Plan National Maladies Cardio-Neuro-Vasculaires 2023-2027

Objectives

Luxembourg’s National Plan for Cardio-Neuro-Vascular Diseases 2023–2027 seeks to reduce morbidity and mortality from cardiovascular, cerebrovascular, neurological and vascular diseases, which were the country’s second leading cause of death in 2021.[1][2]It frames these conditions within the wider burden of non-communicable diseases and complements existing national measures on healthy eating, physical activity, tobacco control, cancer and hospital competence networks.[3][4]

• Establish sustainable governance for coordinated national action on cardio-neuro-vascular health.[2][5]
• Coordinate the collection, analysis and use of reliable data on disease determinants, mortality, morbidity, care pathways and health-system performance.[6][7]
• Strengthen primary prevention by reducing exposure to modifiable risks, including tobacco use, alcohol misuse, unhealthy diet, physical inactivity, hypertension, obesity and diabetes.[1][3][8]
• Promote early diagnosis and screening for cardio-neuro-vascular diseases and their risk factors, supporting secondary prevention and treatment.[9][10]
• Improve coordinated, equitable and evidence-based care pathways, including rehabilitation and support following acute events.[9][11]

The plan contains 19 measures and 58 actions across these five areas for implementation between 2023 and 2027.[2]Its cross-cutting objectives are to reduce social, geographical and cultural health inequalities, incorporate innovation, and strengthen evidence-based medicine.[9]

Prevention priorities include improving nutrition literacy and food-labelling understanding, assessing and reducing salt consumption, adapting lifestyle recommendations on diet, physical activity, sleep and stress, and creating healthier environments in municipalities, workplaces, schools and settings for older people.[12][13][14]The plan also seeks to increase awareness of cardio-neuro-vascular symptoms through public information and education campaigns.[11][15]

The strategic direction aligns with World Health Organization voluntary targets, including relative reductions in premature cardiovascular and diabetes mortality and hypertension, lower population salt intake and physical inactivity, and stabilisation of diabetes and obesity prevalence.[5]The supplied material does not provide Luxembourg-specific baselines or formal national numerical targets for these outcome areas.[5][16]

Implementation

Implementation is led by the Directorate of Health and its National Plans Coordination Service, with a designated plan coordinator responsible for steering measures and actions.[2][17]Governance combines a National Committee for Cardio-Neuro-Vascular Diseases, thematic working groups, a steering committee and the National Plans Monitoring Committee.[18][17][19]The plan was updated in 2023 following delayed earlier implementation during the COVID-19 crisis, when human-resource constraints prevented delivery.[1][2]

• Appoint National Committee members through the Minister responsible for Health, on proposals from the Directorate of Health, to provide scientific and technical advice on implementation, working-group outputs and annual reporting.[19][16]
• Assign measures and actions to working groups on data, prevention, screening and care pathways, with membership developed alongside the National Committee and progress followed regularly.[19][6]
• Coordinate delivery with stakeholders including the Luxembourg Institute of Health, National Health Insurance Fund, professional organisations, hospitals, nursing and patient associations, emergency services and sports-health bodies.[20][21][22]
• Provide public and professional communication through websites, press coverage, campaigns and regular progress reports.[6][23]

The data approach begins with an inventory of available sources and an assessment of their nature, quality, completeness, legal and information-sharing constraints, duplication, and financial and human-resource sustainability.[6][24]It envisages a limited, robust indicator set covering risk factors, disease prevalence and incidence, mortality, morbidity, healthcare provision and implementation progress.[24][7]Technical specifications and quality-control arrangements are to support comparable data collection and analysis.[24][7]

Data governance is intended to identify responsible institutions, use common variables where possible, draw on the Luxembourg National Data Service and National Health Observatory, and develop collaborative organisational arrangements that may require regulatory or legislative change.[25]Innovative sources and tools, including digital tools, shared care records, hospital records and the YOUNG50 pilot, may be considered where feasible and without imposing excessive demands on health professionals.[26]The plan may support targeted one-off data pilots but is not intended to provide permanent financing for collecting and analysing missing health data.[25]

Prevention delivery is to be coordinated with existing national programmes, notably the Gesond Iessen Méi Bewegen framework plan and the tobacco-control plan.[8]Nutrition-labelling work involves food-safety partners, including the Luxembourg Veterinary and Food Administration, while salt-reduction action starts with assessments of population intake and salt content in foods before piloting, evaluating and potentially extending interventions.[12]Workplace, municipal and environmental partners are expected to help create conditions that support physical activity and healthier behaviour.[14]

For screening, the Directorate of Health and Luxembourg Institute of Health are to complete and evaluate the European Commission co-financed YOUNG50 pilot, then adapt or develop screening offers with additional partners and tools.[10][27]Potential delivery partners include pharmacists, occupational and school health services, nurses, dietitians, physiotherapists, social-support organisations and other actors able to reach underserved groups.[27]

Care-pathway implementation builds on competence networks and aims to improve coordination between hospital and non-hospital providers.[28][29]It includes reviewing the use of scientific recommendations, strengthening professional competencies, considering task delegation, mapping equipment and infrastructure, supporting digital health and telemedicine, and developing pathways or networks for stroke, heart failure and cardiac arrest.[30][31][32]Patient associations are to support shared decision-making, therapeutic education, care evaluation, rehabilitation and socio-professional reintegration.[33][15]

Evaluation combines independent expert reviews at mid-term and at the end of the plan, repeated observation of selected indicators, and process and outcome assessment for each action.[2][15][16]Each action is expected to have predefined criteria and indicators before implementation, while the coordinator prepares an annual activity report for review and submission to the Minister responsible for Health.[19][16]Financing is to be provided by the Directorate of Health, which will forecast annual implementation needs and undertake financial monitoring, but the supplied material gives no numerical budget, allocations or funding gap.[34]

