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Luksemburška deklaracija (29. junij 2005)
)+%9HFFJ=
Evropska listina
za zdravje srca
&)2(,%"#-,+
J<)%.)+HFFK
Pomen in vpliv bolezni srca in žilja v
Evropi
•  v razvitem svetu so BSŽ “morilec” N°1
•  BSŽ so odgovorne za skoraj polovico vseh smrti v Evropi
•  vsako leto povzročijo 4.35 miljonov smrti v 53 državah članicah
Svetovne zdravstvene organizacije – regija Evropa
•  v EU (25) povzročijo vsako leto več kot 1.9 miljonov smrti
•  BSŽ stanejo ekonomijo EU 169 milijard Evrov letno
•  v Evropi so BSŽ odgovorne za 55% vseh smrti pri ženskah in 43% vseh
smrti pri moških, kar pomeni, da pomorijo bistveno več ljudi kot vse
vrste raka skupaj
www.heartcharter.eu
w
ww.h
hear tchar te
er.eu
7
Mednarodni politično-javnozdravstveni
kontekst
•  konferenca “Winning Hearts”, Bruselj, 14.februarja 2000 – sprejeta
deklaracija “Valentina”
•  špansko predsedstvo, 2002 – Svet EU 26. junija sprejme »Informacijo
o srčno-žilnem zdravju v državah EU«
•  2003 – 22. decembra Svet EU sprejme “Zaključke o zdravem
življenjskem slogu”
•  irsko predsedstvo – februarja 2004 v Corku konferenca »Promoting
Heart Health, A European Consensus« - sprejeta deklaracija
•  29. junija 2005 svet ministrov sprejme “Luksemburško deklaracijo”
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8
Zaveza…
"Every child born in the new millennium has the
right to live until the age of at least 65 without
suffering from avoidable cardiovascular
disease."
Valentine’s declaration from the
Winning Heart Conference of 14 February 2000
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21
nacionalne politike, strategije in akcijski programi v
zvezi z ogroženostjo za srčno-žilne bolezni ter
obravnavo obolelih
PRIMARNA PREVENTIVA
zdravstve
na vzgoja
SEKUNDARNA PREVENTIVA
izboljševanje kakovosti življenja prebivalstva,
kazalnikov kakovosti zdravstvene oskrbe obolelih ter
zmanjševanje umrljivosti zaradi bolezni srca in žilja
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23
AMBULANTNA OBRAVNAVA
BOLNIŠNIČNA
OBRAVNAVA
Vrednotenje
podatkov
Identifikacija bolnika
- prenehanje kajenja in preprečevanje
relapsa
- izhodiščna ocena telesne
zmogljivosti in stanja telesne
aktivnosti
- napotitev v ambulantno obravnavo
- anamneza
- ocena dejavnikov tveganja
- obremenitveno testiranje
- poklicno svetovanje
Določitev
dolgoročnih
ciljev
Predpisovanje
telesne
dejavnosti
Spreminjanje
dejavnikov
tveganja
- glede telesne dejavnosti
- poklicnega dela
- psiholoških dejavnikov
- kliničnih značilnosti
- aerobna vadba
- rezistenčna vadba
- program vadbe v
ustanovi / doma
- izobraževanje o DT
- prehransko svetovanje
- telesna dejavnost
- zdravila
Register bolnikov z boleznimi srca in žilja
Register oseb, ki jih ogrožajo kardiovaskularne bolezni
'$& H8 %"*20(& ./&(8 ./"!4&!"+&% (2&4+,02& 4 ,(4&/3 ./"!)$+&% /"$&'0(&% "+2/,4 8 &84'+'" *3)+2+"
/"%&)&2&'"&+"),02+"0"(3+!/+"./"4"+2&4"0/ +,G9&)+&%,)"8+&4),4"+&'&A
Nacionalna strokovna
delovna skupina za
širše področje
preventive kroničnih
Register oseb, ki jih
ogrožajo kardiovaskularne bolezni
Register bolnikov z
boleznimi srca in
žilja
REGIJSKI CENTRI
Nacionalna strokovna delovna
skupina za preventivo in
rehabilitacijo srčno-žilnih
bolezni
za preventivno kardiologijo in
rehabilitacijo bolezni srca in žilja
NACIONALNI CENTER
ZA PREVENTIVNO
KARDIOLOGIJO IN SRČNOŽILNO REHABILITACIJO
(implementacija smernic,
koordinacija izvajanja programa,
registracija, upravljanje kakovosti,
konzultacije)
koordinacija (nacionalni
eksperti)
- izobraževanje
mednarodno znanstveno in
strokovno sodelovanje
(ESC, WHF, NHBLI, WHO...)
