Plan National Maladies Cardio-Neuro-Vasculaires 2023-2027

Objectives

Luxembourg’s 2023–2027 National Plan for Cardiovascular and Neurological Diseases seeks to reduce morbidity and mortality from cardiovascular, cerebrovascular and neurological diseases, within the wider national and international response to non-communicable diseases.[1][2]It responds to a substantial disease burden and associated healthcare costs, while recognising the importance of prevention, earlier diagnosis, coordinated care and reduced health inequalities.[3][4]

• Establish sustainable governance for the plan and coordinate its implementation across relevant institutions and professional groups.[1][5]
• Coordinate the collection and analysis of health data on determinants, morbidity, mortality, disease management and care provision, using reliable indicators and epidemiological reporting.[5][6]
• Strengthen primary prevention by reducing exposure to modifiable risk factors, including tobacco use, harmful alcohol use, unhealthy diet, physical inactivity, hypertension, obesity and environmental factors.[7][8]
• Promote screening and early diagnosis of cardiovascular and neurovascular diseases and their risk factors, including evaluation of the YOUNG50 pilot and development of further approaches.[9][10]
• Improve patient care pathways through stronger use of scientific recommendations, professional competencies, equipment and infrastructure planning, integrated care, patient participation, rehabilitation and public information.[11][12]
• Apply cross-cutting objectives to reduce health inequalities, incorporate innovation and strengthen evidence-based medicine across all thematic areas.[2][5]

The plan comprises five axes, covering governance, health data, prevention, screening and early diagnosis, and care pathways.[5]These axes contain 19 measures and 58 actions planned for 2023–2027.[1]Its prevention agenda includes improving understanding of nutritional labelling, assessing and reducing excessive salt consumption, issuing Luxembourg-specific lifestyle recommendations, and creating health-supportive environments in workplaces, municipalities, schools, public places and settings for older people.[13][14]

The plan adopts World Health Organization voluntary targets as an international reference framework, including reductions in premature cardiovascular and diabetes mortality, hypertension, salt intake and physical inactivity, alongside stabilisation of diabetes and obesity prevalence.[2]The supplied material does not specify distinct national numerical targets for all plan measures beyond these adopted global targets.[2]

Implementation

Implementation is led by the Directorate of Health through its National Plans Coordination Service, under the authority of the Directorate of Health, with a plan coordinator responsible for overseeing measures and actions.[15][16]The delivery model combines central coordination, a national expert committee, thematic working groups, collaboration with existing national programmes and competence networks, and action by health, social, research, insurance, emergency-service, patient and community stakeholders.[16][17]

• Coordinate governance through a National Plans Monitoring Committee within the Directorate of Health, a National Committee for Cardiovascular and Neurovascular Diseases, and working groups covering data, prevention, screening and care pathways.[15][16]
• Appoint National Committee members through the minister responsible for health on proposals from the Directorate of Health, and provide committee secretariat, logistical support and regular progress updates.[18][16]
• Assign groups of measures and actions to working groups to maintain technical coherence and limit unnecessary fragmentation.[18]
• Identify human, logistical and technical requirements for coordination, and provide adequate means for the Directorate of Health to undertake this role.[15]
• Build on existing initiatives, including the Gesond Iessen Méi Bewegen framework on healthy eating and physical activity, tobacco-control action, and competence networks established under the Hospital Law of 8 March 2018.[19][20]

The data strand will map existing data actors and sources, assess their quality and usability, define technical specifications for a limited indicator set, identify missing data, and establish an organisational model for collection and analysis.[21][6]It envisages collaboration with the National Health Observatory, the Luxembourg National Data Service and data providers, and may use innovative sources and technologies such as shared care records, hospital records, digital tools and disease declarations where feasible and relevant.[18][22]Data work is also intended to consider territorial coverage, socio-economic variables, health literacy and other sources of inequality.[5][23]

Prevention and screening delivery will use partnerships with food-safety authorities, occupational health services, municipalities, environmental actors, food-sector and collective-catering stakeholders, health professionals and non-health organisations.[13][14][24]The YOUNG50 cardiovascular-risk screening pilot was implemented by the Directorate of Health with the Luxembourg Institute of Health and is to inform subsequent screening actions following evaluation.[9][25]Additional partners may include pharmacists, occupational and school health services, physiotherapists, nurses, dietitians, prison professionals, gyms and social-support organisations.[25]

Care-pathway actions will support coordinated work between hospital and non-hospital professionals, including competence networks and pathways for stroke, heart failure and cardiac arrest.[20][12]They include assessments of clinical-recommendation use, training needs, task delegation, infrastructure and equipment needs, telemedicine, multidisciplinary case discussions, therapeutic education, patient-association support, rehabilitation and socio-professional reintegration.[26][27][28]

Evaluation combines mid-term and final expert assessments, monitoring of selected indicators, and assessment of the processes and effects of individual actions.[1][29]Each action is to have criteria and indicators defined before launch by its relevant working group, with studies undertaken where necessary to assess outcomes.[16]The coordinator is to prepare annual activity reporting, progress is to be reported to the National Committee, and an annual report is to be submitted to the Minister for Health after committee review.[18][16]

