Plan National Maladies Cardio-Neuro-Vasculaires 2020-2024

Objectives

Luxembourg’s National Plan for Cardiovascular and Neurovascular Diseases 2020–2024 provides a national framework to reduce morbidity and mortality from cardiovascular, cerebrovascular and neurovascular diseases, including stroke, while complementing existing action on tobacco, nutrition, physical activity, cancer and competence networks.[1][2]It addresses cardiovascular and cerebrovascular conditions, diabetes and their shared modifiable determinants within the broader response to non-communicable diseases.[3][4]

• Establish sustainable, simple and transparent governance for the plan.[2][5]
• Coordinate the collection and analysis of health data on mortality, morbidity, care, disease determinants and inequalities.[2][6]
• Strengthen primary prevention by reducing exposure to tobacco, harmful alcohol use, unhealthy diet, excess salt intake, physical inactivity, obesity, hypertension, stress and other modifiable risk factors.[7][4][8]
• Promote screening and early identification of cardiovascular and neurovascular diseases and risk factors, enabling secondary prevention, treatment and rehabilitation.[3][9]
• Improve patient care pathways, professional coordination, evidence-based practice, competencies, equipment and infrastructure.[2][10][11]

The plan comprises 24 measures and 82 actions across five thematic axes: governance and supervision, health data, prevention, screening, and patient care pathways.[1][12]Three cross-cutting objectives apply across implementation: reduce health inequalities, use innovative interventions where appropriate, and strengthen evidence-based medicine.[1][12]

Its prevention framework spans primary prevention to prevent disease onset, secondary prevention to detect and address disease early, and tertiary prevention to limit consequences, relapse and chronicity through appropriate treatment and rehabilitation.[3]The plan aligns with World Health Organization voluntary targets, including a 25% relative reduction in premature cardiovascular disease and diabetes mortality risk and hypertension prevalence, a 30% reduction in salt intake, a 10% reduction in physical inactivity, and halting rises in diabetes and obesity prevalence.[2]

Prevention priorities include improving understanding of nutrition labelling, assessing and reducing salt consumption, providing tailored diet and physical-activity advice, and creating environments that support healthier behaviour in municipalities, workplaces, schools and integrated centres for older people.[13][14]The plan also seeks to improve patient information, shared decision-making, therapeutic education, rehabilitation, socio-professional reintegration, patient participation in care evaluation and public recognition of cardio-neurovascular symptoms.[15][16]

Implementation

Implementation is led by the Directorate of Health and a coordination unit established within it, under the authority of the Director of Health.[17][5]The delivery model combines central coordination, expert advice, thematic working groups, collaboration across health and non-health sectors, and integrated care pathways connecting hospital and non-hospital providers.[3][18][19]

• Establish a coordination unit with adequate human, logistical and technical resources to lead delivery and oversee plan activities.[5]
• Convene an expert committee to advise on scientific and technical matters, working-group outputs and the annual activity report; members are appointed by the Minister of Health following Directorate of Health proposals, and international experts may be invited.[18]
• Deploy working groups for data, prevention, screening and care pathways, assigning measures and actions and maintaining regular follow-up.[1][18]
• Report progress to the expert committee at least twice yearly and submit an annual activity report to the Minister of Health following committee review.[18]
• Communicate progress to the public and relevant professionals through innovative channels, including websites, press articles and dedicated campaigns.[18][6]

For the data axis, implementation involves mapping organisations and sources holding relevant information, assessing data quality and collection risks, defining a concise and robust indicator set, identifying missing data, and recommending methods to collect and analyse it.[6][20]The plan envisages an organisational model that clarifies institutional responsibilities, limits unnecessary duplication, supports common variables and may be sustained through collaborative processes or regulatory and legislative change.[21]It also proposes a national information system to centralise data for the selected indicators and explores digital sources, the Shared Care Record and hospital patient records, while protecting the feasibility of clinical work.[21][22]

Prevention delivery is to be coordinated with existing national programmes on nutrition, physical activity and tobacco control, with links to action on alcohol misuse and stress.[8]Operational measures include public and professional education on nutrition information, a baseline assessment of dietary salt and food salt content, a salt-reduction pilot with possible wider deployment if effective, workplace health measures, municipal engagement, digital prevention tools and evidence-informed pilot studies.[13][14][23]Potential fiscal incentives, such as reduced value-added tax on healthier products and incentives for health-supportive workplaces, are identified for consideration but are not costed.[23]

Screening implementation centres on YOUNG50, a three-year pilot co-financed by the European Commission that adapts a cardiovascular risk-factor screening programme previously tested in Italy.[3][9]Preparatory work includes reviewing evidence and international experience, assessing stakeholder acceptability and feasibility, defining the target group and delivery components, identifying responsible actors, organising follow-up prevention programmes, preparing evaluation and considering long-term financing.[9][24]General practitioners, pharmacists, primary-care providers, research organisations, paramedical professions and follow-up services are envisaged as contributors.[9][25]

Care-pathway actions seek to use competence networks and the coordination tools associated with the Hospital Law of 8 March 2018 to organise patient journeys across services.[3][19]They include assessing and embedding scientific recommendations, training professionals, considering task delegation, mapping defibrillators, rehabilitation capacity and other infrastructure, supporting pathways for heart failure and cardiac arrest, and strengthening information-sharing through the referring doctor arrangement and Shared Care Record.[10][26][27]