sodelovanje z
nevladnimi
organizacijami
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*celokupna absolutna srčno-žilna
ogroženost:
- za usodne srčno-žilne dogodke
(SCORE), oz.
- vse koronarne dogodke
(Framingham)
izmerjena vrednost holesterola LDL
<1.8 mmol/l
1.8 – 2.5 mmol/l
2.5 – 4.0 mmol/l
4.0 – 4.9 mmol/l
>4.9 mmol/l
brez intervencije
brez intervencije
spremembe življenjskega sloga
spremembe življenjskega sloga
spremembe življenjskega sloga, v
primeru nedoseganja ciljnih
vrednosti razmislek o zdravilih
spremembe življenjskega sloga
spremembe življenjskega sloga
spremembe življenjskega sloga, v
primeru nedoseganja ciljnih
vrednosti razmislek o zdravilih
spremembe življenjskega sloga, v
primeru nedoseganja ciljnih
vrednosti razmislek o zdravilih
spremembe življenjskega sloga, v
primeru nedoseganja ciljnih
vrednosti razmislek o zdravilih
spremembe življenjskega sloga,
razmislek o zdravilih
spremembe življenjskega sloga,
razmislek o zdravilih
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
spremembe življenjskega sloga,
razmislek o zdravilih
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
spremembe življenjskega sloga in
takojšnje zdravljenje z zdravili
MAJHNA OGROŽENOST
SCORE: < 1 %
Framingham: < 10 %
ZMERNA OGROŽENOST
SCORE: 1 - 5%
Framingham: 10 - 20 %
VELIKA OGROŽENOST
SCORE: 5 - 10%
Framingham: 20 - 40 %
ZELO VELIKA OGROŽENOST
SCORE: > 10%
Framingham: > 40 %
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76
Koronarni klub Ljubljana
30 let
KK Ljubljana – izvajalec programa
vseživljenjske rehabilitacije koronarnih
bolnikov (VRKB)
•  Ustanovljen leta1981.
•  Soustanovitelj in član ZKDKS.
•  Ima status humanitarne organizacije, ki mu ga je
dodelilo Ministrstvo za zdravje.
•  Vpisan v Register prostovoljskih organizacij.
•  Deluje izven zdravstvenega sistema, v skladu z
Etičnim kodeksom organiziranega prostovoljstva
in v povezavi s kardiološko stroko.
Aleksandra Gorup, podpredsednica KKL
Cilji in namen
•  Omogočiti kroničnim koronarnim bolnikom
(KB) nadaljevanje rehabilitacije in
izboljšanje kakovosti življenja.
•  Širitev dejavnosti v kraje bivanja KB z
ustanavljanjem in strokovnim vodenjem novih
vadbenih skupin.
Struktura članstva
•  Koronarni bolniki po končanem zdravljenju
•  Osebe z visokimi dejavniki tveganja
•  Svojci in prijatelji, ki moralno in materialno podpirajo
program
•  20 vadbenih skupin, 425 članov
•  Starost od 50 do 87 let
•  Povprečna starost je 74 let
•  Organizirano prostovoljstvo - vključenih15%
članov
77
Širitev kluba
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0." $ Pogoji realizacije programa
finančni, kadrovski, prostorski
• 
• 
• 
• 
• 
• 
stalni viri financiranja
organizirana prostovoljska mreža
zagotovljena strokovna asistenca
ustrezni kadri in njihovo permanentno usposabljanje
koordinirano delovanje laičnih in strokovnih vodstev
sodelovanje kompetentnih v procesu zdravljenja in
rehabilitacije KB
•  ustrezni prostori in oprema (pripomočki za vadbo, AED,
računalniki)
78
•  '.$ 4(.*%.$ 4&%%.%'$
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•  "$ .$%(+9#' )!*5$%':
• '.&''$9#' )!*5:
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Izvajalci programa in njihove naloge
Laično vodstvo – U. O. in drugi organizatorji dela – prostovoljci
skrbijo za financiranje dejavnosti, strokovno asistenco in usposobljene kadre za
delo s KB, sodelujejo s strokovnjaki s področja zdravljenja in rehabilitacije KB,
informirajo članstvo in druge koronarne bolnike o vsebini programa,
zagotavljajo ustrezne prostore in opremo.
