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Behind us, the XXVI Warsaw Workshop on Interventional Cardiology is one of the largest and most important forum for transferring knowledge and information in cardiovascular medicine. This year’s WCCI showed the two most important trends – on the one hand, increasing specialization in the field allowing for the performance of even more difficult and more spectacular interventional procedures, and on the other hand, the increasing need for cooperation and involvement of all levels of patient care, including primary health care, to achieve full therapeutic success. Conscious communication in health care is also becoming more and more important.
The most difficult treatments for the heart
This year’s congress was dominated by two extremely interesting types of interventions on the coronary arteries, one of the most difficult in the field of cardiology. As prof. Adam Witkowski, WCCI Director, Past President of the Polish Society of Cardiology, attention focused on the restoration of chronically closed coronary arteries in a specialist course, which was held for the third time, and on a course on other interventional procedures in high-risk patients with the use of devices supporting the work of the left ventricle hearts. The session devoted to procedures on peripheral arteries, including carotid arteries, was also interesting.
These were the main topics at this year’s WCCI when it comes to training operators in percutaneous coronary angioplasty and the treatment of cardiac complications. The procedures of unblocking chronically closed coronary arteries are technically very difficult, hence the urgent need for training that we provide to the participants of our congress.
Modern valve treatment
This year’s WCCI has shown new hopes for patients for modern treatment of structural heart diseases with the transcatheter method.
– There are many new achievements in this field, new devices are introduced, there is new research. When it comes to the mitral valve, we already know that some types of therapy, such as edge-to-edge procedures with the use of fasteners on the leaflets of a non-closing valve, are actually routine today. On the other hand, there are many new therapeutic ventures and initiatives in this area – there are bioprostheses, which, similarly to TAVI procedures, can be implemented transcatheter. – explains prof. Witkowski. – The same therapeutic methods are more and more available in the treatment of the tricuspid valve, because it is another big problem in today’s aging society. We have a lot of patients with this defect who cannot undergo surgery, therefore the mortality with conservative treatment is very high. Tricuspid valve bioprosthesis is still a phase of clinical trials, but we are glad that there is a chance to extend the life of these patients and improve its quality. – he adds.
Prof. Witkowski specifies that all valve procedures, except for tricuspid valves, are reimbursed in Poland.
– Treatments on tricuspid valves are always subject to individual consent of the National Health Fund for their reimbursement, so in the near future we will work to introduce them to the normal reimbursement in order to protect our patients.
KOS – heart attack – success and failure in one
Approximately every tenth Polish patient after myocardial infarction dies within the first year after discharge from the hospital, and each year in Poland experiences a heart attack over 80. people. Therefore, in October 2017, the KOS-Zawał comprehensive care program was implemented. It gives amazing results, significantly extending patients’ lives by as much as 30%. reduces the risk of death. What’s more, as much as 96 percent. people participating in this program are satisfied with it.
– KOS-Zawał has repeatedly improved access to cardiac rehabilitation after a heart attack. As many as 71 percent patients requiring rehabilitation benefit from it as part of the program. It is also important that almost 60 percent. patients covered by this program are consulted at a cardiology clinic within 6 weeks of discharge from the hospital, while among patients not using KOS-Zawał – only 17 percent. This is of great importance for maintaining health and improving the quality of life after a cardiovascular incident. In addition, the program by as much as 40-60 percent. increases access to implantation of implantable devices that save the lives of patients with cardiac arrhythmias. – enumerates prof. Robert J. Gil, WCCI Director, President of the Elect of the Polish Society of Cardiology. – On the other hand, the biggest problem of this program, and at the same time the most incomprehensible element, is that only about 50% of people participate in its implementation. centers treating myocardial infarction in Poland, and not, for example, 80 percent. or 100 percent, thus only about 20 percent use the program. patients who require it.
Prof. Gil does not hide the source of the potential causes of this state of affairs.
– Staff shortages are definitely one of the biggest problems of all medicine, including cardiology, including programs such as KOS-infarction. It can also be, among others no hospital outpatient clinic in the center, as well as the fact that some interventional cardiology centers operate outside the hospital network, therefore they do not participate in NHF competition procedures for the implementation of this particular program. – explains the professor. – It is a very demanding administratively and paperwork program, associated with a large amount of additional work, which is always a great challenge in small centers, moreover, I believe that in the medical community there is still a lack of knowledge and awareness about the principles of functioning and accounting for the program, which is for sure is another barrier. There is no adequate, comprehensive communication. It is important to communicate that KOS-Zawał is a source of additional financing for hospitals, in my opinion this program should ultimately be obligatory – he adds.
The effective operation of the KOS-infarction program is also crucial for other cardiological programs with which the vessels could be connected. We are talking about the PCSK9 drug program for patients with extreme cardiovascular risk.
– The KOS-Zawał program is an opportunity to use the possibilities of this drug program, because it lasts 12 months, i.e. as much as the time window for inclusion in the PCSK9 program also has a specific schedule of visits, which allows you to optimize patient care after ACS in accordance with the applicable guidelines, I mean lipid determination or intensification of treatment. – explains the professor.