Funding is to be provided by the Directorate of Health, which will prepare annual budgets for planned measures and actions and conduct financial monitoring.[16]The supplied material does not specify a quantified overall budget, detailed expenditure allocations or funding gap.[16]

Monitoring & Evaluation

The plan combines population-health data, action-level evaluation and external review to monitor implementation and outcomes for cardiovascular and neurovascular diseases during 2023–2027.[1][29][16]It envisages monitoring both disease burden and care provision, while using evaluation findings to adapt delivery where needed.[5][6][29]

• Define and monitor a restricted set of robust indicators covering risk factors, selected disease prevalence and incidence, mortality, morbidity, health-system performance, access to prevention and care, care quality, and progress in implementing the plan.[30][6]
• Coordinate data collection and analysis on health determinants, morbidity, mortality and disease management; assess data-source quality, availability, completeness, sustainability, legal considerations, consent, duplication and information-sharing risks.[5][21][6]
• Establish technical specifications and quality-control arrangements for indicator data, including checks on coding, completeness and analytical quality.[30][22][6]
• Identify data gaps by comparing available information with the agreed indicator list, then develop recommendations for collecting and analysing missing or poor-quality data.[31][30]
• Produce targeted epidemiological reporting based on the selected indicators and disseminate it periodically to the public and relevant health professionals; the reporting interval is not specified.[22][6]
• Apply cross-cutting considerations to data and implementation work by assessing territorial coverage and health inequalities, testing innovative sources and methods where feasible, and grounding action in previous reports or scientific literature.[5][22][23][32]
• Evaluate each action through process and outcome assessment, with relevant working groups defining criteria and indicators before implementation and commissioning studies where necessary.[16]
• Conduct overall external evaluations at mid-term and at the end of the plan. The mid-term review is intended to assess governance, the relevance of measures against international literature, monitoring resources, and the number and scope of actions delivered, producing recommendations that may redirect the plan.[29]
• Review the entire implementation period in the final evaluation and use the findings to support preparation of a subsequent national plan.[29]
• Evaluate prevention and screening pilots, including baseline assessment and subsequent evaluation of salt-reduction measures, assessment of behaviour-change and digital interventions, and evaluation of the YOUNG50 cardiovascular risk-factor screening pilot before adapting or expanding screening.[13][24][9][25]
• Assess professional use of scientific recommendations, conditions for task delegation, equipment and infrastructure needs, multidisciplinary meetings, care pathways and competence networks, including medico-economic evaluation where relevant.[20][26][27][33]
• Report implementation progress to the National Committee at each meeting, submit an annual report on the preceding year's work to the Minister for Health following committee review, and provide regular public and professional communications on progress.[18][34][16]

The Directorate of Health, through its National Plans Coordination Service and plan coordinator, is responsible for implementation coordination and annual activity reporting; a National Plans Monitoring Committee established within the Directorate in 2023 provides wider governance across national plans.[15][16]The extracts do not specify a complete numerical indicator set, indicator targets, a fixed surveillance timetable, or comprehensive formal accountability arrangements beyond the committee, ministerial reporting and financial monitoring mechanisms described.[18][29][16]

Costing & Financing

The plan identifies resource needs for coordination, data infrastructure, prevention, screening, training, care pathways and evaluation, but does not provide an overall quantified budget, costed implementation plan, funding gap, expenditure allocation or economic assumptions for Luxembourg.[15][16][35]Funding is to be provided by the Directorate of Health, referred to as DISA in the extracts, with the plan coordinator preparing an annual budget for measures and actions and DISA undertaking financial monitoring.[16]

• Identify the human resources, logistical arrangements and technical expertise needed for coordination, and provide adequate means within the Directorate of Health.[15][34]
• Recognise that implementation was delayed by the COVID-19 health crisis and associated human-resource constraints.[3][4]
• Use European Commission co-financing for the YOUNG50 pilot, under a Ministry of Health grant agreement signed in April 2019 for three years.[36]
• Consider time-limited funding for targeted or pilot work to address missing health data, while not establishing permanent plan financing for routine collection and analysis of missing data.[31]
• Explore shared financing between the Gesond Iessen Méi Bewegen framework plan and the national plan for activities improving understanding of nutritional labelling.[23][13]
• Consider fiscal incentives, including reduced value-added tax for healthy foods and tax advantages for businesses that create health-supportive environments; the extracts do not confirm adoption of these measures.[24][9]
• Provide partial financial support for targeted professional training, finance a consultant to support development of a cardio-neuro-vascular competence network, and consider financing for methodological support in evaluation.[26][28]
• Examine financial factors affecting the uptake of scientific recommendations, integration of professionals and care-pathway financing, including alternative international financing models.[20][33][28]
• Assess financial and human-resource risks to the sustainability of health-data collection and analysis, without quantifying funding requirements.[21]

The broader economic rationale is that non-communicable diseases create substantial health-system costs: a 2017 European Commission estimate attributed 80% of total European Union health-system costs to these diseases.[37]European Union countries allocated an average of 3% of national health budgets to prevention in 2017, cited as context for possible increased prevention investment rather than as a Luxembourg allocation.[23]