Jostein Grimsmo, MD, Ph.D.Working Group of Cardiac Prevention, Cardiac Rehabilitation and Sports Cardiology, Norwegian Society of CardiologyReport Coordinator
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All of the 5.165.802 people in Norway (2015) have access to a taxpayer-funded public healthcare system. The population has good health status with a life expectancy of almost 82 years. The health care system is partly decentralised. Four different Regional Health Authorities are responsible for the specialist care within and outside hospitals (including specialised cardiac rehabilitation), while more than 400 municipalities are responsible for the primary care. There were 77 cardiologists per million inhabitants in 2016.
Norwegian costs for health care are approximately 10 % of Norway's gross domestic product (GDP), with a 16th place in the WHO European region in terms of the share of GDP spent on health in 2011. Still, Norway has one of the highest values of GDP per capita in the world. There is a growing private health service, because of increasing numbers of people with private health insurances.
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In Norway there has been a dramatic reduction in numbers of deaths from ischemic heart disease from 1970 until today, decreasing 80 % among men and women between 35-74 years old. Cardiovascular disease (CVD) is still the main cause of death among all ages, with cancer on second place.
Figure 1: Age-standardised mortality rates due to cardiovascular disease (CVD), ischemic heart disease (IHD) and cerebrovascular diseases (CEREBRO) in Norway during 1986-2015. Data from the Norwegian Cause of Death Registry.
It is assumed that as many as 46% of all deaths in Norway before the age of 70 years are due to life style factors (unhealthy diet, overweight, tobacco use, inactivity, and alcohol-and drug abuse).
The numbers of smokers have decreased from 53% and 30 % among men and women, respectively, in middle of 1970s to 14 % among all in 2015. The number of smoking pregnant women has decreased from 25 % in 1999 to 5 % today. There has been a reduction in blood pressure in the Norwegian population over decades. However, still 15 % of the population have elevated blood pressure that should have been treated. The average total cholesterol has decreased from almost 7 mmol/l in mid 1970s to approximately 5.6 mmol/l in 2007-2008. The Norwegian Directorate of Health's latest report (2015) on developments in the Norwegian diet shows a positive trend. Inactivity is a great health problem, leading to increasing overweight in the population together with increasing prevalence of type 2 diabetes.
Norway has joined the World Health Organization's Global Strategy on Diet, Physical Activity and Health, and participates actively in the implementation of the Global Action Plan for the Prevention and Control of non-communicable diseases (NCDs). The objectives of the action plan are a 25% reduction of NCDs such as cancer, cardiovascular disease, type 2 diabetes and chronic obstructive pulmonary disease (COPD) by 2025.
There are many ongoing campaigns in the field of eating habits, including "The Keyhole". The National Board for Physical Activity has in 2016 given proposals for new recommendations to the health authorities. The "National Competence Centre Training as Medicine" was established in 2016, working to promote physical activity in the population.
There are campaigns against smoking and snuffing in television and mass media in accordance to "Cessation day". The Norwegian Medical Association is working for an age limit of 20 years to buy cigarettes and other tobacco products.
Cardiac rehabilitation (CR) has a long tradition in Norway. Today there are many models of CR, with mostly hospital-based outpatient CR-programmes lasting for many weeks. In addition many hospitals have short-time heart schools, not defined as comprehensive CR. Inpatient CR are mostly in hospitals for early CR and in private rehabilitation centres for CR phase II. There are approximately 40 CR facilities in Norway available for phase II to IV.
There is a physician based individual referral practice to CR in Norway, and no automatic referral practice. CR is underutilised with probably only 30 % of eligible patients participating. It is supposed that older people, women, lower economic status and minorities are underrepresented in CR. There is neither a national program for CR nor CR guidelines/recommendations in Norway.
The goal of the Norwegian authorities is that life expectancy in Norway must be among the three best in the world. Main activities to achieve this in preventive cardiology are to reduce the burden of new risk factors as type 2 diabetes, overweight and obesity in the population. New recommendations for primary and secondary prevention will be published in 2017.
There is a need for national recommendations in cardiac rehabilitation, together with a registry to help improve equality and quality among people.
In 2016 the Norwegian National Cardiac Society established an official "Working Group for Preventive Cardiology, Cardiac Rehabilitation and Sports Cardiology", which is aimed to improve the status and knowledge of these three topics among politicians, health decision makers, the public, physicians and other health professionals.
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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