Report prepared by Prof. Evangelista Rocha with assistance and advice from:
National CVD Prevention Coordinator for Portugal:
Evangelista RochaMD, PhDCardiologist at the Armed Forces Hospital (Lisbon)Assistant Professor at the Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon.contact: email
Health care | Risk factors | Prevention methods | Prevention activities | Cardiac Rehab. | Future
The Portuguese health system consists of three systems:
Public health insurance coverage for a core set of services is 100% but 20.0% of the total population have double coverage through private insurance. It includes the various levels of prevention: health promotion, disease prevention, diagnosis, treatment and rehabilitation.Total health expenditure is 9.5% of gross domestic product (GDP). Spending on inpatient care and outpatient care accounts for the major part of health expenditure, while 6% goes towards public health and prevention services and administration.
The average life expectancy at birth in Portugal in 2012 was 80.6 years (overall), lower in males (77.3 years) than in females (83.6 years), which is slightly above the EU28 average (respectively, 79.2, 76.1 and 82.2).The trend in mortality is towards a marked and progressive decrease in deaths from cardiovascular disease (CVD). Between 1990 and 2012, proportional CVD mortality decreased from 42% to 30.2%.Prevalence of risk factors in Portugal:
Main actors & prevention methods The main actors are:
Ongoing activities focus on health promotion and screening healthy individuals who may be at risk as well as those with existing conditions, to modify them in a comprehensive approach to the cardiovascular continuum by lifestyle changes and drug treatment as well as interventions to reduce mortality and morbidity in patients with acute coronary syndromes.National priority health programmes to promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases (NCD): tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol:
"Heart Month": Every May there is a campaign on television, radio, cinemas, posters, billboards, and various websites to publicise the importance of caring for the heart. It includes meetings, workshops, conferences, talks, cardiovascular screenings and sporting events. World Heart Day, World No Tobacco Day: The Portuguese Foundation of Cardiology and the Portuguese Society of Cardiology work with local authorities to develop initiatives under the theme set by international organisations.“e_COR”: This study set out to determine the prevalence of major cardiovascular risk factors in the Portuguese population, including genetic characteristics.“Stent for Life”: Public campaign as part of the international “Stent for Life” initiative to raise public awareness of the symptoms of myocardial infarction (MI) and of the need for rapid transport to a percutaneous coronary intervention (PCI)-capable hospital.
The recent 2014 survey performed by the Working Group on Exercise Physiology and Cardiac Rehabilitation (GEFERC) of the Portuguese Society of Cardiology (SPC) shows that 10% of MI patients are now being rehabilitated, compared to 3% in 2009. Other clinical conditions, like coronary artery bypass grafting(CABG) and heart failure, are also more often being treated by cardiac rehabilitation (CR), corresponding to 40% of all rehabilitated patients. There are currently 22 centres (12 public and 10 private), all with a multidisciplinary team. Obstacles to CR include:
In order to overcome these obstacles, GEFERC has carried out several actions:
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