السياسة الموحدة لخفض الوفيات بأمراض القلب والشرايين

Objectives

The 2017–2021 national cardiovascular policy provides a unified framework to reduce cardiovascular disease burden in the United Arab Emirates, aligned with UAE Vision 2021 and World Health Organization recommendations.[1][2][3][4]Its mission is to reduce cardiovascular mortality, morbidity, disability and modifiable risk factors through effective cross-sectoral partnerships, supporting high standards of health and productivity.[4]The central outcome is a 25% reduction in cardiovascular mortality from the 2017 baseline age-standardised rate of 82 to 61.5 deaths per 100,000 population by 2021.[5][6]

• Prevent cardiovascular disease across the population by addressing tobacco use, unhealthy diets, physical inactivity, excess salt, trans fats, sugar, unhealthy fats and processed foods.[7][8][9][10]
• Promote healthier environments through physical activity, healthy diets, food-composition measures, workplace nutrition, healthy restaurants and tobacco-control policies.[8][11][12]
• Strengthen primary and secondary prevention through public awareness, self-assessment, periodic screening, early detection and risk-factor assessment.[13][14][15][16]
• Improve diagnosis, emergency response, treatment, rehabilitation, post-treatment care and social reintegration for cardiac patients.[13][17][18][19]
• Standardise cardiovascular risk assessment, diagnosis and treatment in primary healthcare in line with World Health Organization and International Society of Hypertension guidance.[20]
• Develop a national cardiovascular disease research strategy, registry, information base and annual reporting arrangements to improve evidence and performance measurement.[21][22]
• Build workforce capability in prevention, treatment, community education and cardiovascular care.[23][21]

The national indicator measures cardiovascular deaths per 100,000 population, calculated by age group and subsequently expressed as an age-standardised mortality rate to enable comparison between age groups and countries.[5][24]Annual targets were set at 79.43 in 2018, 76.87 in 2019, 74.312 in 2020 and 71.75 in 2021.[6][24]

Implementation

Implementation combines a Ministry of Health and Prevention-led governance model with coordinated delivery by public, local-authority and private healthcare providers, supported by national data systems, digital tools, international good practice and multi-sectoral partnerships.[25][26][27][28]The policy roadmap was developed by assessing barriers, reviewing internationally applicable practice, identifying gaps between current and desired performance, and defining recommended initiatives.[29]

• Coordinate delivery through the Ministry of Health and Prevention, its central departments and affiliated facilities, local health authorities, public hospitals and centres, private hospitals, international organisations, strategic partners and citizens.[26]Named participating bodies include the Department of Health in Abu Dhabi, Dubai Health Authority, Sharjah Health Authority, Presidential Court, Federal Competitiveness and Statistics Authority, Statistics and Research Centre, Emirates Competitiveness Council and private-sector providers.[30][5]
• Establish executive and sub-teams to coordinate partners, deliver initiatives, follow up results and manage the cardiovascular mortality indicator.[30][31]
• Deliver prevention through multilingual campaigns and materials, schools, universities, pharmacies, clinics, social media, mobile education, digital applications and community programmes.[8][32]
• Implement school policies supporting at least 30 minutes of daily physical activity, encourage healthier family and workplace practices, and support healthy-food standards in restaurants and retail settings.[8][32][33]
• Expand access to screening, mobile screening units, upgraded diagnostic services, emergency electrocardiography, automated external defibrillators, trained personnel, call-centre support and rapid referral pathways.[15][18][19]
• Provide specialised cardiac treatment, including primary percutaneous coronary intervention, emergency care, patient education, rehabilitation, case management and follow-up for patients treated across multiple providers or abroad.[34][35][17]
• Use health-information systems, telemedicine, smart applications, electronic monitoring and national communications networks to support public awareness, prevention, care delivery and shared data collection.[25][23]
• Develop licensing, accreditation and clinical standards for facilities, workforce practice, risk-factor management, acute emergencies, transfer, referral and treatment quality.[16][28][18][19]

Governance assigns roles to the Cabinet, Prime Minister’s Office, local government executive councils, Ministry of Finance, contributing entities, data sources, international reference bodies and the Ministry of Health and Prevention.[27][36][31]The Ministry of Finance coordinates resource availability, budget approval, financial transfers and financial-performance monitoring, although the supplied material does not specify monetary allocations, programme costs, funding sources or a total budget.[36]

Monitoring relies on annual measurement of the mortality indicator, national records and a cardiovascular disease registry, with an annual registry report intended to include effective measurement indicators.[5][6][21]Executive teams are to track operational plans, initiatives and outcomes through monthly results reports, while the Ministry of Health and Prevention submits periodic indicator and initiative reports to the Prime Minister’s Office and mandated-initiative reports to the Cabinet.[31][28]

