from 44,8 to 33,8 % and from 49,9 to 35,2 %, p<0,01).
Over time the total risk factor burden in the male population has increased: the number of persons with only one risk factor has decreased by 2.6 times but among men with three and more risk factors the numbers increased fivefold. A survey of the prevalence of obesity for children and teenagers in Ukraine in 2010-2013 showed a high level of 17,2 %.
There are 45 percutaneous coronary intervention (PCI) centres which performed 15.000 PCIs in 2016; 63% of all PCI procedures were acute interventions.
Cardiovascular preventive care in Ukraine is mainly delivered both by family doctors and by cardiologists, who are employed at the state medical services (hospitals, out-patient clinics) and in private medical facilities.
Guidance in prevention is obtained through the guidelines of the European Society of Cardiology. These guidelines are obligatory for implementation in the medical services after adaptation to the national resources in Ukraine. They are presented in lectures, on conferences and educational schools by the countries’ leading scientists-cardiologists. However, there are no separate efforts to monitor and audit of CVD prevention on the national level.
Education: the different fields of cardiovascular prevention are taught in educational programs in medical institutions/universities and postgraduate medical education.
The main prevention activity occurs within the framework of World Heart Day. Each year in September in different regions at places where usually many people gather there are options for measuring blood pressure, glucose and cholesterol levels in blood, weight, assessment of other risk factors of cardiovascular diseases. At this occasion even recommendations about a healthy life style are given to the general public.
Over the past years two programmes were successfully carried out:
- The National program of prophylaxis and treatment of hypertension (1999 -2005) (decree of president of Ukraine on 04.02.1999 No. 117/99)
- The State Program of prevention and treatment of cardiovascular and cerebrovascular diseases (2006 – 2010) (resolution of cabinet of ministers 31.05.2006 No.761 see here [in Ukrainian language only])
The State Program of prevention, treatment and rehabilitation cardiovascular diseases (2017-2021) has been worked out and becomes firmly established (resolution of ministry of health and National Academy of medical sciences 15.07.2016 No.711/61).
Structured cardiac rehabilitation is available for patients with severe cardiovascular disease. These programmes start in a hospital and continue both in health centres and sanatoriums. The following categories of patients with ischemic heart diseases are entitled to join:
- Patients with STEMI (ST-segment elevation myocardial infarction) and NSTEMI (Non–ST-segment elevation myocardial infarction)
- Patients after percutaneous coronary intervention
- Patients after coronary artery bypass grafting and/or, aneurysm surgery
- Patients with arrhythmia (atrial fibrillation, ventricle premature beats) for evaluation of effects of antiarrhythmic treatment
According to the Ministry of Health Care (order # 206, 30 Dec 1992) working people can be sent to specialised rehabilitation cardiovascular sanatoriums in different regions of Ukraine. Nowadays there are 12 rehabilitation units for 650 patients in cardiovascular sanatoriums in all regions in Ukraine. Annually 7.000-10.000 patients can receive rehabilitation here. The National Insurance Fund pays for a place in sanatoriums during 24 days.
The rehabilitation programme includes physical rehabilitation - step and controlled, increase of the physical activities adapted to individual possibilities of patient. Pharmacotherapy is adapted and optimised if needed. Psychosocial rehabilitation is also available: support in living with a chronic illness and education to promote a heart healthy lifestyle.
Science/research: there is a scientific department in SI “National Scientific Center “M.D. Strazhesko Institute of Cardiology” NAMS of Ukraine. It was founded in 1968 and studies the care of rehabilitation patients with myocardial infarction or after coronary artery bypass.
Aims for the future
Cardiovascular prevention in Ukraine needs to focus more on primary prevention. In agreement with Ukrainian and European guidelines individual motivation and support should be provided for obtaining a healthy lifestyle through smoking cessation, regular physical activity, healthy food habits and weight control.
Our main goals for the near future are implementing the recent prevention guidelines and training cardiologists and other physicians in providing cardiovascular prevention of good quality.
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.