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This report was prepared by Prof. Istvan Czuriga MD, PhD, with the assistance of:
Professor Istvan Czuriga, MD, PhD, FESCProfessor of Cardiology
National CVD Prevention Coordinator for Hungary
Outpatient Cardiology Clinic, Debrecen, HungaryInstitute of Cardiology, University of Debrecen Medical Centre, Debrecen, Hungary1st Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary
Hungary is situated in central Europe with a size of 93,028 km2, more than half of which consists of low land surrounded by mountain ridges and hills. In 2012, Hungary had a population of 9,976 million inhabitants and a gross domestic product (GDP) of 124 billion dollars.
The capital of Hungary is Budapest, a city of some 2,000,000 inhabitants. In Hungary, executive, legislative and judicial duties are carried out within the framework of a parliamentary democracy.
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The central government is responsible for the Hungarian health care system, but there are other main actors:
as well as country and municipal governments.
Municipalities are responsible for primary care services, which include family doctor services, family paediatricians, dental care, out-of-hours services, mother and child nurse services and school health services. The responsibility of secondary and tertiary care provision is shared among municipalities, counties, central government and, to a minor extent, private providers. Health care spending in Hungary reached USD 9.8 billion in 2012. This is translated into 7.82% of the GDP and approximately USD 1,729 per capita.
In the last decades, a significant decrease in cardiovascular mortality has been witnessed in Hungary, which has led to a dramatic increase in life expectancy. However, it still remains one of the lowest among the OECD countries (see Figure 1).
While there has been a decrease in cardiovascular mortality, it is still twice that of the European Union (EU) average. Moreover, despite a marked increase in the quality of medical care, failing primary prevention strategies at the national level represent hurdles that need to be overcome.
In regards to preventable risk factors such as smoking and obesity, Hungary is among the highest risk countries in the EU. In recent national surveys, a high prevalence of unrecognised hypertension, hypercholesterolaemia and a high risk of diabetes mellitus were also found, in line with the higher rate of increased carotid intima-media thickness and coronary calcium score in asymptomatic adult participants.
Figure 1. Life expectancy at birth by sex (2013).
The Public Health Department is responsible for creating a health strategy in Hungary. There is a cardiovascular public prevention programme developed by the National Institute for Health Development. Programmes and regulations are carried out by the National Public Health and Medical Officer Service.
As for cardiovascular prevention, the Hungarian Society of Cardiology (MKT) is responsible for creating health programmes with the active involvement of the Hungarian Society of Hypertension, the Hungarian Atherosclerosis Society, the Hungarian Diabetes Association and the National Institute of Primary Care.
The main participant in post-graduate education is the Department of Cardiovascular Prevention and Rehabilitation at the University of Pécs Medical School, which was founded in 2015.
The latest complex health behaviour programme created in 2006 was entitled the "National Programme for Preventing and Treating Cardiovascular Diseases".
Important data concerning cardiovascular prevention can also be retrieved from the "National Registry of Myocardial Infarction" run by the Gottsegen György National Cardiology Institute.
Hungary’s health screening programme for 2010-2020, as part of the European National Health Care Programme, concentrates in particular on heart and vascular diseases and risk factors. The country also participates in other European campaigns like "World Heart Day" and "Go Red for Women"; and 2015 was officially designated the year of stroke prevention in Hungary.
A number of laws and regulations have been created in Hungary in recent years to promote the cause of public health. One of the most important amendments was made regarding the "Act on the Protection of Non-smokers". According to its main regulations, smoking is strictly prohibited in public institutions as well as in open air spaces of public educational- and health care service institutions. "Stop salt" is a national salt lowering programme that seeks to reduce salt intake in the overall population. "HAPPY-week" is a Hungarian Aqua Promoting programme of the younger generation, in which water consumption is promoted in primary schools. In the "Exemplary canteen programme", the use of locally available ingredients and bio products are promoted. "Let’s move Hungary" is a leisure activity movement including a "walk of 10,000 steps" programme, which seeks to change sedentary lifestyles. The "ACTION-FOR-HEALTH" EU project is helping to reduce health inequalities among people living in the most backward regions of Hungary.
Cardiac Rehabilitation is available for Hungarian citizens free of charge. The total cost of this service is covered by the national health insurance agency. The service is provided primarily within the framework of phase II and III inpatient programmes (1,738 beds for a total population of 10 million). Nonetheless, this country has made great efforts to develop and expand the outpatient service. The development and implementation of a multidisciplinary form of activities are carried out in line with the corresponding European recommendations. Participation in the early phases of cardiac rehabilitation is typically offered to patients following open-heart surgery or acute coronary syndrome, while the ratio of patients entering this programme with stable angina or heart failure syndrome is relatively low. Data is systematically collected on cardiac rehabilitation practices throughout the country, but specific public data on the ratio of participants are hard to access.
National cardiovascular disease (CVD) prevention programmes concerning controlled hypertension, healthy nutrition and regular exercise, as well as an outpatient cardiac rehabilitation network are to be established in the future. With this in mind, the most recent achievements of information technology such as e-health and mobile health applications should be exploited to develop improved patient-oriented strategies for the prevention and management of CVDs and for living and ageing healthily.
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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