循環器病対策推進基本計画

Objectives

Japan’s National Control Plan on Cardiovascular Health provides the national policy framework for comprehensive and systematic cardiovascular disease control under the Act on Promotion of Measures for Cerebrovascular and Cardiovascular Disease. It seeks to extend healthy life expectancy, reduce age-standardised cardiovascular mortality, lessen health and long-term care burdens, and support people to live with disease with the fewest possible restrictions on daily life.[1][2][3]The overarching 2040 target is to increase healthy life expectancy by at least three years while reducing age-standardised cardiovascular mortality.[3]

• Prevent cardiovascular disease onset, recurrence, complications, exacerbation and progression through healthier lifestyles, risk management, appropriate treatment and timely consultation, while recognising that some conditions arise from congenital, genetic, infectious or age-related causes independent of lifestyle.[4][3]
• Improve public knowledge of cardiovascular disease, warning signs, sequelae and the need for urgent action after onset, alongside prevention messages across all life stages.[5][6][7]
• Strengthen coordinated health, medical, long-term care and welfare services across emergency, acute, recovery, chronic and community-living phases.[8][9]
• Provide rapid transport and appropriate acute treatment, rehabilitation, palliative care, information, consultation, support for sequelae, and assistance to remain in work or return to work.[10][11][12][13]
• Advance research on disease mechanisms, prevention, risk assessment, diagnosis, treatment, rehabilitation, prognosis, quality of life, medical devices and evidence-based policy.[9][14][15]

The plan addresses the substantial population burden of cardiovascular disease, which accounted for more than 310,000 deaths from heart and cerebrovascular disease combined in 2018 and represented the largest combined share of reported main causes requiring care in 2019.[16][17]It also promotes equitable, sustainable and regionally appropriate care, including specialist-service concentration where advanced expertise is needed and continuous support for patients in familiar communities.[18][19][20]

Priority populations include children and young people, working-age adults, older people, people with congenital heart disease or cardiomyopathy, and people living with cardiovascular sequelae.[21][22][23][24]The plan therefore combines primary prevention with early identification, acute response, long-term disease management, independent living, social inclusion and employment participation.[2][25][20][13]

Implementation

Implementation relies on coordinated action by national government, prefectures, local authorities, medical insurers, healthcare and welfare providers, academic bodies, employers, patients, families and the public.[21][26]Prefectures are expected to prepare cardiovascular disease plans reflecting local conditions, align them with medical, health promotion, long-term care and emergency medical plans, and use the Plan, Do, Check, Act cycle to improve delivery.[26][27][28]

• Coordinate prevention through communities, workplaces, schools, health examinations and health guidance, using behavioural approaches and accessible, scientifically grounded communications through mass media, social networking services and relevant organisations.[29][7][25][30]
• Strengthen emergency pathways by reviewing prefectural patient transport and acceptance criteria, maintaining 24-hour acute-care coverage, improving ambulance transfers and developing emergency crews’ evidence-based cardiovascular skills through medical control systems.[31][32][33]
• Develop regional care networks through functional differentiation and collaboration among advanced acute, acute, recovery and chronic-care providers, home-based services, primary care and specialist facilities.[9][18][19]
• Deliver integrated community care by linking medical care, long-term care, prevention, housing, welfare and livelihood support, with multidisciplinary input from health, rehabilitation, pharmacy, nutrition, social-work and care-management professionals.[31][25][34]
• Provide continuous rehabilitation from acute care through recovery and community living, including disease-management programmes, outpatient or home-based options after stabilisation, and support for social reintegration and employment.[11][35]
• Support treatment and work through individual plans and a triangle model linking the attending physician, employer or occupational physician, and a treatment-and-work support co-ordinator.[23][36]

A central operational mechanism is the development of a public clinical-information framework for specified acute cardiovascular conditions, including cerebral infarction, cerebral haemorrhage, subarachnoid haemorrhage, acute coronary syndrome, acute aortic dissection and acute heart failure.[37]The framework is to support acute care, service planning and public-health policy, involving the National Cerebral and Cardiovascular Centre, healthcare institutions and academic societies.[37]Information technology, existing data sources and big-data methods are intended to reduce reporting burdens, improve understanding of incidence and clinical practice, and enable more individualised prevention and treatment.[38][39]

Research delivery is coordinated across the Ministry of Health, Labour and Welfare, the Ministry of Education, Culture, Sports, Science and Technology, and the Ministry of Economy, Trade and Industry, including through the Japan Agency for Medical Research and Development.[31][40]The approach links basic, clinical, practical and industry-academic research, promotes translation of promising discoveries into diagnostics and treatments, and supports evidence for effective and cost-conscious policy.[14][41][15][42]

Governance includes stakeholder engagement through prefectural councils, with patient and family perspectives incorporated when plans are prepared or amended.[26]The national plan was indicatively implemented from fiscal year 2020 to fiscal year 2022, with national progress assessment by fiscal year 2022; the Council may issue recommendations and review groups may be established where needed.[27][43]The national and prefectural plans are to be reviewed at least every six years, considering changes in prevention and service delivery, research progress and evidence on effectiveness.[44][43]

