When it comes to average life expectancy, Germany is at the bottom of the league compared to other Western European countries. This is the result of a recent study by the Federal Institute for Population Research (BiB) and the Max Planck Institute for Demographic Research.
Statement by Prof Dr Holger Thiel, President of the German Society of Cardiology:
The German Society of Cardiology - Cardiovascular Research (DGK) welcomes the publication of this study and the new attention it brings to the topic. For years, the cardiological societies have been complaining about the shortcomings in health policy, the underfunding of the German Centre for Cardiovascular Research and the deficits in educating society about prevention and emergency measures, (early) self-diagnosis and the perception of health-promoting offers (see, among others, the position paper on the demand for a National Heart and Circulation Strategy, Autumn 2021).
On the initiative of the DGK, the National Heart Alliance (NHA) was founded, the most long-term action alliance in the history of German heart medicine. The DZHK is a member of the National Heart Alliance. The alliance brings together all the major cardiology societies in Germany and patient representatives to develop concepts for research funding, improved digitalisation of the healthcare system, prevention measures and networking between hospitals and general practitioners in order to make a lasting improvement in the situation of cardiac research and patient care in Germany.
With regard to the detailed reasons for the low life expectancy of Germans in international comparison, despite the financial advantages of the Federal Republic as the leading economy in Europe, we cite the following failings as examples:
Prevention and diagnosis
Prevention has yet to be sufficiently established as a priority in Germany. For example, less than 20% of patients at high risk of atherosclerosis in Germany achieve the desired targets for LDL cholesterol.
In addition, unlike other countries, early childhood screening for the relatively common hereditary condition familial hypercholesterolaemia (FH) is not established in Germany. Fewer than 5% of cases are detected, and those affected often suffer a heart attack at a young age due to vascular occlusion caused by unfavourable life circumstances. A simple, inexpensive blood test as part of the U9 to J1 check-up for young children could provide important information about the presence of FH and allow timely treatment of those affected.
It has been known for years that heart patients are six times more likely to have a heart attack if they are infected with influenza. Despite this, Germany has one of the lowest rates of influenza vaccination, especially among high-risk heart patients. Routine vaccination, for example in hospitals for patients with acute myocardial infarction, could prevent many deaths, as the IAMI study has shown.
For example, screening for arterial hypertension or hypercholesterolaemia is not established in Germany, unlike screening for colorectal cancer, prostate cancer or breast cancer. According to the latest survey by the German Federal Statistical Office, cardiovascular events will account for a third (33.3%) of all causes of death in Germany in 2021. In contrast, cancer will account for less than a quarter (22.4%). It should be added that the number of people needed to screen for arterial hypertension or hypercholesterolaemia is many times lower than for the above-mentioned cancers and can therefore be much more effective. We therefore advocate the inclusion of regular cardiac screening in primary health care from the age of 50.
Screening for heart failure also needs to be established in Germany. Approximately 4 million people in Germany suffer from heart failure, which is a widespread disease. Based on other studies, it can be assumed that for every recognised patient with heart failure, at least as many patients remain undiagnosed. As heart failure in particular can be better treated the earlier it is detected, those affected could live longer and enjoy a much better quality of life if they were diagnosed and treated in time.
Emergency measures
Compared with other European countries, Germany ranks in the bottom third in the willingness of the population to perform CPR on a stranger in an emergency. As in other countries, this rate could be significantly increased by making CPR training compulsory in schools.
In addition, the telephone-based instruction of laypersons in resuscitation by rescue coordination centres, which is recommended in the guidelines, is rarely used in Germany.
App-based alerts for first responders are also used in less than 5% of cases in Germany. Trained first responders in the vicinity could be directed to the patient by this software, where they could perform resuscitation and guide bystanders to gain vital time until the emergency services arrive.
Conclusion
If implemented nationwide, the exemplary measures mentioned here could massively increase the survival rate of sudden cardiac death in Germany. None of these measures are fundamentally new or utopian, but they have been successfully practised in other (European) countries for years. The National Heart Alliance is committed to establishing a master plan for cardiovascular health in Germany. In the future, there will be comprehensive and, above all, noticeably better diagnosis, prevention and patient education.