Olga Pavlova, MD, PhD
National CVD Prevention Coordinator for Belarus
Head of Scientific Laboratory of Arterial Hypertension, Republican Scientific and Practical Center «Cardiology»
The report was prepared by Olga Pavlova with the assistance of:
- Dr. Alexandr Patseyev, MD, Deputy Director of Republican Scientific and Practical Center «Cardiology»
- Dr. Valeriy Stelmashok, PhD, MD, Head of the Laboratory of Emergency and Interventional Cardiology, Head Interventional Cardiologist, the Ministry of Health of the Republic of Belarus.
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Health care
Belarus has established the health care system, features of which are the full coverage of medical care provided by the budget resources, government regulation and planning with the implementation of complex state programs in the field of public health. The solution of problems related to cardiovascular disease (CVD) is a priority task for the Ministry of Health and for the Belarusian government as a whole, the majority of health expenditures in Belarus are covered by the state. In the last decade Belarus has seen a trend towards reduction of CVD mortality due to the development of high level specialised care and treatment for CVD and access to high-tech facilities for aute myocardial infarction (AMI) and stroke. Nevertheless, the total mortality rate in Belarus remains higher than the mean European rate, and this discrepancy is basically due to higher CVD mortality.
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Risk factors
Belarus as many other countries faces a growing burden of CVDs being the major cause of deaths, making 54.1% in 2009 and 55.3% in 2015 of the overall mortality. The life expectancy in Belarus during past decade has seen a positive trend from 69.0 years in 2010 to 73.75 years in 2015. In Belarus smoking among men remains a serious health issue and its prevalence is one of the highest (48.0%) in Europe. Despite the presence of conditions for sports in all regions of Belarus, the level of physical activity among the population remains low; only a quarter of the population (25.6%) involves in physical activity. According data in 2016 a large number of the population had overweight (61%) and obesity (25.2%). The ongoing cross-sectional epidemiological national survey STEPS provided by World Health Organization (WHO) with the STEP-wise approach will help to obtain qualitative data on the prevalence of major CVD risks factors (tobacco and alcohol use, high level of blood pressure, physical inactivity, unhealthy diet, overweight and obesity, abnormal blood glucose and lipids) at the population level.
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Main actors
In order to strengthen population health, reduce premature mortality and to prevent disability from non-communicable diseases (NCD) and their risk factors development, the Ministry of Health worked out the National State program «Health of the Nation and the demographic security of the Republic of Belarus» (2016 - 2020). A mayor part was devoted to «Prevention and control of non-communicable diseases» through the development of cross-sectoral cooperation with the involvement of concerned ministries and organisations. At the individual level primary care physicians or general practitioners, cardiologists, assistant doctor and nurses in polyclinics, clinics and high-specialised centers engaged in CVD prevention and rehabilitation.
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Prevention activities
Belarus shows positive changes in terms of reduction of CVD mortality due to the State program «Cardiology» (2011 – 2015). Thanks to the preventive work of health and education organisations, for the first time over the past 20 years, stabilisation of overall CVD morbidity was registered and the awareness of young people and adults about the risks of CVD development has grown to 90%. In 2011 the project «Acute Coronary Syndrome (ACS)» started and promoted a development of health care system in patients with acute coronary syndrome, allowing in recent years a reduction of mortality caused by AMI in Belarus. Standardised AMI mortality rate per 100 000 inhabitants decreased from 14.3 in 2010 to 10.8 in 2014. From 2015 until now the project «Road Map» has been developed to offer patients with ACS maximum inter-regional accessibility to coronary intervention at all care levels (primary, emergency, hospital).
Every year at least 2-3 nationwide medical actions are organised with the participation of 150 to 350 thousand Belarusian inhabitants. During those events, lectures were organised; publications and flyers were distributed in factories, organisations and educational institutions. Activities included also consultation by telephone on CVD risk factors and promoting healthy lifestyles in polyclinics as well as in specialised centres. In 2016 a national medical and educational event «Healthy Heart - a successful future» and an educational campaign «Day of knowledge about heart failure» were held.
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Cardiac Rehabilitation
In Belarus since 1983, cardiac rehabilitation in patients with ischemic heart disease and after acute myocardial infarction (AMI) is widely used by the original national programs. There are several stages of cardiac rehabilitation:
- a hospital stage in cardiology or cardiac surgery departments
- a specialised hospital stage in the departments of rehabilitation in regionals hospitals or the Republican clinical hospital of medical rehabilitation
- an ambulatory-polyclinic stage.
Cardiac rehabilitation is carried out without age limits and the costs are covered by the state in patients after AMI, revascularisation with percutaneous coronary intervention (PCI) or post-surgical revascularisation (CABG), cardiac surgery for valve disease, heart transplantation. Monitoring and control of cardiac rehabilitation are regularly performed by authorised and specialised cardiologists as part of comprehensive audits of cardiac health care at the regional and republican levels.
In 2016, 53.3% of patients after AMI underwent cardiac rehabilitation in cardiology or cardiac surgery departments of hospitals, among them 84.1% were patients in working age, and most of patients in working age returned to work (88.4%).
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Aims for the future
The best possibility for improving CVD prevention and outcomes in Belarus, lies in scaling up population interventions to reduce the prevalence of smoking, alcohol consumption and other major CV risk factors (hypertension and hyperlipidemia) and to promote healthier lifestyles.
The greatest opportunities also include:
- involvement of all structures of the society in the primary prevention of CVD
- monitoring and control of the prevalence of major CV risk factors
- promotion of healthy lifestyles technologies among population from childhood
- strengthening primary health care and developing of a model based on family medicine for a greater role in primary and secondary prevention of CVD
- shifting CVD interventions towards a higher degree of patient involvement and increasing responsibility for their own health.
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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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