EAPC Country of the Month - Egypt

Report prepared by Prof. Ihab Attia with the assistance and advice from:

• Prof. Fahmy Charl Fahmy, Professor of Preventive Cardiology, Head of Department of Occupational Health, High Institute of Public Health, Alexandria University, Egypt

• Dr Ghada Selim, MD, Lecturer of Cardiology, Ain Shams University, Cairo, Egypt; Founding Director of cardiac rehabilitation unit, Ain Shams University, International Masters of Health Leadership participant, McGill University, Canada

• Dr Hazem Khorshid, MD,  Lecturer of Cardiology, Ain Shams University, Cairo, Egypt; Founding member of cardiac rehabilitation unit, Ain Shams University

National CVD Prevention Coordinator for Egypt (-2017):

Ihab Attia
Professor of Cardiology, Ain Shams University, Secretary General of the Working Group of Preventive Cardiology and Cardiac rehabilitation, Egyptian Society of Cardiology

Contact: email

(Note: National CVD Prevention Coordinator for Egypt since 2017: Prof. Gamela Nasr)

Documents to download

• Full report
• CV and Publications I.Attia

Baseline information about Egypt

Egypt is considered as a lower middle-income country with estimated inhabitants of 90 millions. According to the World Bank (2011), the total health expenditure is 4.88 % of gross domestic product (GDP). It’s health care system shows a pluralistic health financing and delivery systems where the government regulates the “Health Insurance Organisation” and the “Social Health Insurance” and the rest of the population is covered by different healthcare “houses models” according to their employment. Financial barriers to access to care and the rise in out-of-pocket spending are significant challenges.

Health care

In Egypt 43.5% of the population is living in urban areas. However, inequalities in provision of health services present a great problem due to diversities in geographic, demographic and socioeconomic distribution of population across the country.
The total expenditure on health was 5% of the general domestic product in 2012. The population pyramid of Egypt is typical for developing countries with a young population. A great part of population is covered by health insurance including school age but even the private sector is covering a considerable part of health care.
There are increasing numbers of percutaneous coronary intervention (PCI) capable centres especially in Cairo, Alexandria and other big cities across Egypt.

Risk factors

Mortality due to cardiovascular diseases accounts for 46% of total deaths according to WHO statistics in 2014. The current profile of risk factors is changing expressing an increase in unhealthy lifestyle, thus increasing the threat of non-communicable diseases for public health.
The reported prevalence of hypertension in the Egypt STEPwise survey (2011-2012) was 38.7% for men and 40.8% for women.
Almost half of the male adults are smokers but less than 0.5% of the women use tobacco. In contrast, obesity is twice as high among females (41.6%) compared to males.
Food habits appear to be poor as only a small percentage consumes the recommended amount of vegetables and fruits.

Prevention methods and main actors

Cardiovascular disease (CVD) primary prevention is mainly community-based; post-event prevention however is individually based. The main actors in CVD preventive programs are:

• Egyptian Society of Cardiology
• Public Health Professionals
• Ministry of Health
• Doctors and Paramedical Staff

Guidance of most of the Egyptian cardiologists and physicians is provided through European and American guidelines for prevention and management of the different CV risk factors. Currently, the Egyptian guidelines for prevention of atherosclerotic diseases are available. The specific objectives are healthy lifestyle changes, early detection and management of CV risk factors.

Prevention activities

The general objective of prevention is decreasing the burden of CV disease and its risk factors in Egypt. Campaigns, projects and education at different levels for the different community sectors are the main activities of prevention. Increasing effectiveness of CVD preventive programs by optimisation of possibilities and overcoming obstacles due to limited resources are great challenges for preventive cardiology in Egypt.

Cardiac Rehabilitation

Cardiac Rehabilitation is so far not well applied in Egypt. Lack of governmental funding is one of the main causes. This lack is discouraging for other university centres or large hospitals and it leaves merely a few and scattered centres in the private sector which operate programs for where patients pay out of pocket. Expanding cardiac rehabilitative centres across the country would assist in reduction of CV disability.
However, a well-designed program is available at the Ain Shams (El Demerdash) University hospital where a multidisciplinary team provides a full comprehensive model for referred patients with a small fee for the participants. This could be a model for other hospitals.

Aims for the future

• The current socio-political momentum in Egypt may create an opportunity to stimulate CVD prevention initiatives in health care institutions. Hereby it is highly desirable that a national health policy officially adopts and endorses cardiac rehabilitation (CR) programs as part of a strategic plan for implementing preventive cardiology.

• Increasing the awareness of CR programs among health workers and patients alike in order to increase referral and participation in cardiac rehabilitation, a role for the Egyptian Working Group on CVD prevention.

• Expansion of the Ain Shams university CR unit to achieve a capacity of 1000-1500 patients per year.

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