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Berlin With the Healthy Heart Act, the Federal Ministry of Health (BMG) wants to combat cardiovascular diseases and is prepared to accept a major conflict with the self-administration. According to the draft bill, which was submitted to the German Medical Journal The planned preventive examinations for children and young people, as well as the check-ups at 25, 35 and 50, are to be accompanied by questionnaires developed by the Federal Ministry of Health itself. A legal regulation is planned for each of these.

To date, the Federal Joint Committee (G-BA) has been responsible for developing anamnesis questionnaires. The BMG also wants to set guidelines for the remuneration of these new examinations – a task that would otherwise be carried out by the Extended Assessment Committee made up of the National Association of Statutory Health Insurance Physicians (KBV), health insurance companies and impartial members.

Increase prescription of statins

In addition, the law states that the prescription of statins should be significantly expanded, contrary to previous guidelines. Both the guidelines of the German Society for Cardiology (DGK) and the guidelines of the German Society for General Medicine (DEGAM) provide for statin therapy depending on the risk of a cardiovascular event and LDL cholesterol level. People with familial hypercholesterolemia are already considered high-risk patients, so drug therapy is recommended even for lower cholesterol levels. Doctors should now be able to prescribe statins earlier in cases of familial hypercholesterolemia. The draft law does not yet provide any more precise information on limit values.

Health insurance companies should regularly invite children and young people aged between 12 and 14 to the J1 examination. There should also be preventive discussions on the subject of smoking and information on HPV vaccination. This should increase the low participation rates in the J1 examination.

The new law also aims to close the gap in early childhood examinations: although the current guideline provides for the collection of family history in the U1-3 examinations, it is not included in the J1 examination and explicit questions for the identification of sudden cardiac death are missing.

However, the G-BA guideline for youth examinations already provides for a differentiated medical history and a clinical physical examination, which most doctors will also include the family history. However, a standardized questionnaire for recording cardiovascular risk has not yet been included in the G-BA guideline.

Vouchers for check-ups

The health insurance companies should also send out invitations for check-ups for 25-, 35- and 50-year-olds. Vouchers should be enclosed with these, which can be used to obtain consultations and blood pressure measurements as well as measurements of risk factors for diabetes in pharmacies. The standardized questionnaires and parameters for the laboratory tests should also be regulated by law, not by self-administration as has been the case up to now.

The law also includes an expansion of drug therapy for smoking cessation: in future, the insured person’s entitlement will no longer only be financed in cases of severe tobacco addiction, but also more frequently than every three years.

The law has sparked significant criticism among health insurance companies and doctors. The draft bill for the Healthy Heart Act could also be called the Pills Instead of Prevention Act, explains Carola Reimann, Chairwoman of the AOK Federal Association. The broad use of screenings and statins in children and young people, as envisaged in the bill, is going in completely the wrong direction.

Statins are not smarties, such decisions should be made on the basis of scientific evidence via the established evaluation methods of the Federal Joint Committee, Reimann continued. It is a problematic narrowing of perspective when lifestyle issues are shifted to medicine and children are turned into chronically ill patients.

The federal chairmen of the Association of General Practitioners (HV), Nicola Buhlinger-Gpfarth and Markus Beier, stressed that the health system urgently needs to catch up when it comes to preventing cardiovascular diseases and their consequences. However, the Healthy Heart Act is the wrong approach.

We are clearly against more and more tests and the administration of medication using the watering can principle. The principle applied here, “more is better”, is more than questionable from a medical point of view, particularly because the evidence is very thin, say Buhlinger-Gpfarth and Beier. Particularly with the very young, comprehensive screenings, which could result in lifelong medication, should be used with extreme caution and always based on evidence.

Intervention in medical practice

A targeted use of statins is sensible and important, but this is always an individual decision between the doctor and the patient. It is therefore very strange how detailed the legislature wants to intervene in concrete medical actions.

The plans announced by Federal Health Minister Lauterbach certainly contain positive approaches, but a truly consistent implementation of the prevention concept is lacking, criticized Andreas Gassen, Chairman of the Board of the National Association of Statutory Health Insurance Physicians (KBV).

It has to start with campaigns in schools so that children learn to live a heart-healthy life. Because they are the heart patients of tomorrow, says Gassen. © bee/mim/aerzteblatt.de