Evaluation combines external reviews in 2022 and 2024, trend observation using selected indicators, and assessment of implementation processes and action effects.[17][28]External experts are to assess governance, the relevance of measures against international evidence, monitoring resources, and the number and scope of actions delivered; findings are to inform recommendations and potential development of a subsequent national plan.[28]The plan does not specify an overall budget or quantified allocations, although it identifies resource needs for coordination, possible one-off data-financing interventions, European Commission co-financing for YOUNG50, and partial support for selected professional training.[5][21][9][26]

Monitoring & Evaluation

The plan establishes a multi-level monitoring and evaluation approach combining implementation review, data and indicator development, routine reporting, action-level assessment and external review. It prioritises a restricted, robust indicator set and targeted epidemiological reporting, while several operational details, including final baselines and collection frequency, are to be determined during implementation.[17][5][20][28]

• Develop and maintain a concise set of relevant, reliable and robust indicators on cardiovascular and cerebrovascular health and its determinants, supported by technical specifications, indicator sheets and quality control for collection and analysis.[5][20]
• Map existing data on mortality, morbidity, care and risk determinants; identify data owners, assess data quality and collection risks, compare available information with the agreed indicator list, and recommend approaches for addressing missing or poor-quality data.[6][20][21]
• Coordinate institutions collecting and analysing health data through an organisational model that assigns responsibilities, limits data sources where feasible, uses common variables and may be supported by regulatory or legislative change.[5][21]
• Develop a national information system to centralise collection and processing of the selected indicator data, while exploring feasible contributions from digital tools, the Shared Care Record, hospital records and other potential sources.[21][22]
• Record indicator-data completeness and coding quality, incorporate variables relevant to social inequalities, and assess the feasibility and value of innovative data-collection and analysis methods.[22][8]
• Produce and disseminate a targeted epidemiological report on the selected indicators to the public and relevant health professionals. The feasibility of producing this report every two years is to be considered, and regular production is expected to be needed.[22]
• Inform the public and relevant professionals about implementation progress through channels including websites, press articles and dedicated campaigns, and issue a formal progress report every two years.[18][6][29]
• Require the coordination unit to present progress and the forthcoming agenda to the expert committee, which meets at least twice yearly, and prepare an annual short activity report for the Minister of Health following expert-committee review.[18]
• Review implementation through foreign-expert evaluations in 2022 and 2024, examining governance, the relevance of measures against international literature, resources assigned to monitoring, and the number and scope of implemented actions.[17][28]
• Assess both implementation processes and the effects of individual measures and actions, using external synthesis reports with recommendations to support any reorientation and inform a possible subsequent national plan.[17][28]
• Use repeated measurement of the same consensus-based indicators to provide snapshots of cardiovascular health over time; the collection and analysis interval will be decided during implementation, with a possible two-year frequency.[28]
• Evaluate prevention interventions, including the salt-reduction pilot and digital or other innovative behaviour-change pilots, before wider deployment of effective measures.[13][23][30]
• Evaluate the YOUNG50 screening pilot for feasibility, acceptability, recruitment of vulnerable people, effectiveness, efficiency and sustainability, using defined screening measures and potentially healthcare billing data.[9][24][25]
• Assess professionals’ use of scientific recommendations, training and competency needs, task-delegation feasibility, and the adequacy of equipment and infrastructure against recommended provision.[10][26][11]
• Evaluate care pathways and competence networks with methodological and medico-economic support, while increasing patient participation in the evaluation of care.[31][27][16]

Costing & Financing

No total budget, costed implementation plan, monetary allocation, funding gap or formal resource-mobilisation strategy is specified in the supplied material. Financing is instead described through selected co-financing, potential pooled or one-off support, partial training finance, evaluation support and possible fiscal incentives.[1][17][2][12]

• Provide adequate human, logistical and technical resources for the coordination unit within the Directorate of Health, although no monetary amount or funding source is identified.[5]
• Recognise that sustained data collection and analysis may face financial and human-resource risks. The plan is not intended to provide permanent financing for missing health-data collection and analysis, but may provide one-off financing for interventions addressing these gaps.[20][21]
• Support prevention financing by pooling funds for nutrition-labelling work with the national nutrition and physical-activity plan where appropriate.[8][13]
• Note the European Commission estimate that non-communicable diseases accounted for 80% of European Union health-system costs in 2017, framing prevention and control as important to health-system economic sustainability.[4]
• Note that prevention represented an average 3% of national health budgets in the European Union in 2017, indicating potential scope for greater preventive investment in Luxembourg.[8]
• Co-finance the three-year YOUNG50 screening pilot with the European Commission, while preparing project financing, considering financing for participating general practitioners and downstream prevention programmes, and examining long-term financial sustainability.[3][9][24][25]
• Consider fiscal incentives for prevention, including reduced value-added tax on healthier food products and tax advantages for companies creating health-supportive environments, without monetary estimates.[23]
• Partly finance professional training after competency needs have been identified, and explore whether financing arrangements can encourage appropriate use of scientific recommendations.[10][26][11]
• Finance a consultant to provide methodological support for developing competency networks and consider appropriate financing for methodological and medico-economic evaluation of care pathways and networks.[27]
• Document financing arrangements affecting professional integration and coordinated care, including potentially beneficial alternative systems used abroad, but without specifying a preferred model or costs.[27]