Monitoring is intended to use scientific and comprehensive evaluation of both individual measures and the overall programme, alongside visibility of epidemiology and service delivery.[45][43]Specific indicators include fiscal-year-2023 targets of at least 70% participation in specific health examinations and 45% participation in specific health guidance among people aged 40 to under 75.[46]Financial measures are envisaged, with limited budgets to be prioritised, duplication reduced, inter-ministerial collaboration strengthened and public-private roles and costs shared; monetary allocations are not specified.[27][47]

Monitoring & Evaluation

The plan establishes a multi-level monitoring, evaluation and review framework to support comprehensive cardiovascular disease control. It combines long-term population outcomes, service-delivery monitoring, clinical-information collection, plan review and continuous improvement by national and prefectural authorities.[16][44][43][28]

• Track the overarching outcomes of extending healthy life expectancy by at least three years by 2040 and reducing age-standardised cardiovascular mortality.[3]
• Monitor healthy life expectancy as a population outcome, reported at 72.14 years for men and 74.79 years for women in 2016, increases of 1.72 and 1.17 years respectively from 2010; regional disparities had also narrowed.[31]
• Measure participation in specified health examinations and health guidance, with fiscal year 2023 targets of at least 70% and 45%, respectively, among people aged 40 to under 75.[46]
• Use the fiscal year 2017 baselines of 53.1% participation in specified health examinations and 19.5% in specified health guidance to identify the need for further implementation efforts.[46]
• Review the National Health Insurance insurer effort support system’s evaluation indicators, identify effective prevention and disease-aggravation prevention practices, and disseminate good practice associated with improved participation.[30]
• Review prefectural criteria for emergency patient transport and hospital acceptance on an ongoing basis, supported by medical control systems that improve emergency crews’ cardiovascular knowledge and technical skills.[32]
• Assess arrangements for acute cardiovascular care, including effectiveness and safety, and use data-based collaboration to inform workforce development and deployment.[19]
• Establish a public clinical-information framework covering cerebral infarction, cerebral haemorrhage, subarachnoid haemorrhage, acute coronary syndrome, acute aortic dissection and acute heart failure, including acute exacerbations of chronic heart failure.[37]
• Collect information on disease incidence and clinical practice, including onset and severity, treatment effects and relevant complications, to support data-based evaluation, service planning, acute care and evidence-based policy.[38][39]
• Draw on existing sources, including the Ministry of Health, Labour and Welfare Patient Survey and researcher- and academic-society-led initiatives, while addressing their limitations for acute care, service planning and public-health policy.[39]
• Use epidemiological visibility and clinical information to evaluate measures, verify their effects and identify emerging policy challenges.[45][37]
• Apply scientific and comprehensive evaluation methods to assess both individual measures’ contribution to specific objectives and the overall effectiveness of the plan, and consider setting concrete targets for individual measures during implementation.[43]
• Require prefectures to manage implementation through the Plan, Do, Check, Act cycle and use results to improve policy.[28]
• Monitor changes in prevention and health, medical and welfare service provision, research progress and the effects of cardiovascular disease measures.[44]
• Review the national plan at least every six years and amend it where necessary; review prefectural plans at least every six years and align these reviews, where appropriate, with review of the national Basic Plan.[48][44][43]
• Assess national Basic Plan progress by fiscal year 2022, use findings to identify issues and adjust measures, and enable the Council to make implementation recommendations or establish review groups where needed.[43]

Detailed reporting timetables, a complete surveillance architecture, disaggregated performance indicators and a named formal accountability body are not specified beyond the national and prefectural statutory planning, council, review and continuous-improvement arrangements.[48][44][43][28]

Costing & Financing

The plan requires financial measures for comprehensive implementation and calls for efficient use of constrained resources, but it does not provide a programme budget, quantified allocations, funding gaps or a detailed financing model.[16][27][47]

• Provide necessary financial measures for comprehensive and planned cardiovascular disease control.[16][27]
• Prioritise and concentrate limited budgets, avoid duplication between measures, strengthen inter-ministerial collaboration, and share roles and costs between public and private sectors.[47]
• Use the National Health Insurance insurer effort support system as a financing-related mechanism for prevention and health promotion, although no funding allocation is specified.[30]
• Consider how costs should be borne for secondary use of information collected through the clinical-information framework, including the appropriate access-provision model.[37]
• Recognise treatment cost-effectiveness as a consideration in research intended to inform cardiovascular policy and improve care quality.[42]
• Provide employment support through available employer subsidies for people receiving treatment, although subsidy values and programme budgets are not specified.[23]
• Record fiscal year 2017 total medical expenditure by disease classification at 30,833.5 billion Japanese yen, of which cardiovascular diseases accounted for 6,078.2 billion Japanese yen, or 19.7%, the largest disease-group share.[1]

No quantified costs are specified for emergency transport, care networks, rehabilitation, workforce development, clinical-data infrastructure, research, public communication, palliative care, welfare support or prefectural implementation.[32][33][18][11][40]