Start of a legislative process on early detection of CVDs and SHDs in Germany

For a considerable time period in German politics, the significance of early detection of cardiovascular diseases and, particularly, structural heart diseases remained rather marginal. However, at present, this issue is progressively gaining prominence. Thus, the prevention and early detection of cardiovascular diseases received increased attention in the course of the Bavarian state elections in October, from which the Christian Social Union in Bavaria (CSU) again emerged as the strongest force with 37% of the vote. In addition, the Federal Ministry of Health has launched a strategy on cardiovascular diseases, for which an Impulse Paper “Early detection and care of cardiovascular diseases”  has now been published. 

Almost all parties, especially the CSU in Bavaria, are committed to improved early detection and prevention of cardiovascular diseases. The previous Bavarian government had already launched several initiatives for the prevention of cardiovascular diseases, which are now to be continued. For example, in addition to the Federal Prevention Act, a separate prevention plan exists and the Bavarian Ministry of Health has launched a new campaign « Hand on Heart » to educate citizens about the risks of cardiovascular diseases. 

These measures could serve as a blueprint for the planned measures in the Impulse Paper.  It includes four concrete fields of action for improved early detection and prevention of cardiovascular diseases: 

  1. improving the early detection of children and adolescents 
  1. improving early detection in adults 
  1. strengthening disease management programmes (DMPs) 
  1. reduction of nicotine consumption 

The paper is indeed an important and very welcomed step towards improved nationwide prevention and early detection of CVDs and SHDs in Germany.  Most certainly the SHD Coalition’s efforts have been a significant contribution and served among others, as a basis for the Impulse Paper.  

Important demands of the SHD Coalition such as the establishment of a cardiac examination guideline, a « Check-up 50 », which includes a structured screening for risk factors and cardiometabolic diseases or the awareness raising about CVDs among the population as well as a stronger involvement of the statutory health insurance funds to improve the preventive infrastructure are now being implemented. 

However, it is to be noted that the Impulse Paper touches upon mostly primary prevention measures, like nicotine consumption reduction, healthy life-style and lipid score screenings. It is necessary to stress the importance of that secondary prevention/early detection and the age-related factors leading to cardiovascular disease, especially structural heart disease such as valvular heart disease, as these diseases mainly affects people over 65 years and cannot be prevented by primary prevention. In addition, asymptomatic patients cannot be detected and treated in time without comprehensive early detection. Therefore, improving early detection, especially for older people, is absolutely necessary.  

Furthermore, the Impulse Paper does not address digital health apps (DiGAs) that could support the treatment and early detection of CVDs and SHDs. The paper also does not include better cross-sectoral communication and treatment in outpatient and inpatient settings with a clear treatment pathway for all partners. Additionally, a legal mandate is needed to define truly cross-sectoral care and integrate it into existing structures. This corresponds to the demands of the EU SHD Coalition and must definitely be included in the Impulse paper. 

Nevertheless, the campaign in Bavaria and the Impulse Paper are good first steps to build on.