Heart failure and COVID-19. Problems with treating heart disease in Poland. Expert translators

Heart failure is a very big problem not only in Poland but also in the world. In December 2020, the report “Heart failure in Poland” was published, which was created on the initiative of patient organizations operating in the field of cardiology, in cooperation with prominent experts, incl. from the Polish Society of Cardiology (PTK). The conclusions of the report are depressing, but it also shows that improving care for patients with heart failure is the most urgent unmet health need in the field of cardiology, which requires immediate attention from the Ministry of Health and the public payer – emphasizes the cardiologist, Prof. dr hab. n. med. Adam Witkowski in the MedTvoiLokony #OkiemLekarza series.

1. Patients with heart failure have a worse prognosis than those with the most common cancers
2. Prof. Witkowski: COVID-19 caused two pandemics to overlap because cardiovascular diseases, including heart failure, are also a pandemic
3. Specialist: there are too many hospitalizations in Poland, and we know that the more frequent hospitalizations, the paradoxically – we increase the chances of death of a patient with HF. We do not have well-organized short-term care
4. Heart failure is the final, declining stage of many cardiological diseases, “therefore we must do everything we can to help patients avoid this bad ending”
5. You can find more such stories on the TvoiLokony home page

“Cardiovascular disease is also a pandemic”

Over 1.2 million Poles are diagnosed with heart failure (NS). It is today the largest direct cause of death in Poland. Every year 41 die from this. people. Patients with heart failure have a worse prognosis than those with the most common cancers: 40,6% patients do not live five years after being diagnosed with heart failure.

1. MedTvoiLokony interview with prof. Witkowski: Cardiovascular diseases are killing Poles

Unfortunately, the number of deaths due to heart failure has been increasing in recent years, and the expenditure on treatment is also increasing. Over the past five years, they have increased by 125%. up to PLN 1,6 billion for hospital treatment alone. Thus, increasing the outlays does not bring the expected results. PTK believes that only systemic solutions can improve the situation of patients with heart failure. Single actions will not change it.

The COVID-19 pandemic meant that we are dealing with an overlapping of two pandemics, because cardiovascular diseases, including heart failure, are also a pandemic in Poland and in the world. In this way, there is what is known as a syndrome – a synergistic overlap between two pandemics.

This overlap comes at the expense of the diagnosis and treatment of heart disease patients. Apart from pharmacological treatment, revascularization, which is very important in patients with NS, because most of them have coronary disease and heart failure develops on its background, the use of implantable devices and heart transplantation, a systemic approach to these patients is very important.

Problems in the diagnosis and treatment of heart diseases in Poland

There are too many hospitalizations in Poland, and we know that the more frequent hospitalizations, the paradoxically, the greater the chances of death of a patient with HF. We do not have well-organized short-term care – one-day hospitalization units should be in every major hospital, which would give patients with exacerbation of heart failure a chance for quick help, and a short hospitalization would significantly reduce, for example, the risk of nosocomial infection.

Patients are also not taught self-assessment, and there are no community nurses dedicated to caring for patients with heart failure.

Another problem is the lack of telemonitoring of electrical implantable devices, which is crucial in the era of the COVID-19 pandemic and the unlimited availability of modern drugs and interventional therapies. However, some drugs important for the improvement of the quality of life and the reduction of mortality, such as sacubitril / valsartan or phloids, are not reimbursed for Polish patients with NS. So systemically, this problem is poorly resolved, and that is why we have such a high mortality rate, despite the ever-increasing expenditure on treatment that is systemically misdirected. The coronavirus pandemic has made the situation even worse, severely restricting access to treatment.

KONS Program, Coordinated Care for Patients with Heart Failure

That is why the Polish Cardiac Society is so anxious to launch the KONS program, i.e. Coordinated Care for a Patient with Heart Failure. PTK has been striving for it for 3 years. Although the KONS program was included in the regulation of the Minister of Health of 23.10.2018/XNUMX/XNUMX, it still has not been launched, even in the pilot form. Unfortunately, it resumed in June 2020, and then in January this year. talks at the Ministry of Health have still not led to the implementation of the KONS program.

We want to introduce KONS because it has a systemic approach to the diagnosis and treatment of patients with HF, and its activities are focused on outpatient care, patient self-assessment, one-day hospitalization departments, greater involvement of family doctors (POZ) and AOS. Hospitalization in centers of excellence would only occur in patients who could only be helped more drastically by surgery, implanting heart pumps, percutaneous mitral valve closure procedures, etc.

Having very good results after the implementation of the Coordinated Care for Patients after Heart Attack (KOS-Zawał) program, which was also initiated by PTK, one should expect similar ones in the KONS program. First of all, we expect a reduction in the number of hospitalizations, which will be beneficial for patients and the payer, and, in the longer term, for a decrease in mortality due to NS.

Heart failure is the final, declining stage of many cardiac diseases

In an appropriate approach to the treatment of patients with HF and to convince decision makers in the field of health care, organizations of cardiac patients, which have already undertaken a number of information and educational initiatives, also jointly with the Polish Cardiac Society, are starting to play an increasingly important role. It was on their initiative that the much-needed report “Heart failure in Poland” was created.

The coordinated care program, such as KOS-Zawał or KONS, programs dedicated to patients with hyperlipidemia (family and for patients with very high cardiovascular risk) and the mechanical thrombectomy program in the treatment of stroke should in the near future become part of the national cardiological network of the National Health Program. Hearts and Vessels, about which talks with the Ministry of Health have been held for several years. Prevention, primary and secondary, is also of key importance, as heart failure is the last, declining stage of many cardiovascular diseases, so we must do everything we can to help patients avoid this bad ending.

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