This report was prepared by Prof Johan De Sutter, Dr Delphine De Smedt and Prof Dirk De Bacquer and reviewed by Prof Guy De Backer, Dr Hubert Dereppe (past chairman of the Belgian working group on cardiovascular prevention and rehabilitation [BWCPR]), Dr Catherine De Maeyer (chairman of BWCPR) and Dr. Freddy Van de Casseye (Chairman of the Belgian Cardiology League).
This report was endorsed by the BWCPR and the Belgian Cardiology League.
Professor Johan De Sutter, MD, PhD, cardiologist
National CVD Prevention Coordinator for Beglium
Ghent University – Department of internal medicine – Ghent, BelgiumAZ Maria Middelares – Department of Cardiology – Ghent, Belgium
Belgium is a federal state made up of a federal authority, communities and regions. Health care is a shared responsibility of both the federal state and the different communities. The Belgian health care system is largely based on solidarity and equity, with a mandatory health insurance system. Health care expenses account for 10.9% of the gross domestic product (GDP). About three quarters of the expenses are publicly funded.
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Although the mortality due to cardiovascular disease has decreased substantially over the latest decades, cardiovascular disease remain a major cause of disease burden and deaths accounting in 2012 for 28.8% of deaths and responsible for 561,300 DALYs. Despite, the increase in awareness about risk factors for cardiovascular disease among the population the prevalence of the main cardio vascular (CV) risk factors remains high. About one in five persons smokes tobacco daily, only one in three is physically active and half of the population is overweight or obese. Type 2 Diabetes, arterial hypertension and hypercholesterolaemia are also very common.
The main actors in early detection and treatment of CV risk factors are primary care physicians and cardiologists, endocrinologists and nephrologists. Prevention is being delivered both at the individual level by health care physicians and at the population level using national and regional prevention strategies initiated by federal and local agencies.
Prevention is a major element in the education of medical students and other health care professionals. In addition, several general prevention campaigns to stimulate health behaviour are initiated. Also, heart disease specific campaigns, supported by the Belgian Heart League are set up. Finally, some decisions and restrictions made by the government are being implemented. A smoking legislation has prohibited smoking in all public places including restaurants and bars. Just recently a sugar tax was introduced, as an initial step in a broader food plan, with the aim to convince the Belgian population to adopt a healthier lifestyle.
Only phases 1 and 2 of cardiac rehabilitation are regulated by law in Belgium. The indications giving right to reimbursement for cardiac rehabilitation include patients after acute myocardial infarction, coronary artery surgery, therapeutic percutaneous endovascular intervention on the heart and/or the coronary arteries, surgical intervention for a congenital or acquired malformation of the heart or valves, heart and/or lung transplantation and cardiomyopathy with dysfunction of the left ventricle.
According to the Belgian contribution to EUROASPIRE IV (Ghent region), about 78% of coronary patients are advised to follow a cardiac rehabilitation programme and 83% of patients attended a least half of the sessions. There is currently no structured quality or outcome control organised for cardiac rehabilitation by the government. Recently, the Belgian Working Group on Cardiovascular Prevention and Rehabilitation collected outcome data in over 2000 patients and is performing an audit for quality control in several cardiac rehabilitation centers.
In order to meet the economic challenges as well as the changing health care needs, Belgium is in the process of a health care reform, making health care more efficient, equitable, accessible, producing a better quality of care. However, there remain several challenges which will have to be addressed in the upcoming years.
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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