Strokovno vodstvo – strokovni svet, mentorji, vaditelji in stalni zunanji
strokovni sodelavci
svetujejo organom kluba vsebino programa in nadzirajo njegovo izvedbo,
zdravstveno izobražujejo člane in izvajalce programa.
Strokovni sodelavci – vaditelji in vodje delavnic
vodijo skupinsko vadbo, delavnice in svetovalne pogovore.
Prioritetne naloge
Težave in posledice neurejenih pogojev
•  neurejen sistem financiranja - stalnih virov ni, razen
sofinanciranja FIHO in prispevkov članstva, razpisni pogoji
možnih sofinancerjev (ZZZS, MZ, MOL) v večini primerov niso
kompatibilni z našo dejavnostjo,
•  vsebina dela presega usposobljenost prostovoljcev za
naloge, ki jih določajo zakoni in predpisi,
•  pomanjkanje prostorov in predrage najemnine.
•  krčenje programa celovite VRKB; ukinjanje že utečenih
dejavnosti (delavnice psihološke pomoči in zdrave prehrane,
testiranje članstva, nordijska hoja in druge gibalne dejavnosti),
•  Nezmožnost vključevanja mlajših in zaposlenih KB, ki
potrebujejo vadbo v večernih urah; telovadnic v teh terminih
in po dostopni ceni nismo mogli zagotoviti.
Izboljšati pogoje delovanja (finančne, kadrovske)
•  finančne vire pridobiti v javnih razpisih,
•  financiranja s prispevki prijateljev in sorodnikov članov kluba
ter drugih donatorjev,
•  gospodarno ravnati z razpoložljivimi finančnimi viri,
•  vsebino in širitev dejavnosti prilagajati potrebam članstva in
realnim možnostim,
•  razširiti mrežo prostovoljcev in usposobiti prostovoljce
•  nadaljevati sodelovanje in usposabljanje, izvajalcev programa
•  ohraniti dobre odnose in aktivno sodelovanje s stalnimi
strokovnimi sodelavci (npr. zdravniki)
"
Novi klubski prostori
•  Izziv za obnovitev opuščenih in uvajanje
novih dejavnosti
•  Spodbuda za ohranitev medsebojnega
zaupanje in spoštovanja ter dolgoletne
tradicije prostovoljnega dela.
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79
smo!
ZVEZA KORONARNIH DRUŠTEV IN KLUBOV SLOVENIJE
(ZKDKS)
USTANOVLJENA 1996.
DELUJEJO V 65 KRAJIH
ZDRUŽUJE 15 KDK, VEČ KOT 4000 ČLANOV IN
142 VADBENIH SKUPIN.
Naloge ZKDKS
•  zagotoviti koronarnim društvom in klubom (KDK)
pogoje za izvajanje celovitega programa VRKB,
usklajenega s priporočili kardiološke stroke
•  promocija programa VRKB
•  ustanavljanje novih KDK in rehabilitacijskih skupin
•  usposabljanje izvajalcev programov
80
Namesto zaključka
Člani smo soustvarjalci, izvajalci in uporabniki
programa. Pogumni, radovedni in dejavni
spreminjamo svoj življenjski slog!
Vabimo vas, da s svojim znanjem in izkušnjami
prispevate k razvoju in promociji vseživljenjske
rehabilitacije koronarnih bolnikov