استراتيجية برنامج مكافحة الأمراض القلبية والوعائية

Objectives

The strategic vision is a society free from avoidable cardiovascular disease burden, supported by a mission to reduce cardiovascular mortality, morbidity and risk factors through effective partnership across all sectors of society, contributing to health, productivity and economic development.[1][2]The overarching goal is a 25% relative reduction by 2025, compared with 2014, in premature adult deaths from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases.[2]

• Reduce the cardiovascular disease epidemic and its risk factors through primary prevention, secondary prevention, high-quality services, surveillance, evaluation, research, patient and family participation, and community partnership.[3][4][5]
• Promote healthy diets, physical activity, health awareness and education, including walking initiatives, while addressing unhealthy social behaviours.[6][7]
• Reduce adult tobacco use by 5% annually and exposure to second-hand smoke by 10%, alongside action on hypertension and raised blood lipids.[8]
• Embed cardiovascular disease, healthy nutrition and risk-factor education in school curricula, improve food sold in school canteens, and make physical activity a core school subject.[7][9]
• Detect cardiovascular risk factors early through screening and risk assessment, particularly among healthy people, high-risk groups and people with a family history of heart disease.[6][10]
• Improve cardiovascular care quality through periodic practitioner assessment, access to medicines, clinical guidance, referral arrangements and management of complications.[10][11][4]
• Strengthen research, national surveys, monitoring and evaluation, including patient satisfaction, patient participation in treatment and the effects of programmes on disease control.[4][12][13]

Implementation

The programme uses a comprehensive national approach to cardiovascular disease control in Saudi Arabia, combining prevention, early detection, treatment, surveillance and multi-sectoral partnership.[6][2]Delivery is centred on primary healthcare, while linking patients to secondary and specialist services where required.[11][4]

• Develop legislation and public-health policies for tobacco control, smoke-free public places and reduced consumption of foods high in saturated fat, alongside coordinated activity with diabetes, obesity, food and physical-activity control programmes.[14][15]
• Deliver field-based, media and community education campaigns on cardiovascular risk factors, healthy nutrition, physical activity and disease prevention, and assess awareness before and after campaigns.[15][7][9]
• Implement school-based measures by improving food provision, integrating nutrition and cardiovascular risk-factor education into teaching materials, providing physical-activity sessions and encouraging additional walking tracks.[9][16]
• Provide integrated screening for chronic diseases and cardiovascular risk factors through primary healthcare centres, supported by periodic practitioner training on symptoms and signs and an early-detection risk-factor register.[16][17]
• Ensure primary healthcare centres provide essential preventive and therapeutic medicines, manage cardiovascular disease and operate clear referral pathways to secondary and specialist care.[11][4]
• Provide medical advice and medicines to adults aged 40 years or over whose cardiovascular disease risk is 30% or higher.[11]
• Ensure primary and specialist centres have diagnostic and laboratory supplies, and establish policies and dispensing mechanisms for continuous access to medicines for hypertension, diabetes and high cholesterol.[17][12]
• Develop, update and apply national clinical practice guidelines, assess their availability and use, and monitor compliance with quality and performance standards.[11][4]
• Build workforce capacity through training, continuing medical education, seminars, workshops and conference participation for healthcare workers.[12]
• Involve patients and families in treatment responsibilities, programme enrolment and adherence, while engaging community members in prevention and care.[3][13]
• Activate the National Committee for Health Promotion and Cardiovascular Disease Control and expand joint programmes among government institutions, the private sector, civil society and other relevant organisations.[5][18]
• Establish a national cardiovascular disease surveillance system and comprehensive database, standardise computerised patient-review systems across primary healthcare centres, and involve health information and statistical specialists in annual performance-quality reporting.[4][18]
• Monitor tobacco use, second-hand smoke exposure, hypertension, raised blood lipids, screening coverage, medicine availability, service use, acute myocardial infarction, stroke, heart failure, biomarker control and referral-system operation.[8][10][11]
• Conduct a national cardiovascular disease and risk-factor survey, including lifestyle research, every five years, with a research completion timetable and budget monitoring.[12][13]

Monitoring & Evaluation

Monitoring and evaluation combine population risk-factor surveillance, service-quality assessment, programme-performance tracking, research and information systems. The framework prioritises monitoring cardiovascular disease and risk factors among both healthy people and people at high risk, but leaves several governance arrangements unspecified.[6][3]

