Call for action: to promote a heart-healthy environment in Europe

In January 2008, a European Summit on cardiovascular disease (CVD) prevention was organized by the European Society of Cardiology to support both the practical and political implementation of the 4th Joint European Guidelines on CVD Prevention in Clinical Practice [1], while addressing the remaining challenges highlighted in the European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey [2]. As stated by Professor Guy De Backer (Ghent, Belgium), ‘bridging the unacceptable gap between what is recommended and what is achieved in daily practice regarding the prevention of cardiovascular disease’ was what brought together 200 delegates from 46 countries and 27 different health organizations, with the support of DG SANCO of the European Commission. Conclusions of the European Summit were drawn from national practical experiences of effective implementation into the ‘call for action’ outcome document, which was endorsed by the Joint European Societies on CVD Prevention. The ‘call for action’ is encouraging European countries to develop national strategies to combat heart diseases. To ensure optimal implementation of: The European Heart Health Charter (EHHC) [3]. The Guidelines of the 4th Joint European Task Force on CVD Prevention in Clinical Practice [1]. To ensure equal access to efficient healthcare structures for CVD prevention and rehabilitation, adapted to individual CVD risk profiles, throughout Europe. All European countries are expected to have adopted and launched the EHHC [3] by the end of 2008 and each European country will have a multidisciplinary alliance of health policy makers and representatives of scientific, professional, and voluntary societies of agencies dedicated to CVD prevention by the end of 2010. A strong partnership of multidisciplinary societies oversees the development and implementation of prevention strategies across Europe. It includes the following professional health organizations: European Society of Cardiology, European Heart Network, European Atherosclerosis Society, European Society of Hypertension, International Society of Behavioural Medicine, European Society of General Practice/Family Medicine, European Association for the Study of Diabetes, International Diabetes Federation Europe, European Council for Cardiovascular Nursing and Allied Professions, European Association for Cardiovascular Prevention and Rehabilitation, and European Stroke Organisation. All of these partners have contributed to the writing of the 4th Joint European Guidelines on CVD Prevention in Clinical Practice [1] and most of them are signatories of the EHHC [3]. Together, these partners are committed to pursuing the creation of a heart-healthy environment in Europe through various actions at a national level (Fig. 1): Each country will create a ‘multidisciplinary alliance’, which will take actions to implement the EHHC [3], in particular articles 9–18 to which each country has subscribed. This alliance will: Develop a national strategy to encourage professionals and politicians to find incentives for local populations to make healthy choices (balanced diet, physical activity, avoidance of tobacco). Coordinate the implementation of the 4th Joint Task Force guidelines [1] locally, taking into account specific cultural, socioeconomic, and medical issues. Recommend the use of management tools such as the HeartScore® program [4] and the Health Professional Toolkit. National strategies should include the following areas: Education: educational programs in all schools throughout Europe should promote the integration of a healthy lifestyle (balanced diet, physical exercise, avoidance of tobacco). Health insurance: an adequate budget should be allocated to health education, preventive care and rehabilitation within national health services. Actions related to CVD prevention should be reimbursed within existing health insurance plans. Primary care: the contribution of primary care physicians to CVD prevention should be encouraged through the use of tools such as the HeartScore® program [4] and the Health Professional Toolkit. Hospitals: units treating patients with CVD should provide multidisciplinary prevention and rehabilitation services with particular attention to smoking cessation; healthy eating habits; adequate physical exercise; health education programs involving patients as well as their families; follow-up ensuring adherence to lifestyle changes and compliance with lifelong drug therapies. Evaluation: The national implementation of the EHCC [3] and of the 4th Joint Task Force Guidelines [1] should be evaluated at regular intervals and should include: definition of an evaluation baseline performed by the national multidisciplinary alliance countries should be encouraged to keep registers of CVD morbidity and mortality countries should survey CV risk factors (obesity, diabetes, high blood pressure, tobacco consumption) and total CV risk. Networks for concerted actions. CVD, cardiovascular disease. Although a preventable condition, over 2 million people die of CVDs each year in the European Union [5]. The human and economic costs of heart diseases were highlighted in recent studies and calculated to be 192 billion Euros per year [5]. As guidelines can remain quite ineffective without clearly defined national implementation strategies, a call for action was strongly made by the European Society of Cardiology in partnership with other professional societies to encourage European countries to develop local strategies targeting mainly four areas: education, health insurance, primary care, and hospitals. A multidisciplinary approach is a critical factor of success as CVD is usually the result of multiple interacting risk factors. Evaluation of efforts in implementing national strategies will be monitored regularly and the European Society of Cardiology through one of its Registered Branch, the European Association for Cardiovascular Prevention and Rehabilitation, will continue to strive to make people live longer and better.