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Cardiology is one of the most dynamically developing fields of medicine. In fact, it is impossible to compare the state of knowledge 50 years ago with what we know and can do today. However, there is still a long way to go.
Half a century ago, a heart attack was a death sentence, and the sick were dying in agony. The golden hour, i.e. the first hour after the heart attack, was indeed a chance for the patient – but even the help provided quickly did not guarantee survival. Today’s medicine is much, much more effective. We can repair damaged heart muscle. We can replace damaged blood vessels with those that will serve for many years to come. We are able to prevent the most dangerous complications. Optimistic? Yes. The numbers don’t lie: it’s been getting better since the early 90s. Fewer and fewer people are dying from heart and vascular diseases. We observe a systematic decrease in the number of deaths. We also perform a large number of procedures each year that save patients’ lives. Last year, over 200 jobs were carried out. coronary angiography and over 3 thousand. angioplasty treatments! In this respect, we are among the European leaders. As many as 143 interventional cardiology centers in our country successfully perform angioplasty procedures, clearing the narrowed arteries of the heart muscle. It also places us in an excellent position among the countries of the European Union.
– But the problem could not be overcome to the end. Heart and vascular diseases, despite advances in therapy, are still the bane of doctors. They are the main cause of death: three years ago, statistically, every second Pole died of cardiovascular disease. They also dominate as the causes of premature mortality (aged 25-64), both among men and women (respectively: 50% of men and 44% of women who died in recent years due to cardiovascular diseases) – says Prof. Grzegorz Opolski, National Consultant for Cadriology
Mortality in cardiovascular diseases
The most important causes of mortality among cardiovascular diseases are invariably ischemic heart disease and cerebrovascular disease, as well as the underlying atherosclerosis and arterial hypertension. Heart and vessel diseases are so common that they are considered civilization diseases. Smoking, dietary neglect, alcohol consumption and coffee abuse, obesity, laziness and aversion to any physical exertion – all these are everyday phenomena – and at the same time serious risk factors for the development of vascular diseases. According to WHO (World Health Organization) estimates, these factors are responsible for more than half of health problems. The problem of passive smoking is also more and more often emphasized: it turns out to be just as harmful and even more dangerous than active smoking! The WHO data is both alarming and hopeful: if these risk factors could be eliminated, it could be as much as 80 percent. reduce the incidence of cardiovascular diseases, type II diabetes, strokes and heart diseases and by as much as 40 percent. reduce the incidence of certain cancers. – The problem is that changes in lifestyle and unhealthy habits are a long-term process and it is difficult to persuade people to change. Only when the disease hits do we start to take our health seriously. Only a small percentage of us believe in prophylaxis – most of us live in a false sense of indestructibility, disregarding doctors’ recommendations. These are the people who benefit most from the development of medicine: the hope for those who neglect heart health is the fact that medicine is getting better at the therapy, and the in-hospital mortality of people after a heart attack has been reduced by more than a half – says Prof. Zbigniew Kalarus, President of the Elect of the Polish Cardiac Society.
Life after a heart attack
However, the effectiveness of hospital treatment is only half the battle. Statistics warn: although we more and more often manage to survive a heart attack, a significant number of patients still depart from a heart attack within a year. The numbers are telling: in 2003, about 19% of people died of a heart attack within a year. sick. Ten years later, the first year after the heart attack is still high mortality: as much as 15 percent die. sick. Why is this happening? There are several reasons. The first is the still not fully used opportunity for the Golden Hour.
“Too many patients still wait too long from the moment they have a fresh heart attack to the time they go to a specialist center for treatment. This is partly due to insufficient knowledge of the patients themselves and their families (who do not call an ambulance immediately as soon as the first symptoms of a heart attack appear), and partly to insufficient availability of interventional surgery centers – Residents of small towns and villages need more than an hour to reach place – says prof. Kalarus. It is estimated that residents of larger cities reach intervention centers in just over two hours – and people outside large cities need over three hours to do so. In addition, a patient with a heart attack should be taken immediately to a center that performs interventional cardiology procedures, not an ordinary hospital. If the hospital does not have a hemodynamics lab, the patient will not be given the necessary help. Meanwhile, each hour of delay means less chance of survival and the risk of more damage to the heart muscle.
The waiting time for the planned procedure
Another problem is the long waiting time for treatments – those planned. In Poland, the waiting time varies and depends on how well-known a given center is, and how long the queue of patients is waiting for the operation. The waiting period for angioplasty varies from 2 to 4 weeks, implantation of a pacemaker is from 1 to 8 weeks. The waiting time for coronary angiography is even longer – sometimes up to 12 weeks (similar to a cardiodefibrillator). The patients who require ablation surgery are in the worst situation – the waiting time can be up to 100 weeks.
However, in order to be referred for surgery, you must first undergo a series of tests – and even before that, sign up for a cardiologist. And here comes the problem. In most Polish cities, waiting for an appointment with a cardiologist is several months, in extreme cases even a year. Rehabilitation is also necessary after a heart attack. Every patient with a heart attack should undergo it – and only every fifth patient actually has access to it. In addition, they are usually people from large cities – living in the countryside have no chance of rehabilitation.
An epidemic of heart failure
Polish cardiology has two faces. On the one hand, it copes better and better with the most difficult challenges, such as saving patients over 70. Such people are difficult to treat, because not only their hearts are already diseased and infarcts are usually very extensive, but also cardiological diseases are accompanied by many other diseases. – On the other hand, however, a new problem has arisen: chronic heart failure, characterized by, inter alia, shortness of breath and swelling around the ankles. It’s so common now that doctors are talking about an epidemic. Moreover, in Poland, compared to other EU countries, patients with heart failure are hospitalized most often. It costs a lot, and according to specialists, it would not be necessary if the health care system were to be changed a bit, says Prof. Janina Stępińska, President of the Board of the Polish Society of Cardiology. Today, primary care physicians do not encourage patients to treat their heart problems. GPs do not have sufficient powers to refer patients for cardiological examinations. Therefore, patients have to wait a year for a consultation with a cardiologist – and the circle is closed.