Stratégie Nationale Contre Les Maladies Cardio-Vasculaires, L'Attaque Cérébrale Et Le Diabète

Objectives

The National Strategy for Cardiovascular Diseases, Stroke and Diabetes 2017–2024 provides a common Swiss framework for reducing the burden, consequences and costs of heart disease, peripheral vascular disease, stroke and diabetes. It complements the National Strategy for the Prevention of Non-Communicable Diseases by linking prevention, early detection, patient-centred care, data, quality and financing across the four disease groups.[1][2][3]

• Reduce the incidence of cardiovascular disease, stroke and diabetes, associated complications and avoidable premature deaths.[4][5]
• Improve quality of life, social participation, autonomy and productive capacity for affected people, including those with chronic illness, multimorbidity and complex care needs.[4][6]
• Strengthen health promotion and prevention through healthier lifestyles, supportive living conditions, reduced tobacco use, balanced diets, physical activity, weight management and improved health literacy.[7][5]
• Promote early detection and evidence-based management of cardiovascular and diabetes risk factors, including hypertension, hyperglycaemia, high cholesterol, atrial fibrillation and other modifiable risks.[8][9]
• Provide high-quality, integrated and needs-based care throughout prevention, diagnosis, treatment, rehabilitation and palliative care, with patients and relatives at the centre.[6][10]
• Improve emergency care for myocardial infarction and stroke, including rapid referral to specialist stroke units or centres and timely reperfusion treatment.[11][12][13]
• Develop data infrastructure, disease registers, research, quality improvement and sustainable financing arrangements for prevention and care.[11][7][14]

Implementation

Implementation builds on existing Swiss health-system structures, uses a participatory and interdisciplinary model, and coordinates common actions across disease groups while assigning disease-specific priorities to relevant lead organisations. Measures are phased over the eight-year period according to available resources and are intended to complement related national strategies and avoid duplication.[11][15][16]

• Coordinate implementation through the Cardiovascular, Cerebrovascular and Diabetes Steering Committee, provisionally termed CP CCV&D, which oversees common measures, may establish thematic working groups and can delegate development of strategic areas.[16]
• Support networking and delivery through an integrated coordination body within CardioVasc Suisse, working with responsible and lead organisations on common and disease-specific actions.[16]
• Engage the Swiss Heart Foundation, Swiss Society of Cardiology, Union of Swiss Vascular Societies, Swiss Cerebrovascular Society, diabetes organisations, professional bodies, primary-care organisations, patient organisations, federal authorities, cantons, insurers and other partners.[17][1][18]
• Deliver measures through interprofessional and multidisciplinary groups, integrating medical and non-medical professionals, patients and carers, primary care, hospitals, rehabilitation providers, pharmacies, community organisations and public-health services.[19][10]
• Develop common objectives and measures through strategic tables covering cross-cutting priorities and the four disease groups: heart disease, peripheral vascular disease, stroke and diabetes.[11][15]
• Align actions with the national non-communicable diseases strategy and exploit interfaces with strategies on cancer, dementia, musculoskeletal diseases, addictions, rare diseases, nutrition and palliative care.[20][3]
• Use patient-centred care, shared decision-making, self-management, health literacy and support for relatives as operational principles across the care pathway.[6][10][21]
• Monitor implementation through a concept defining indicators, procedures and responsibility interfaces; provide periodic reports to the steering committee and responsible organisations; and use reassessment to adapt, revise or renew the strategy.[22][23]
• Mobilise financial and personnel resources through lead and responsible organisations, seek external support from the Confederation, cantons, insurers and industry where resources are insufficient, and prioritise measures according to available resources.[22][16]

Monitoring & Evaluation

The strategy establishes a monitoring, evaluation and accountability architecture centred on a future monitoring and evaluation concept, periodic implementation review, disease registers, quality controls and use of national non-communicable disease data.[22][14]

• Define indicators, procedures and responsibility interfaces through a monitoring and evaluation concept.[22]
• Monitor implementation and progress towards shared objectives periodically through the coordinating body, in agreement with disease-group leads for disease-specific measures.[22]
• Report monitoring results periodically to the steering committee and responsible organisations.[22]
• Reassess the strategy periodically using monitoring findings, exchanges with other strategies and developments in Switzerland and abroad; enable the steering committee to adapt, revise or renew the strategy.[23]
• Use concrete objectives and measures in the strategic tables as the common implementation framework, with periodic reporting on implementation progress.[24]
• Strengthen data generation, analysis and use, and develop research in priority areas.[25]
• Select relevant indicators from the national non-communicable disease monitoring system, identify further essential indicators for care, and develop and implement a monitoring concept.[14]
• Engage member organisations, professional societies, the Federal Office of Public Health, the Federal Statistical Office, the Swiss Health Observatory, the Swiss National Association for Quality and QualiCCare as potential monitoring and reporting contributors.[14]
• Establish and connect disease-specific registers, including a national diabetes register, a Stroke registry, cardiovascular registries and a national Swiss Vascular Database, to improve epidemiological data, care-quality assessment and outcome analysis.[26][27][28][29]
• Record every first stroke through systematic Stroke registry implementation, conduct follow-up after three months, and use registry data to monitor outcomes and treatment adherence.[27][30]
• Apply certification criteria, sanctions where necessary and rotating recertification as quality-control mechanisms for emergency and stroke units.[27]
• Define quality indicators and indicative figures for cardiology and cardiac-surgery procedures, and support evidence-based treatment through guidelines adapted for Switzerland where needed.[28]

Several parts of the strategy specify outcome-oriented ambitions, including reducing disease incidence, preventable cases, recurrent strokes, premature mortality, cardiac-arrest deaths, infarction complications and rehospitalisation.[5][31][32][12][33]However, the available text does not provide numeric targets, a comprehensive indicator set, standard reporting intervals or a full formal accountability framework.[14][27][26]

Costing & Financing

The strategy seeks more efficient use of resources, long-term financing for measures and action on financing gaps, but does not provide an overall implementation budget, costed workplan, quantified funding gap or economic model.[11][25][22]

• Improve pooling and efficiency of existing resources and prioritise measures according to available resources over the eight-year implementation period.[11][16]
• Address funding gaps and improve health-policy framework conditions as strategic priorities.[11]
• Secure long-term financing for strategy measures.[25]
• Require lead organisations to address the financial and personnel resources needed for assigned measures, with all organisations contributing within their means.[22]
• Seek additional external support jointly from the Confederation, cantons, insurers and industry when available resources are insufficient.[22]
• Consider affordability, use of existing resources, low-cost options and substantial savings potential when selecting priorities.[15]
• Establish cost coverage for priority services, including prevention and early detection, care coordination, delegated non-medical services, patient education and self-management.[34]
• Seek reimbursement for coordinated diabetes prevention and care across the continuum, and extend reimbursement indications for evidence-based lifestyle interventions and medicines for people with pre-diabetes.[26]
• Support federal participation in financing existing registers and use political lobbying and parliamentary interventions to secure coverage of priority services.[14][34]
• Mobilise necessary funds to merge the Swiss Vasc Database and the PTA registry, which is described as costly.[29]

Reported disease-cost evidence identifies annual costs of 10.3 billion Swiss francs for cardiovascular diseases, within 25.6 billion Swiss francs for the listed disease groups and a broader displayed total of 64.6 billion Swiss francs.[35]The source also identifies health-workforce shortages and pressure on resource use as implementation challenges.[35]The strategy-development project was financed by the responsible organisations, alongside substantial staff contributions.[18]