• Monitor diabetes, overweight and obesity, inadequate physical activity, and raised blood pressure as core risk-factor indicators.[14]Define diabetes as fasting plasma glucose of at least 7 millimoles per litre, equivalent to 126 milligrams per decilitre, or use of medication for raised blood glucose.[14]Define overweight and obesity among adults aged 18 years or over as body mass index of at least 25 and at least 30 kilograms per square metre respectively.[14]
• Target a reduction in overweight and obesity prevalence of at least 10%, at a rate of 1% annually, and monitor the proportion of people consuming three to five daily portions of vegetables and fruit.[14]Define inadequate physical activity as less than 150 minutes of moderate activity, 75 minutes of vigorous activity, or an equivalent combination per week.[14]Define raised blood pressure as systolic pressure of at least 140 millimetres of mercury and/or diastolic pressure of at least 90 millimetres of mercury.[14]
• Track tobacco use, exposure to second-hand smoke, hypertension and raised blood lipids against defined indicators and targets.[8]Measure screening coverage among target groups through a cardiovascular risk table.[10]
• Assess cardiovascular service delivery through the availability of essential medicines in primary healthcare, patterns of primary-care use relative to secondary and specialist care, and recorded cases of acute myocardial infarction, stroke and heart failure.[11]Monitor control of glucose, blood pressure, lipids and other biomarkers.[11]
• Evaluate the availability and application of updated national clinical guidelines, referral-system operation, and compliance with quality and performance standards.[11][4]Monitor periodic service assessment by health practitioners as part of efforts to improve cardiovascular care quality.[10]
• Establish a national cardiovascular disease surveillance system and comprehensive database for quality-based monitoring and evaluation.[4]Use a cardiovascular information system to collect risk-factor and disease data, support programme assessment, and standardise computerised patient-review systems across primary healthcare centres.[18]
• Monitor public-health and prevention activities through awareness levels before and after campaigns, the number of awareness programmes delivered, school healthy-food provision, curriculum integration, nutrition-awareness activities, physical-activity campaigns and the availability of walking tracks.[7][9][16]
• Measure early detection through numbers of trained practitioners, creation of an early-detection risk-factor register, detected cases, and the proportion of detected cases within the target population.[16][17]Track diagnostic-supply and medicine availability, annual training coverage, continuing medical education events, patient and family participation, programme enrolment and adherence.[17][12][13]
• Conduct a national survey of cardiovascular diseases and risk factors, including lifestyle research, every five years.[12][13]Define a timetable for completing research and monitor the study budget.[13]
• Monitor health-system research, patient satisfaction, patient participation in treatment, effects of programmes on disease control, joint programmes, and institutional support for prevention.[4][5]Assess risk-factor control legislation, compliance with the World Health Organization Framework Convention on Tobacco Control, compliance with applicable laws, and the number and reach of awareness programmes.[15]
• Include performance-quality indicator assessment results in the annual report, with health information and statistical specialists involved.[18]Monitor implementation through the existence of an action plan and operational programmes, institutional-partnership activities, and availability of a unified computer programme in all primary healthcare centres.[18]
• Strengthen follow-up, surveillance, research, patient participation and community partnerships as strategic components of cardiovascular disease control.[3][4][5]Reporting schedules, designated reporting bodies, detailed accountability procedures and explicit enforcement mechanisms are not specified.[3]

Costing & Financing

Economic considerations recognise that cardiovascular diseases impose costs through clinical care, long-term treatment and reduced individual productivity.[1]The available material does not provide a programme budget, costed implementation plan, financing allocation, named funding source, quantified funding gap, resource-mobilisation mechanism or economic assumption.[6][1][8][18]

• Monitor the budget associated with the planned research study on cardiovascular disease economics and burden.[13]
• Support prevention, management, surveillance, early detection, primary healthcare and cost-effective care as elements of the national cardiovascular disease control programme, without assigning monetary values to these activities.[6]
• Ensure access to medicines, diagnostic and laboratory supplies, workforce training, clinical guidance, referral pathways, surveillance infrastructure and research activity, but do not specify the financing arrangements or allocations required.[11][4][17][12][13]
• Engage government institutions, the private sector and civil society in partnerships and joint programmes, but do not identify whether these bodies contribute financial, in-kind or other resources.[5][13][18]