Plan National Maladies Cardio-Neuro-Vasculaires 2023-2027

Objectives

Luxembourg’s National Plan on Cardiovascular and Neurovascular Diseases for 2023–2027 is the country’s first national framework dedicated to reducing morbidity and mortality from cardiovascular and neurovascular diseases, which are the second leading cause of death after cancer.[1][2]It complements existing national initiatives on healthy eating, physical activity, tobacco control, cancer and hospital competence networks rather than duplicating them.[3]

• Establish sustainable governance, supervision and coordination for the plan.[2][4]
• Coordinate the collection and analysis of cardiovascular and neurovascular health data, including mortality, morbidity, care, determinants, data gaps and health inequalities.[2][5]
• Strengthen primary prevention by reducing exposure to modifiable risk factors, notably tobacco use, alcohol consumption, physical inactivity, unhealthy diet, obesity, hypertension, dyslipidaemia, diabetes and excessive salt intake.[1][6][7]
• Promote screening and early diagnosis of diseases and risk factors to enable timely secondary prevention and treatment.[2][8]
• Improve patient-centred care pathways, rehabilitation and continuity of care for people with cardiovascular and neurovascular diseases.[2][9]

The plan contains 19 measures and 58 actions across these five areas, to be delivered from 2023 to 2027.[2]All measures are expected to reduce health inequalities, incorporate innovation and strengthen evidence-based medicine.[2][10]

Its prevention and disease-management direction is aligned with voluntary World Health Organization targets, including reductions in premature cardiovascular and diabetes mortality, hypertension, population salt intake, smoking and physical inactivity, alongside halting increases in diabetes and obesity.[11][10]These priorities respond to a substantial national burden: circulatory diseases caused 1,046 deaths in 2021, or 24% of all deaths.[6]

Prevention action includes improving nutrition-labelling literacy; establishing baseline assessments of salt in foods and population salt consumption; piloting and, if effective, extending salt-reduction measures; developing lifestyle advice on diet, physical activity, sleep and stress; and creating health-supportive environments in workplaces, schools, municipalities and settings for older people.[12][13][14]

Screening priorities include completing and evaluating the YOUNG50 pilot, broadening screening through pharmacists and other community, occupational, school and social-sector actors, and exploring screening of children for familial hypercholesterolaemia.[8][15]Care priorities include integrating scientific recommendations, digital health and telemedicine; developing pathways and competence networks for stroke, heart failure and cardiac arrest; strengthening workforce competencies; assessing task delegation; and mapping equipment and infrastructure needs.[16][17][9]

Implementation

Implementation is led by the Directorate of Health and its National Plans Coordination Service, supported by a plan coordinator, a National Cardiovascular and Neurovascular Diseases Committee and thematic working groups.[2][4]The plan was updated in 2023 after the earlier 2020 version could not be implemented because of insufficient resources during the COVID-19 crisis.[2]

• Maintain a national expert committee that provides scientific and technical advice, reviews working-group outputs, considers annual activity reporting and meets at least twice yearly.[18]
• Appoint committee members through the Minister responsible for Health on proposals from the Directorate of Health, selecting experts for scientific expertise.[18]
• Use working groups to develop detailed action plans and pilot projects, preserve technical coherence across measures and submit operational proposals to the Directorate of Health.[4][19]
• Coordinate plan governance with the National Plans Monitoring Committee, established within the Directorate of Health in 2023.[4]
• Engage health professionals, researchers, health insurance, hospitals, pharmacies, emergency services, patient organisations, social-care bodies and relevant non-health sectors in delivery.[20][21][22][23]

The data-delivery model requires a dedicated working group to map existing sources, assess data quality and risks, identify missing data, define a limited indicator set and create technical specifications and quality controls.[24][25][26]It envisages collaboration with the National Health Observatory, the Luxembourg National Data Service and organisations holding relevant data, while considering legal requirements, consent, duplicate collection, interoperability and the financial and human-resource sustainability of data systems.[25][27]

Indicators are intended to cover risk factors, disease prevalence and incidence, mortality, morbidity, governance, financing, workforce, infrastructure, service availability, accessibility and quality.[26]Selected data should be consolidated into targeted epidemiological reports and disseminated to the public and relevant professionals.[27]Public communication should also use websites, press coverage, campaigns and periodic progress reports.[19]

Evaluation combines external expert reviews at mid-term and completion, monitoring of trends in selected indicators, and process and outcome assessment of every action.[2][28]The mid-term review should assess governance, the relevance of measures against international evidence, monitoring resources and the number and reach of implemented actions, enabling redirection where needed.[28]Working groups are responsible for defining action-level process and outcome criteria and indicators.[29]

Annual activity reports are to be prepared by the plan coordinator and National Plans Coordination Service, reviewed by the National Committee and submitted to the Minister responsible for Health.[18][29]The Directorate of Health finances the plan, while the coordinator forecasts the annual budget required for measures and actions and financial monitoring is undertaken within the Directorate.[29]No monetary budget, detailed allocations, funding sources beyond Directorate financing, or quantified funding gap is specified.[29]