Data improvement is a major operational requirement because mortality data have been inaccurate and inconsistent owing to absent common definitions, standards and verification mechanisms.[35]Priority actions include establishing a unified electronic data-collection system, improving cooperation among data-source organisations, training physicians in International Classification of Diseases coding for cardiovascular deaths, coordinating with the World Health Organization on indicator calculation, and using national survey data in cardiovascular statistical reports.[35][21][37]Patient satisfaction with prevention and treatment campaigns, community knowledge and behaviours, adult risk-factor screening, tobacco-use data and post-treatment reintegration are additional proposed monitoring activities.[32][10][11][18]

Monitoring & Evaluation

The policy establishes cardiovascular mortality as the principal national outcome measure, expressed as deaths from cardiovascular diseases per 100,000 population, and links performance management to the 2017–2021 national agenda.[1][5][36][28]It combines mortality reduction with supporting measures for risk-factor assessment, prevention, diagnosis, treatment, rehabilitation, data quality and patient experience.[20][13][21][18]

• Monitor the age-standardised cardiovascular mortality rate annually, with lower rates indicating better performance.[5][24]The 2017 baseline was 82 deaths per 100,000 population, and one stated 2021 target was 61.5 deaths per 100,000 population.[5][6]
• Apply age-specific crude mortality calculations for five-year age groups, then derive the age-standardised rate using population weights and World Health Organization comparison standards.[6][24]
• Track annual mortality targets of 79.43 in 2018, 76.87 in 2019, 74.312 in 2020 and 71.75 in 2021.[6][24]These annual targets differ from the separately stated 2021 target of 61.5 deaths per 100,000 population.[5][6][24]
• Target a 25% reduction in cardiovascular mortality, although the policy materials refer variously to achievement by 2021 and by 2025.[30][4]
• Standardise performance indicators for cardiovascular risk-factor assessment, diagnosis and treatment in primary healthcare, using World Health Organization and International Society of Hypertension guidance.[20]
• Establish a national cardiovascular disease registry, a consolidated information base and an annual registry report containing effective measurement indicators, including cardiovascular mortality.[21][22]
• Improve mortality-data accuracy, consistency and completeness by adopting common definitions, standards and verification mechanisms, developing a unified electronic data-collection system, and strengthening cooperation among data-source organisations.[35]
• Address measurement challenges arising from population age structures that do not align with indicator age groups and from treatment occurring outside official reporting pathways.[7][34]
• Use Ministry of Health and Prevention information systems, electronic monitoring, national electronic-system links and shared statistics to support surveillance, follow-up and reporting.[25][23]
• Report progress monthly through executive and sub-teams, tracking operational-plan delivery, initiatives and outcomes against the indicator.[31]Submit periodic indicator and initiative reports to the Prime Minister’s Office and reports on mandated initiatives to the Cabinet.[28]
• Maintain oversight through senior leadership, government monitoring of national indicators, an executive team for the cardiovascular indicator, and ministerial or administrative teams responsible for coordinating partners and following up results.[30][3][38][31]
• Measure patient satisfaction with prevention and treatment campaigns and assess post-treatment community reintegration.[32][18]
• Conduct community studies on cardiovascular-risk knowledge and behaviours, undertake adult risk-factor screening, and monitor tobacco-use data to inform prevention and control policies.[14][10][11]
• Prepare cardiovascular disease statistical reports using national survey data and train physicians in International Classification of Diseases coding for cardiovascular deaths.[37]

Detailed evaluation designs, a complete indicator dictionary, consistently specified baselines and targets, and formal sanctions for non-performance are not fully specified in the supplied material.[39][20][21][40][37]

Costing & Financing

The policy identifies resource availability, workforce capacity and prevention-oriented financial support as important enablers, but it provides no quantified national budget, programme cost, funding gap, financing target or economic assumption.[23][36]The assessment highlights high healthcare costs and an imbalance in which treatment receives substantial resources while prevention and early detection receive limited budgets.[34]

• Coordinate resource availability, budget approval, financial transfers and financial-performance monitoring through the Ministry of Finance.[36]
• Allocate qualified human resources and build national capacity for cardiovascular prevention, treatment, data management and community health education.[23][21]
• Strengthen preventive financial protection, as the assessment identifies the absence of compulsory insurance coverage for all population groups that includes minimum preventive services such as smoking-cessation counselling and nutrition support.[34]
• Provide or consider incentives for healthy-food retailers and restaurants, affordable healthy food, patient adherence to blood-pressure and cholesterol control, reduced medicine prices, lower follow-up charges and reduced fees for supportive devices or services.[32][41][33][9][42]
• Encourage hospitals providing cardiovascular treatment to contribute free clinical services for community support.[33][10]
• Promote pricing measures that raise the cost of unhealthy foods, lower the price of healthy foods and encourage insurers to offer low-cost preventive insurance packages.[12]

Funding sources beyond institutional responsibilities, allocation rules, the scale and eligibility criteria of proposed incentives, and the costs of registry, screening, treatment, rehabilitation and information-system activities are not specified.[21][9][12][36]