Report prepared by:
National CVD Prevention Coordinator for Slovenia:
Professor Zlatko Fras, MD, PhD, FESC, FACC
Medical Director, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia
Professor of Internal Medicine, Medical Faculty, University of Ljubljana, Slovenia
Chairman of the Nationwide Programme on Primary CVD Prevention and President of the Slovenian Society of Cardiology
Contact: email
Documents to download
Short Summary
Slovenia is a central European country, a democratic parliamentary republic and a member of the European Union and North Atlantic Treaty Organization. It has a population of 2.03 million (2008), approximately half of whom live in urban areas. Since regaining independence in 1991, the political environment is stable enough and various economic and social sector reforms have been implemented which aim to further ensure stability.
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Health care
Morbidity and mortality data show that Slovenia experiences the same characteristics as other European countries in Western and Central Europe. Diseases of the circulatory system are the most common cause of death in the country, causing almost 39% of all deaths. Since the 1980s a decreasing birth rate has been observed. The life expectancy for women was 83.1 in 2013 and 76.9 years for men. This is comparable to those of other EU member states. As in other European countries the population is ageing rapidly.
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Risk factors
The national preventative screening campaign in adults (n=1.044.133, age: males 35 – 65, females 45 – 70) performed in the period 2002 – 2012 reported manifest CVD in 5.1%.
The prevalence of major risk factors is high: 24,3% smokers, high total cholesterol 66,2%, hypertension 32,5%, 71,0% are overweight of which 27,2% are obese. One fifth of the adult population was at high 10 year coronary risk (>20% using the Framingham Risk Score).
A 2007 survey showed that salt consumption is too high, on average 12,4 g/day. The consumption of healthy food is unsatisfactory (data 2012): merely 53,4% of adults consume at least one standard portion of fruits and 39,1% consume at least one portion of vegetables daily. Only one in six was at least moderately physically active on a regular basis.
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Main actors
The main actor in the health system in Slovenia is the Ministry of Health which initiated fundamental reforms in 1992: the introduction of compulsory health insurance, an approval process of private practice in the field of health care, introduction of co-payments for health care services. Primary health care services within the public health care network are paid for through a combination of capitation and fee-for-service payments. There is a national coordinator for health promotion, responsible for health promotion at the national level.
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Prevention activities
Health promotion and education programmes are implemented at the national level through various population campaigns, while high risk individuals are managed at the primary health care level. Programmes in cooperation with WHO are the Countrywide Integrated Non-communicable Disease Intervention Programme and the Healthy Schools project. Several screening programmes have been launched since the year 2000, of which the Nationwide Programme on Primary Prevention of CVD is the most successful activity. During recent years even more emphasis is given on prevention within the growing network of so-called “reference clinics” at the primary health care level.
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Cardiac Rehabilitation
The secondary CVD prevention including cardiac rehabilitation is provided by nationally appointed multidisciplinary group of professionals, including also representatives of patients following national guidance. Cardiac rehabilitation is provided in hospitals: the early phase inpatient- as well as out-patient rehabilitation, mainly after the acute myocardial infarction (AMI), is available at the Preventive Cardiology Unit at the University Medical Centre Ljubljana. Most of the patients after acute coronary syndrome (ACS) and surgery are rehabilitated in special rehabilitation centers or spas.
Previously referrals to early phase cardiac rehabilitation after the AMI and/or cardiac surgery were almost universally accessible (up to 90% of patients) but since the beginning of 2014 this has been restricted due to lack of resources. The Slovenian Society of Cardiology is actively engaged in battling for a return to the previous higher provision of care. Long term programmes engage the regional / local units of the Slovene Association of Coronary Clubs, which are widely spread all over the country.
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Aims for the future
- Modernising cardiac rehabilitation: in 2007, the Working Group on Preventive Cardiology and Cardiac Rehabilitation of the Slovenian Society of Cardiology issued recommendations on cardiac rehabilitation with emphasis on the development of a network of out-patient rehabilitation units with multidisciplinary teams at all hospitals (both regional and university). Even rehabilitation was designed for special groups of patients including those post coronary revascularisation, with peripheral arterial disease, chronic heart failure, as well as the elderly (>75 years of age). This model with prolonged out-patient care (sessions 2-3 times per week, for at least 3 months), is fundamentally different from the current situation where the early stationery rehabilitation in spas is provided by only 2 weeks programme in most cases.
- National registry for secondary prevention: the national guideline on secondary prevention and rehabilitation for post-myocardial infarction (MI) patients provides recommendations for a long-term shared care. This network could provide the necessary ground for the establishment of the National Registry of CVD patients. Unfortunately, due to the general economic crisis and the lack of resources this rpoject still remains a main target for the future.
- Health promotion: continuous provision of well established CVD health promotion campaigns and prevention programmes and establishment of the nationally coordinated, monitored and supervised network of out-patient facilities for the provision of integrated secondary CVD prevention (including cardiac rehabilitation).
- The national prevention campaign: to enlarge its scope of healthy lifestyle counseling to cover all the non-communicable diseases, not only CVD (depression, cancer etc.) and to provide different counseling modules (group/individual) on lifestyle change also to patients – mainly those post-MI.
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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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