EAPC Country of the Month - Latvia

August 2014

Report prepared by Dr.Vilnis Dzerve with the assistance and advice from:

Latvian Society of Cardiology
The National Health Service
The Centre for Disease Prevention and Control
The Rural Family Doctors Association

National CVD Prevention Coordinator for Latvia:

Vilnis Dzerve
MD, PhD, FESC
Senior Resercher,
Chief, Scientific Board of Research Institute of Cardiology, University of Latvia
Vicepresident, Latvian Medical Association

email

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Health care

After independence in 1991, Latvia started to create a social health insurance type system. However, problems with decentralised planning, fragmented and inefficient financing led to this being gradually reversed, and finally the establishment of a National Health Service type system in 2011. The most important source of revenue for the health system is the general tax system, although the share of government spending on health has been decreasing contributing only around 60% of total health expenditure.

Challenges in Latvian health care system include:

Reducing cardiovascular risk factors and cardiovascular deaths
Increasing coverage of prescription pharmaceuticals
Reducing the excessive reliance on out-of-pocket payments; reducing inequities in access and health status
Improving efficiency of hospitals
Monitoring and improving quality

Since 2007, the percentage of premature cardiovascular disease (CVD) death cases (before reaching the age of 64) has been decreasing each year (26% in the year 2006; 20% in the year 2012). The mortality rate has also decreased, while in 2012 it reached the lowest level in the last ten years - 155 per 100,000 of people in the age group below 64.

Regardless of the observed decrease, the CVD-related premature mortality rate in Latvia is three times higher than the average EU rate and is the highest for the Baltic States.

Risk factors

The first population-based cross-sectional epidemiological study of cardiovascular risk factors in Latvia (2010) shows a cumbersome picture: the average amount of cardiovascular risk factors was 3.0 per subject for all population, 3.5 in men and 2.7 in women. This is due to the high prevalence of smoking, elevated blood pressure and hyperlipidemia.

Smoking: In 2012 the prevalence of smoking among adults (aged 15 or more) was 52% for men and 18% for women, making Latvia the country with the second highest smoking prevalence in Europe.

Hypertension: The prevalence of elevated blood pressure is estimated to 52.9 % among adult males and 40.2% among females.

Lipids and glucose: The prevalence of elevated total Cholesterol as well as LDL Cholesterol level was very high in both gender groups (72,0% and 78,0 men / women; 73,1 and 73,9 men / women respectively). Hyperglycemia with statistically significant difference between gender groups was found in 39.2 % of investigated persons.

Body mass index: The prevalence of overweight and obesity in the respondents was 37.7% and 30.1%, respectively with statistically significant gender differences. The overweight as well as obesity increased with age among women, but among men the increase is statistically significant only for obesity.

Prevention methods and main actors

The main actors are general (family) physicians and cardiologists in collaboration with Ministry of Health, Centre for Disease Prevention and Control, Latvian Society of Cardiology and Latvian general physicians. On top of the list of prevention methods are population screening campaigns, population based epidemiological and secondary prevention research, and, of course, the daily work of general physicians and cardiologists in their offices.

As successful examples the population screening campaign of all 11 year children and 45 year men in Liepaja region (around 80 000 inhabitants) in 2013 and establishment of the outpatient department in Latvian Centre of Cardiology mainly for secondary prevention could be mentioned.

Prevention activities

Main CVD prevention activities are officially published in the "Public Health Strategy for 2011-2017” and "Action plan of improvement of CV health for 2013-2015”.
Besides the above mentioned there are several very practical CV health promotion campaigns organised by the Latvian Society of Cardiology.
Some of them:

World Heart Day: For already 9 years, starting from year 2005, the following activities are organised in Riga, by the Latvian Society of Cardiology: Press activities, concerts/dancing events, public education (distributing leaflets, talks, counselling, etc), newsletters and awareness surveys. Around 5000 Latvians are active participants.
Go Red for Women: The Latvian Society of Cardiology is guiding the Go Red project to reduce female coronary heart disease and stroke. To reduce heart disease in women we have to think more about and administer a healthy way of living. The Women’s day (8th March) is also a part of “Go Red” in Latvia.
Campaign „Love your heart” together with The Centre for Disease Prevention and Control: The aim of this campaign is to be informed about CVD risk factors and their prevention methods. It includes several activities, such as on-line internet TV communication sessions with the participation of leading general physicians and cardiologists, lectures, interviews and discussions in enterprises, the „Heart bus” circulating in countryside regions etc.

Cardiac rehabilitation

Inpatient rehabilitation is provided at the National Rehabilitation Centre and at several multi-profile hospitals. Cardiac rehabilitation activities in Latvia are focused on patients after myocardial infarction, heart surgery and percutaneous coronary intervention procedures. Patients entering outpatient cardiac rehabilitation are offered a programme with a typical duration of 3-4 weeks, consisting of group-based therapies (exercise training, relaxation and stress management training, education therapy, and/or lifestyle change therapy). Ambulatory rehabilitation and physiotherapy is provided by individual professionals, at health centres and outpatient rehabilitation units in hospitals.

The application of cardiac rehabilitation is less satisfactory: Although modern preventive drug therapy is widely used only a small part of the eligible patients is enrolled in a rehabilitation programme, mainly due to financial reasons: the services are only partially paid by National Health Service and a high proportion has to be paid out of the pocket by patients.

Aims for the future

For the future, the ambition on the national level is to decrease the premature CVD mortality of men to 220 /100 000 and to 60 / 100 000 for women. Plans include focusing on CV health promotion, smoking cessation and increase of physical activity.

Furthermore, we would like to activate the Health Promoting Hospital (HPH) movement in Latvia, to see more use of national CVD registers and population based research in the preventive strategies.

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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