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Berlin Last week, the Healthy Heart Act was removed from the agenda due to a lack of agreement in the traffic light coalition. Tomorrow it is to be decided by the Federal Cabinet. Apparently there have been last-minute changes to the draft bill.

The project has so far been met with severe criticism from the specialist community, particularly with regard to the planned screening for familial hypercholesterolemia (FH) and the prescription of statins for children. The Federal Ministry of Health (BMG) had previously wanted to issue a legal regulation on this. Now the Federal Joint Committee (G-BA) could regulate this.

According to reports, the cabinet draft could give scientific findings and medical guidelines greater importance than before when it comes to the prevention of serious cardiovascular events such as heart attacks or strokes and the prescription of statins.

This would bring Federal Health Minister Karl Lauterbach (SPD) closer to the recommendations presented yesterday by the Institute for Quality and Efficiency in Health Care (IQWiG) on cascade-based screening.

Until now, children and young people were legally entitled to an examination for the early detection of a lipid metabolism disorder with a focus on familial hypercholesterolemia. To this end, health insurance companies should invite all children to the J1 examination. This could now be regulated differently in the cabinet draft.

The changes are likely to be welcomed by the parliamentary groups in the Bundestag. They had been very critical of parts of Lauterbach’s previous plans or had at least announced that they would examine the draft law in detail, as a survey by the German Medical Journal among the parliamentary groups in the Bundestag.

“Once the Healthy Heart Act has been passed by the cabinet, we will examine the draft law in detail in the parliamentary process and also discuss the question of examinations of children and young people again,” said Johannes Wagner (Greens), member of the Bundestag, when asked.

The current state of scientific research must be the basis for our political decisions, said the doctor. Even more than with adults, the benefits and risks of FH screening must be weighed up for children and adolescents, said Wagner. The possible psychological effects of the examination and a possible false-positive result must also be taken into account.

The IQWiG publication is undoubtedly interesting and must be part of the deliberations on the Healthy Heart Act, emphasized Nezahat Baradari (SPD), member of the Bundestag. In times of rising contributions, we are of course required to take a close look at the benefits of new services.

However, the basic idea of ​​the Healthy Heart Act is correct, as prevention in the German health system is verifiably average, said Baradari. New methods, such as lipid screenings for the early detection of familial hypercholesterolemia, are urgently needed to avoid piling up subsequent costs for the health system, said the specialist in pediatrics and adolescent medicine.

The FDP considers the intention of the Healthy Heart Act to be good and correct. In the coalition agreement, it was agreed to promote prevention. But we must also draw clear boundaries in the competence of the legislature, said Andrew Ullmann (FDP), member of the Bundestag, to the German Medical Journal.

According to Ullmann, the legal framework should not determine the medical measures in detail. We will let the professional and practical level and the independent profession of the doctor decide based on evidence wherever possible, he said.

The opposition clearly supports the IQWiG’s proposal to only examine children and young people whose family members have already had FH. Dietrich Monstadt (CDU/CSU), member of the Bundestag, criticizes the large-scale preventive measures still planned in the draft bill, which are to be prescribed as part of the Healthy Heart Act.

Prevention must be scientifically based and must not be replaced by a widespread, unreflective distribution of medication, he said. Instead of promoting personal responsibility and health literacy, Lauterbach is relying on state-imposed preventive measures, which in their current form are scientifically questionable and expensive.

If there is a family history, doctors usually order a cascade screening, as recommended by the IQWiG, Monstadt (CDU/CSU) told the German Medical Journal Without a family predisposition or other reasons, this examination is only expensive and unnecessary.

According to the Die Linke group, the IQWiG recommendation should be considered as the basis for political action. We will follow up on this issue during the parliamentary consultation and apply pressure to ensure that there is an improvement, said Kathrin Vogler (Die Linke) to the German Medical Journal.

Especially in preventive medicine, studies have shown a questionable benefit of screenings, said Vogler. Lauterbach’s waste of money is irresponsible for the insured in times of fierce budget disputes and rolling premium increases, she stressed.

The AfD believes that the goal of reducing the number of cardiovascular diseases and associated deaths and increasing life expectancy is worth supporting. With regard to preventive measures, too, the evidence of evidence, effectiveness and cost-effectiveness should not be replaced by state regulations, said Martin Sichert (AfD), member of the Bundestag. The IQWiG’s proposal is therefore fundamentally worth supporting.

The Healthy Heart Act is intended to strengthen the prevention of cardiovascular diseases in the population and reduce the number of cardiovascular diseases. Plans include invitations to check-ups for adults aged 25, 35 and 50, as well as preventive examinations for children and young people.

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 invitations to the check-ups should be accompanied by vouchers that can also be used in pharmacies for consultations and blood pressure measurements as well as measurements of risk factors for diabetes. © nfs/may/aerzteblatt.de