Specific delivery mechanisms include piloting interventions before scale-up, such as salt reduction and innovative behavioural initiatives; evaluating YOUNG50 before adapting screening; financing a consultant to support competence-network development; and partly financing targeted professional training where competency gaps are identified.[13][30][15][9][17]

Monitoring & Evaluation

The plan establishes a multi-level monitoring and evaluation approach combining implementation oversight, population-health indicators, action-level assessment, public reporting and independent review.[2][28]

• Conduct independent expert evaluations at mid-term and at the end of the plan, assessing governance, the relevance of measures against international literature, resources assigned to monitoring, and the number and reach of implemented actions.[28]
• Use mid-term findings to produce recommendations and redirect the plan where necessary during its final years; use the final evaluation to inform a subsequent national plan.[28]
• Monitor trends in an agreed, limited set of indicators on cardiovascular and neurovascular health, with the frequency of data collection and analysis to be determined during implementation.[28]
• Evaluate each action implemented from 2023 to 2027 against predefined process and outcome criteria and indicators established by responsible working groups, undertaking additional studies where required.[29]
• Define indicators covering cardiovascular and cerebrovascular health, determinants, prevention and care, health-system governance, financing, workforce, infrastructure, equipment, service availability, accessibility and quality, and progress in implementing the plan.[25][26]
• Establish technical specifications, coding standards and quality controls for indicator data, including checks on data completeness and quality.[25][26][27]
• Map data on mortality, morbidity, care and determinants; identify data gaps and risks; assess source quality; and develop recommendations for missing or inadequate data collection and analysis.[24][31]
• Coordinate sustainable data collection and analysis through an organisational model that identifies responsible institutions, limits unnecessary data sources, considers common variables and draws on the Luxembourg National Data Service and National Health Observatory.[31][27]
• Produce targeted epidemiological reports presenting selected indicators and disseminate progress information to the public and relevant professionals through reports, websites, press articles and campaigns.[19][27]
• Integrate health inequalities into data collection and analysis through socioeconomic variables, health-literacy concepts or linked datasets consistent with the Findable, Accessible, Interoperable and Reusable principle.[7]
• Require the National Cardiovascular-Neurovascular Diseases Committee to review plan progress and forthcoming actions at each meeting, meet at least twice yearly, and review an annual activity report before its submission to the Minister of Health.[18]
• Evaluate specific interventions before scale-up, including the YOUNG50 screening pilot and the pilot salt-reduction initiative; use findings to adapt subsequent screening or population-level prevention actions.[13][8][15]
• Assess implementation barriers to scientific recommendations, workforce competency needs, task delegation, and the adequacy of equipment and infrastructure against clinical needs and recommended provision.[16][17][32]
• Support clinical and medico-economic evaluation of care pathways and competence networks, while increasing patient participation in care evaluation.[33]

The plan provides for data surveillance, indicator development and reporting, but does not specify the final indicator list, numerical indicator targets, data-collection frequency, detailed reporting schedule or a comprehensive accountability framework beyond committee oversight, annual reporting and external evaluations.[19][25][28][29]

Costing & Financing

Financing is to be led by the Directorate of Health, referred to as DISA in the supplied extracts, with annual budget forecasting and financial monitoring, but no overall monetary budget or costed action plan is provided.[29]

• Finance the national cardiovascular and neurovascular diseases plan through DISA, with the plan coordinator forecasting the budget needed for measures and actions each year and DISA undertaking financial monitoring.[29]
• Provide human, logistical and technical resources for plan coordination through the National Plans Coordination Service and the national plan coordinator.[18]
• Recognise that insufficient resources prevented implementation of the earlier 2020 plan.[2]
• Use occasional funding for targeted or pilot interventions to collect and analyse missing health data, while clarifying that the plan is not intended to permanently finance missing-data collection and analysis.[31]
• Consider financial and human-resource sustainability as a risk to continued health-data collection and analysis.[25]
• Explore shared financing between the Gesond Iessen Méi Bewegen framework and the national plan for nutrition-labelling activities.[12]
• Partly finance targeted professional training and examine whether financing arrangements can encourage appropriate use of scientific recommendations.[16][17]
• Finance a consultant to provide methodological support for establishing cardiovascular and neurovascular competence networks, and potentially fund methodological support for their evaluation.[9]
• Document domestic and international financing arrangements that may support or hinder professional coordination and integrated patient care.[33]
• Support the YOUNG50 pilot through a co-financing agreement between the Ministry of Health and the European Commission for three years from April 2019.[34]

The extracts identify broader resource pressures and possible fiscal incentives, including reduced value-added tax for healthy foods and tax advantages for companies creating health-supportive environments, but provide no fiscal estimates.[30]Non-communicable diseases were estimated by the European Commission to account for 80% of European Union health-system costs in 2017, while prevention accounted for an average 3% of national health budgets across the European Union.[35][7]No detailed allocations, funding gaps, cost estimates, currency-denominated budget, resource-mobilisation strategy or economic assumptions are specified.[29]