Monitoring & Evaluation

The monitoring and evaluation framework combines plan-level external review, repeated health indicators, action-level assessment, routine reporting and strengthened health-data governance. It is intended to assess implementation of the 2023–2027 National Plan for Cardio-Neuro-Vascular Diseases, population health trends, and the processes and effects of individual actions.[2][15][16]

• Conduct independent external evaluations at mid-term and at the end of the plan period. The mid-term review is to examine governance, the relevance of measures and actions in light of international literature, resources allocated to monitoring, and the number and scope of actions deployed; it may recommend reorientation.[2][15]
• Use the final external evaluation to assess delivery over the full 2023–2027 period and inform preparation of a possible subsequent national plan.[2][15][16]
• Observe trends through a limited, relevant, reliable and robust set of indicators covering cardio-neurovascular health, determinants, healthcare provision and plan implementation.[24][7][23]
• Select population-burden indicators on risk factors, prevalence and incidence of selected conditions, mortality and morbidity, and assess health-system performance through indicators on governance, financing, workforce, infrastructure, equipment, availability, accessibility and quality of prevention and treatment.[7]
• Agree the indicator set among Luxembourg stakeholders concerned with health data, repeat measurements over time, and determine collection and analysis frequency during implementation. Attribution of observed health trends to the plan is to be clarified and discussed.[16]
• Define technical specifications for indicators, establish quality control for the collection and analysis of underlying data, document data quality and completeness, and compare the available-data inventory with the indicator list to identify gaps.[24][7][35]
• Produce synthesis documents on indicator definition, specifications and quality control, and prepare a concise epidemiological report on the selected indicators for dissemination to the public and relevant health professionals.[24][7][26]
• Assess existing data on mortality, morbidity, care pathways and disease determinants by identifying sources, data types, quality problems, collection and analysis risks, and gaps in availability or reliability.[6][23]
• Use the data working group to examine legal, consent, information-sharing, duplication, financial and human-resource sustainability issues affecting data collection and analysis.[24]
• Evaluate the feasibility and relevance of innovative data approaches, including digital tools, shared care records, hospital records and new actors, while considering workload for health professionals and the measurement of health inequalities through socioeconomic and health-literacy variables.[25][26]
• Require relevant working groups to set process and outcome criteria and indicators for each action before implementation, with further outcome studies where necessary.[16]
• Evaluate specific interventions before wider rollout, including the YOUNG50 cardiovascular-risk screening pilot, salt-reduction pilots, behaviour-change interventions, innovative screening pilots, care pathways and competence networks.[12][10][27][32][36]
• Use medico-economic evaluation as part of methodological support for assessing multidisciplinary care pathways and competence networks.[32][36]
• Maintain oversight through the National Plans Monitoring Committee, the National Committee for Cardio-Neuro-Vascular Diseases and the plan coordinator within the Directorate of Health’s National Plans Coordination Service.[17][19][16]
• Present implementation progress and forthcoming actions at National Committee meetings, hold Committee meetings at least twice yearly, and submit an annual report on completed work to the Minister responsible for Health following Committee review.[19]
• Communicate progress regularly to the public and relevant professionals through reports, websites, press articles and dedicated campaigns.[6][23]

Individual numerical baselines, final indicator targets, reporting templates and a fixed surveillance frequency are not fully specified in the supplied extracts, although the plan adopts World Health Organization target areas for premature cardiovascular and diabetes mortality, hypertension, diabetes, obesity, salt intake, smoking and physical inactivity.[37][5][16]

Costing & Financing

The plan identifies financing and resource requirements, but the supplied extracts provide no overall monetary budget, quantified allocation, funding gap, unit cost or economic model for the 2023–2027 programme. Financing is to be provided by the Directorate of Health, referred to in the source as DISA, with annual budget forecasting and financial monitoring undertaken within that authority.[34]

• Provide adequate human, logistical and technical resources for plan coordination, including a coordinator within the National Plans Coordination Service.[17][11][23]
• Recognise that insufficient resources prevented implementation of the earlier national plan after the 2020 COVID-19 crisis, providing context for the 2023 update.[2][18]
• Examine resources allocated to monitoring as part of the mid-term external evaluation.[15]
• Do not treat the plan as a source of permanent financing for collection and analysis of missing health data; it may instead provide one-off funding for targeted pilot data interventions.[25]
• Identify financial and human-resource sustainability issues affecting health-data collection and analysis.[24]
• Consider joint financing between the Gesond Iessen Méi Bewegen framework plan and the cardio-neurovascular plan for activities improving understanding of nutrition labelling.[12]
• Use European Commission co-financing for the YOUNG50 pilot, for which a three-year grant agreement was signed in April 2019.[38][10]
• Consider fiscal measures, including a reduced value-added tax rate for food products considered healthy and tax advantages for businesses creating health-supportive environments; the extracts do not confirm adoption or quantify their fiscal effect.[10]
• Part-finance professional training to address identified competency needs and explore how financing arrangements may support appropriate use of scientific recommendations.[31][36]
• Finance a consultant to provide methodological support for establishing competence networks where statutory networks do not exist, particularly for heart failure and cardiac arrest, and consider financing support for their evaluation.[32][33]
• Document financial factors that may facilitate or hinder integration of professionals, care pathways and competence networks, and examine alternative financing approaches used abroad.[32][33][15]

Economic context includes the estimate that non-communicable diseases accounted for 80% of health-system costs across the European Union in 2017 and that average European Union national health spending on prevention was 3% in 2017. These figures provide contextual rationale for prevention investment rather than a Luxembourg plan budget or confirmed allocation.[3][8]