EAPC Country of the month - Serbia

Vojislav Giga, MD, PhD, Cardiologist
National CVD Prevention Coordinator for Serbia
Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia

The report was prepared by Vojislav Giga with the assistance of:

• Prof. Branko Beleslin, MD, PhD, FESC, FACC - President of Cardiology Society of Serbia
• Prof. Ana Djordjevic-Dikic, MD, PhD, FESC, FACC – President Elect of Cardiology Society of Serbia

Documents to download

• Full report
• CV and publications Vojislav Giga

Health care

Health care in Serbia is provided through the network of health care institutions mainly belonging to the public health system that is owned and controlled by the Ministry of Health (MoH). The public health system is predominantly financed by the Health Insurance Fund (HIF). The HIF collects revenue from the mandatory insurance (based on 10.4% of payroll tax), which represents the largest source of its income (about 70%) and distributes it to health providers. Curative and rehabilitative services account for about half of all the health expenditures, whereas around 7.5% of the total health expenditures are allocated to prevention. The cornerstones of prevention on individual level are general practitioners in 158 primary health care centres evenly distributed across the country. The main characteristic of the health system lies in its accessibility to all citizens.

Currently the major issue in health policy is the optimal treatment of the disease rather than its prevention. Private health care providers mainly provide services on out-patient basis and their contribution to primary prevention is negligible.

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Risk factors

Cardiovascular diseases are the leading cause of morbidity and mortality in Serbia. According to the epidemiological data from the Public Health Institute, CVD were responsible for 53.9% of all deaths in Serbia in 2011, and for 52.4% in 2015. The mortality rate per 100 000 inhabitants in 2015 was 766.4. The risk factors trends according to the National Survey Data are listed in the table:

According to the survey conducted in 2013, 13.2% percent of the population has increased cholesterol levels, 7.4% are treated for diabetes. The percentage of obese children (age 7 to 14) rose from 8,5% in 2006 to 13,7 in 2013.

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Main actors

Prevention strategies in Serbia are defined through the joint actions of the Ministry of Health and the National Public Health Institute. The Cardiology Society of Serbia through its contacts with authorities modifies prevention strategies in the field of cardiovascular disease prevention and releases its own preventive campaigns and actions. On individual basis, general practitioners are involved in cardiovascular prevention, especially through the treatment of cardiovascular risk factors. Primary CV prevention is also supported by 25 regional public health authorities. Cardiologists in Serbia are mainly involved in secondary prevention of cardiovascular patients, together with internal medicine specialists. 

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Prevention activities

In 2010, MoH adopted the National Strategy for the Prevention of CV disease in Serbia that is to be implemented by the end of 2020. In order to decrease the number of smokers in Serbia, MoH released a campaign against smoking, with broad media coverage. The campaign was accompanied by legislative framework. Serbia adopted a law against smoking in public places in 2010 and forbade smoking in work and public places, and public transportation. However, smoking is still allowed in restaurants if its area is larger than 80m2. The Cardiology Society of Serbia participates every year in the World Heart Day campaign.

Since 2012, Serbia has actively participated in the Heart Failure Awareness Day. Serbia is part of the “25 by 25” global campaign for the 25% reduction of CV mortality by 2025 and is part of the “Pace for Heart” campaign which promotes physical activity for the prevention of cardiovascular diseases. Serbia was involved in EUROASPIRE IV and the Stent for Life Initiative. The Cardiology Society of Serbia endorses the ESC guidelines and developed National Guidelines on Cardiovascular Disease Prevention aimed to help general practitioners in preventive efforts. Cardiovascular prevention is part of cardiology but is not part of the student training in Serbia.

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Cardiac Rehabilitation

Patients who are eligible for Cardiac Rehabilitation (CR) are defined according to the current legislation that is available only for inpatients programmes (out-patient CR is not defined by law). CR is available for patients after first or recurrent myocardial infarction, by-pass surgery, or after heart valve surgery, and for patients with diabetic angiopathy without specific age limit. Also, CR is provided for children up to 18 years old that were operated for congenital heart disease. For these groups, 3 week rehabilitation programme is completely paid by the Health Insurance Fund.

Phase II CR is provided only as inpatient programme and is conducted in four specialised institutions for 3 weeks.

There are some Phase III CR programmes in Serbia, but they are not clearly structured. There is no available data on number of eligible patients participating in Phase II and Phase III CR programmes in Serbia. CR is conducted by cardiologists, internal medicine specialists, dieticians and trained nurses. 

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Aims for the future

The main needs in CV prevention include: Better financial support for preventive campaigns and programmes by the government; increased public awareness of the importance CV disease prevention through more active media coverage; increase in referral rate to CR and inclusion of heart failure patients in CR.

Future plans:

• To establish an action plan to reduce the burden of CVD and to define indicators for the achievement of the goals
• To decrease the percentage of patients with high blood pressure, high cholesterol levels both in primary and secondary prevention
• To launch a campaign for promotion of regular exercise as important part of risk reduction
• To establish a national data registry for CR in order to detect obstacles for better referral to rehabilitation programmes

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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.