Table 3.

A ten-point plan for cardio-kidney-metabolic health in Croatia.

1	Early detection of elevated BP and elevated LDL cholesterol	-Introduce regular BP and lipid panel checks in adults at least once a year at the family practice. -Include data in the single CKM panel of the central healthcare information system of the Republic of Croatia (CEZIH).
2	Changes in poor dietary habits with an emphasis on reducing salt intake, increasing potassium intake, and fostering physical activity	-Change school and university curricula by increasing the number of physical education classes, allowing for physical activity in the workplace to change sedentary lifestyles. -Change of menus in kindergartens, schools, students and workers’ canteens and restaurants (reducing salt, use of salt substitutes, increasing vegetables, eliminating trans fatty acids, increasing the use of olive oil, fish etc.). Actual implementation requires the provision of appropriate foodstuffs and additional training of cooks to be able to follow the new recipes. -Continue, expand and regulate cooperation with the food industry. -Encourage the use of salt substitute (KCl) in primary and secondary prevention with required caution in patients with advanced stage CKD, and those taking potassium-sparing medications.
3	Reduce the number of smokers	-Provide education on the harmfulness of smoking. -Prohibit smoking in public areas including cafés. -Prohibit and provide strict sanctions for selling any form of tobacco (and nicotine) products to children (this pertains to new products—e-cigarettes, heated tobacco and so-called snuff). -Provide a larger number of places that provide help to those who want to quit smoking, so called schools of non-smoking.Raise awareness on how, for new products (e-cigarettes and heated tobacco), although containing fewer toxic ingredients, there is no evidence of a beneficial effect on CV health, and should be used only in smokers who are trying to quit smoking.
4	Regular physical examinations in adults over the age of 30	-Enable all citizens to have regular physical examinations which must become mandatory. -Panel tests on those examinations, in addition to medical history, basic clinical examination and proper BP measurement, should contain basic elements necessary to properly assess CKM health (urine, glucose, lipid panel (determination of lp (a) once in a lifetime), serum creatinine and estimated glomerular filtration, albumin-creatinine ratio for persons who are already at moderate CV risk, assessment of overall CV risk and CKD stage, and ECG.
5	Screening for familial hypercholesterolemia	-Launch a national plan and make it mandatory for all children when enrolling in primary school.
6	Prepare and publish clear protocols for diagnosis, treatment and monitoring of patients with a history of CV events	-The protocols must be concise, feasible and practical to provide for efficient clinical work, while also educational to increase the health literacy of medical doctors and thus reduce clinical inertia. -The protocols must specify the role of other healthcare professionals, e.g., pharmacists, and active role of the patients.
7	Define and regularly monitor patients with high CV risk who have not yet experienced a CKM event	-These patients in particular should have physical examinations as specified above once a year or more frequently as per the physicians’ assessment, i.e., prepared protocols. -Those patients should have their overall CKM health and total risk assessed. -Those patients should be additionally educated to change their poor habits actively and permanently, and to understand the importance of regular medication.
8	Increase access to diagnostics and patient monitoring through day hospitals	-There are multiple advantages to treatment and monitoring in day hospitals, because in addition to the possibility of monitoring and treating a larger number of patients, great financial savings can also be achieved. -It is necessary to educate physicians additionally on mutual communication, since it is practically a rule that patients are followed by several specialists (family medicine, cardiology, neurology, hypertensiology, etc.).
9	Increase the number of outpatient centers for CV rehabilitation	-The current number of such centers is insufficient.
10	Monitoring of treatment outcomes	-Digitalization aimed at connecting hospital systems to CEZIH for healthcare professionals providing care to the same patient to have access to all data (family practitioners, hospital specialists, pharmacists). -Setting up and connecting CKM patient registers. -Fast and successful integration into the European Health Data Space that will make it possible for our healthcare professionals, researchers and institutions to access health data from the entire European Union and, thus, enable better policymaking and the development of new health technologies.