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OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
This report was prepared by:
Professor Josef Niebauer, MD, PhD, MBA, cardiologist
Chief and University Chair, Institute of Sports Medicine, Prevention and RehabilitationParacelsus Medical University, Salzburg, Austria
Bernhard Reich, MSc.
University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria.
The Austrian health care system provides universal coverage for a wide range of diseases and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialists and hospitals) are characteristic features of the system. As the costs of the health care system were rising in recent years, the Austrian parliament defined ten core health targets. These core targets build the basis for a health care reform. Prevention is one of the key factors of this reform and should play an important role in the future health care system, with the aim to being able to handle the system financially also in future.
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Although the incidence of myocardial infarction slightly decreased over the last ten years, cardiovascular diseases are still the leading cause of death. According to the Ministery of Health and Women only approximately 20% of 11-15-year old school children can be considered to be sufficiently physically active. Also, only 25% of the adult population report to fulfil WHO and ESC recommendations, whereas 1/3 remains physically inactive. 49.9% of the Austrian adult population have a BMI of ≥25 of which 32.6% are classified as overweigh and 14.4% as obese.
A health care plan helps the system to react on developments within the health care system and to guarantee medical coverage for the population. In this process the federal government, all states and all insurances are involved. “Gesundheit Österreich GmbH” (Health Austria Ltd.) works on the core concept of the system, which is revised on a regular basis ("Österreichischer Strukturplan Gesundheit").
In the Austrian Cardiovascular Disease Report which is published by the Ministry of Health all preventive strategies are summarised which focus on changes of lifestyle and promote nationwide roll out. Most of the interventions focus on nutrition (48) and exercise (32), eight out of 114 on cardiovascular diseases. There are also several nationwide projects that focus on prevention or aim at increasing physical activity. Already in 1974 the insurance companies started a medical screening program with the main objective to treat risk factors and to detect cardiovascular diseases at an early stage. Screeing programs ("Vorsorgeuntersuchung") are said to be one of the reasons for increased life expectancy. In addition to the increased life expectancy there is also a 45% reduction of stroke due to earlier detection of high blood pressure. Topics of cardiac rehabilitation increasingly become part of the Physiotherapists’ and Sport Sciences’ curricula in order to become experts for training and exercise. Prevention is meanwhile part of some nursing education curriculae but it is not being taught as separate subjects in medical schools or other health professions. The Austrian Workig Group of Outpatient Cardiac Rehabilitation offers post-graduate training courses for physicians, sports scientist and physiotherapists to specialise in the field of cardiac rehabilitation.
There are 13 in-patient facilities that provide phase II and 11 out-patient centers that conduct phase II and III cardiac rehabilitation. Regardless of whether CR centres are private or public, many professionals cooperate within the CR centres, such as cardiologists, internal medicine specialists, sports medicine specialists, nurses, physiotherapists, occupational therapists, sport scientists, and others. Nonetheless, of all the patients with a diagnosis that qualifies them for cardiac rehabilitation only approx. 30% enroll in a phase II and only approx. 20% in a phase III rehabilitation. The main reason for this is the small number of out-patient cardiac rehabilitation facilities which are thus only accessible for a minority of patients in need. This shortage could easily be overcome by granting more insurance contracts to new centers in areas of demand. Once enrolled in a rehabilitation program, adherence commonly reaches 95%. Due to the lack of a national rehabilitation database no data are available about drop-outs. The average length of hospitalisation is 8 days in the acute care. Between the event and the start of rehabilitation in hospital 36 days elapse on average. Nearly 17.000 patients per year were referred to CR and the rehabilitation was performed in rehabilitation centers for inpatients and outpatient clinics with a strong prevalence of inpatients CR (94%) vs. outpatients 6%.
One of the key weaknesses of the health-care system still lies in the prevention of illness. Spending on preventive medicine, i.e. 2% of total health care spending, is significantly lower than the EU15 and OECD average (both 3%). It remains to be seen whether the focus on health promotion and prevention of the 'framework health goals' approved in 2012 will be translated into concrete measures.
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.
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