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Reducing the burden of Cardiovascular Disease in Indonesia: Evidence Review
report
posted on 2017-02-22, 00:00 authored by Clara Chow, Emily Atkins, Shariful IslamShariful Islam, Thomas Lung1. Indonesia has a population of 260 million and over 10% of the population live in poverty.
2. Cardiovascular disease (CVD) is responsible for 37% of deaths in Indonesia. Stroke is the leading cause, followed by coronary heart disease, and diabetes.
3. There are considerably more years of life lost due to premature mortality from stroke, coronary heart disease, and diabetes in Indonesia when compared with neighbouring regions.
4. Modifiable risk factors (high blood pressure, high cholesterol, diabetes, obesity, and tobacco) are the main contributing factors to the burden of cardiovascular disease in Indonesia. The trend of increasing levels of risk factors over time indicates CVD health burden in Indonesia is likely to increase further.
5. Population health surveys found:
65% of males smoke
Over a quarter of the population have high blood pressure
A third have high cholesterol and a third are overweight
8% of females have diabetes
6. Universal healthcare coverage will provide a comprehensive level of cardiovascular disease care for all Indonesians however, healthcare personnel and services for CVD are currently inadequate. In 2015-16 there was an estimated 3.8 neurologists, 0.4 endocrinologists and 1.5 cardiologists per 1,000,000 and there were only 30 stroke units across Indonesia, with the majority of specialists and specialist services provided in Jakarta.
7. Primary care has insufficient capacity to diagnose, monitor or manage cardiovascular diseases including diabetes. Strengthening primary care to manage CVDs through existing established community health centre networks is a potential way of addressing this.
8. Medications for primary and secondary prevention of CVD are made available under the Jaminan Kesehatan Nasional (JKN) however, issues with coordination between levels of government and inadequate staffing have led to inequalities with regards to availability and access to medicines across Indonesia.
9. Some studies have identified poor awareness, treatment and control of cardiovascular risk factors. Addressing these gaps could reduce and prevent cardiovascular disease. Over half of participants with high blood pressure were unaware of their diagnosis and untreated and over half of patients with diabetes were untreated.
10. There is evidence to suggest that patients present late in their disease course. A large percentage of the population are estimated to have undiagnosed diabetes and a first presentation with established diabetes, with secondary complications, is common.
11. Studies revealed that patients with ST elevation myocardial infarction (STEMI) presented late to hospital and many (~60%) did not receive reperfusion therapies with high (~13%) in-hospital mortality among these patients.
12. Focussing on prevention and treatment of risk factors in primary care and implementing protocols for acute stroke and heart attack management could be some practical strategies to address the burden of CVDs. Improving data collection for health service utilisation and deaths will help monitor strategies for reducing the cardiovascular disease burden and assist in directing resources where they are most needed.
2. Cardiovascular disease (CVD) is responsible for 37% of deaths in Indonesia. Stroke is the leading cause, followed by coronary heart disease, and diabetes.
3. There are considerably more years of life lost due to premature mortality from stroke, coronary heart disease, and diabetes in Indonesia when compared with neighbouring regions.
4. Modifiable risk factors (high blood pressure, high cholesterol, diabetes, obesity, and tobacco) are the main contributing factors to the burden of cardiovascular disease in Indonesia. The trend of increasing levels of risk factors over time indicates CVD health burden in Indonesia is likely to increase further.
5. Population health surveys found:
65% of males smoke
Over a quarter of the population have high blood pressure
A third have high cholesterol and a third are overweight
8% of females have diabetes
6. Universal healthcare coverage will provide a comprehensive level of cardiovascular disease care for all Indonesians however, healthcare personnel and services for CVD are currently inadequate. In 2015-16 there was an estimated 3.8 neurologists, 0.4 endocrinologists and 1.5 cardiologists per 1,000,000 and there were only 30 stroke units across Indonesia, with the majority of specialists and specialist services provided in Jakarta.
7. Primary care has insufficient capacity to diagnose, monitor or manage cardiovascular diseases including diabetes. Strengthening primary care to manage CVDs through existing established community health centre networks is a potential way of addressing this.
8. Medications for primary and secondary prevention of CVD are made available under the Jaminan Kesehatan Nasional (JKN) however, issues with coordination between levels of government and inadequate staffing have led to inequalities with regards to availability and access to medicines across Indonesia.
9. Some studies have identified poor awareness, treatment and control of cardiovascular risk factors. Addressing these gaps could reduce and prevent cardiovascular disease. Over half of participants with high blood pressure were unaware of their diagnosis and untreated and over half of patients with diabetes were untreated.
10. There is evidence to suggest that patients present late in their disease course. A large percentage of the population are estimated to have undiagnosed diabetes and a first presentation with established diabetes, with secondary complications, is common.
11. Studies revealed that patients with ST elevation myocardial infarction (STEMI) presented late to hospital and many (~60%) did not receive reperfusion therapies with high (~13%) in-hospital mortality among these patients.
12. Focussing on prevention and treatment of risk factors in primary care and implementing protocols for acute stroke and heart attack management could be some practical strategies to address the burden of CVDs. Improving data collection for health service utilisation and deaths will help monitor strategies for reducing the cardiovascular disease burden and assist in directing resources where they are most needed.