A hyper-failure of the hypercholesterolaemia program
Despite almost 4 years of operation of the drug program with PCSK-9 inhibitors for patients with extreme cardiovascular risk, which also includes patients with familial hypercholesterolaemia, the use of the initiative’s potential and recruitment of patients is small. According to the data of the National Health Fund, in 2021 only 263 patients were treated, the year before – 200. This is surprising, especially considering the many years of efforts at the Ministry of Health to launch this program. Prof. Gil still sees the reasons for this absurd situation in the low awareness of both doctors and patients about the possibility of treating patients under the drug program.
– The paths of qualifying a patient to participate in the program at all qualification levels, starting from primary health care, are still not widely known, ignorance also concerns the criteria for inclusion in the program so that the proposed treatment can be reimbursed by the National Health Fund and in which centers the program is implemented. Problems with the program start in primary health care because the lipid profile is still too rarely performed, one of the most crucial control tests in cardiovascular patients. Moreover, the eligibility criteria for the program are still too restrictive. – explains the professor.
As the professor describes, in 2021 the inclusion criteria for patients with familial hypercholesterolaemia were relaxed. A similar action is also needed in the second part of the program dedicated to patients after acute coronary syndrome.
– There has been a long discussion about the need to extend the period from a cardiovascular event to patient enrollment in the program. Currently, it is a 12-month period, with clinicians pointing to the need to extend it to 24 months, which would also allow the qualification of patients who have completed the KOS-Zawał program. This would definitely contribute to better care of patients and increase the use of the potential of both services offered. Additionally, it is worth taking care of a group of patients with statin intolerance, because this group of patients with an extreme cardiovascular risk is currently unable to achieve the therapeutic goal due to the inability to use a PCSK-9 inhibitor. – evaluates prof. Bullfinch.
National Cardiology Network
The KSK program started a few months ago in the province. Mazowieckie and about 700 patients entered it. The program is designed to accelerate the diagnostic and therapeutic path for patients referred to this network. It also assumes acceleration of some types of procedures, such as percutaneous aortic valve implantation or edge-to-edge therapy in mitral valves, which are unlimited in the program and better financed by the National Health Fund.
– After our last meeting as PTK at the Ministry of Health with the participation of the National Consultant, a decision was made that five more regions will be added to the KSK in the near future. Thanks to this, new patients will be able to benefit from faster therapeutic paths and unlimited treatments. – emphasizes prof. Witkowski. – The program lasts only a few months and is under development, so its effectiveness can be estimated in about a year, but I believe that the 700 patients so far are a good and promising result. – he adds.
Conscious Media debate
For the third time, on the occasion of the workshop, the Media Conscious Cardiology Debate was organized in cooperation with the Institute of Consciousness Foundation, which is a kind of forum for summarizing both the situation in interventional cardiology presented at the workshop, and the situation in cardiology in general.
– Over the years, not only the situation in cardiology itself changes, but also the opinion and awareness of cardiologists themselves. To achieve success, it is impossible to look only at the very tip of the iceberg, which is interventional cardiology. You have to go down – to the outpatient clinic, to the health care center, because this is where the patient’s therapeutic path begins, which can be led quickly and well, saving his life and health, or leading to bad diagnostics, poor therapy and, consequently, the cardiac patient’s disability. Today, big medicine needs little medicine more than ever, is one of the most important conclusions of the debate. – admits prof. Bullfinch.
The participants of the debate came to the conclusion that the effectiveness of medicine, including cardiology, depends not only on the medical and financial sphere, but also on the communication sphere, and this still fails because it is either too complicated, especially for patients, or … it does not exist at all.
– It can be seen on the example of the aforementioned cardiological programs – such as KOS-Zawał or PCSK9, these names may say nothing to patients and even cause fear in them. They are unintuitive and too complicated. Perhaps, if the names of such important programs were simple and friendly, patients would remember them more easily, ask for them more often, find information about them easier and use them more willingly. Communication in medicine is a very important aspect, we cannot underestimate it. During the debate, several names were proposed, the simplest of which seem to be the best, such as a heart attack or a minus cholesterol. – summarizes prof. Bullfinch.
Creating Cardiovascular Medicine Worldwide
This year, WCCI was held, just like a year ago, in a hybrid formula, and for the first time in over a quarter of a century, it has adopted a new guiding motto of the congress, which reflects both the goal and values of the event – Creating Cardiovascular Medicine Worldwide.
– Our mission is the broadest possible, both national and international dissemination of knowledge and information in the field of cardiovascular medicine, which, as Poles, both create and present achievements from abroad. As Poles, we are still at the forefront of the treatment of acute myocardial infarction, we also conduct specialized courses for the restoration of chronically closed coronary arteries for people from Poland and abroad. We train specialists and proctors, i.e. teachers of a given medical procedure, who can then train other doctors on a national and international scale, and this competently develops new centers and provides modern treatment to patients. – explains prof. Witkowski.
– Creating Cardiovascular Medicine Worldwide is our mission, history and passion, which we have been creating in Poland for over a quarter of a century, but also on an international scale together with teams, experts and speakers from around the world, as well as friends, because cardiovascular medicine is not only about medicine is, first and foremost, people. – emphasizes prof. Robert J. Gil.