- According to data from a new report entitled 'Heart Failure in Poland 2014-2021', compiled by experts from the Heart Failure Association of the Polish Cardiac Society (ANS PTK) and analysts from the Ministry of Health (MZ), the annual number of deaths due to heart failure currently exceeds 140,000.
- Epidemiological projections indicate that the incidence of heart failure is expected to increase between 2022 and 2031. The incidence of advanced heart failure has been increasing in recent years.
- On the basis of data from the Ministry of Health and the National Health Fund (NFZ) contained in the report, the current key problems in the area of heart failure in Poland have been defined: lack of continuity of care, lack of coordination and cooperation between doctors, use of suboptimal treatment, including too late initiation of highly specialised treatment, limited access to innovative therapies, suboptimal access to cardiac rehabilitation and palliative care.
- In light of the data from the ANS report of the PTK and the MZ and the latest guidelines from The European Society of Cardiology (ESC), presented in August 2023 in Amsterdam, the goals in the area of heart failure in Poland today are to improve health outcomes related to survival, reduce the risk of hospitalisation for heart failure and improve patients' quality of life.
Heart failure 2023 - latest report
On 11 September 2023, a new report entitled "Heart Failure in Poland 2014-2021" was presented at a press conference held at the PAP Press Centre in Warsaw. "Heart Failure in Poland 2014-2021", developed by experts from the Heart Failure Association of the Polish Society of Cardiology and analysts from the Ministry of Health. The study is a continuation of the assessment of the situation of heart failure patients in Poland from previous years, conducted on the basis of data from the Ministry of Health and the National Health Fund.
- Heart failure is a condition characterised by a serious prognosis, a significant incidence of multimorbidity, the need to implement highly specialised procedures and the need for continuous monitoring of the patient's condition. A recent study based on data from the Ministry of Health and the National Health Fund has made it possible to make a confident diagnosis and, based on this, to develop appropriate recommendations. The authors' recommendations are consistent with the guidelines presented at the European Society of Cardiology Congress in August 2023. We know what needs to be improved and we know what tools we should use to do so effectively. These challenges, as well as the increasing population of patients with heart failure and certain barriers to treating this group of patients in Poland, have led the Congestive Heart Failure Association of the Polish Cardiac Society to develop a proposal for a care plan for people with the advanced form of the disease,' points out Professor Małgorzata Lelonek, Head of the Non-Invasive Cardiology Unit at the Medical University of Łódź and Chair of the Congestive Heart Failure Association of the Polish Cardiac Society.
Diagnosis: suboptimal treatment path and incomplete use of available tools
On the basis of data from the Ministry of Health and the National Health Fund (NFZ) contained in the Report, the current key problems in the area of heart failure in Poland have been defined: lack of continuity of care, lack of coordination and cooperation between doctors, use of suboptimal treatment, including too late initiation of highly specialised treatment, limited access to innovative therapies, suboptimal access to cardiac rehabilitation and palliative care. Hospitalisations remain a serious and growing problem in heart failure.
- For years, it has been said that Poland is a country with a high rate of hospitalisation for heart failure. Based on a comparison with other Organisation for Economic Co-operation and Development (OECD) countries, it is known that this rate is currently the highest in Poland among the countries included in the analysis. The average value of the heart failure hospitalisation rate per population has increased and is almost three times higher for Poland than for the other countries," calculates Professor Małgorzata Lelonek.
According to experts, repeated hospitalisations are a multifaceted problem. First and foremost, hospitalisations indicate disease progression and a worse prognosis for the patient. According to data compiled by the Ministry of Health, the occurrence of one hospitalisation for urgent heart failure significantly worsens the prognosis of patients. It has been calculated that the expected five-year survival is then around 31-33 per cent (with a median survival of 2.5 years) compared to 57 per cent survival from the time of diagnosis. Numerous hospitalisations mean significantly higher costs of care (compared to a model in which heart failure is treated more on an outpatient basis).
In 2019, the total cost of heart failure treatment was more than PLN 1.6 billion. According to the data analysed in the ANS and PTK report, in just five years the cost of hospital treatment of this condition per calendar year has increased by 116 per cent.
- Hospitalisations are the main cost driver for heart failure treatment. They account for 94 per cent of the total amount spent on treating this group of patients. The significant increase in hospital costs for this patient population is due, among other things, to a 41 per cent increase in hospitalisations (between 2014 and 2019). This trend can and should be curbed, but a comprehensive and coordinated action is needed for noticeable effects,' Professor Małgorzata Lelonek points out.
Recommendations: optimised pathway, treatment in accordance with current medical knowledge
Based on the findings of the new report, experts have defined key goals in the area of heart failure: improving health outcomes related to survival, reducing the risk of hospitalisation for heart failure and improving patients' quality of life.
In a recent paper, experts from the PTK Heart Failure Association point out that a coordinated care model is needed for patients with advanced heart failure, after discharge from hospital due to an exacerbation of the disease. Patients with advanced heart failure cannot be treated like other patients with the disease. The model considers comprehensiveness of care, combining elements of outpatient care, pharmacotherapy, invasive treatment and rehabilitation. The proposed model is designed to provide coordinated multidisciplinary and continuous care, taking into account the patient's own involvement in the treatment and enabling the right services to be provided at the right time. Experts specify: the right treatment is an effective and safe treatment.
- As cardiologists, we reiterate that we primarily consider the so-called hard endpoints when assessing the effectiveness of the therapy provided. We assess whether a given treatment measurably prolongs patients' lives. We take into account whether the therapy protects against exacerbations of heart failure and other cardiovascular incidents, and whether it improves patients' quality of life. This approach is reflected in the latest guidelines of the European Society of Cardiology, in which, for the first time, a dedicated therapy is included for heart failure patients with preserved left ventricular ejection fraction: the SGLT2 inhibitors, the phlazines with recommendation class IA. The same group of drugs was included for the first time in the ESC guidelines as a dedicated therapy for heart failure patients with mildly reduced ejection fraction. This is an example of a treatment with well-documented efficacy and safety that is reimbursed in Poland for the treatment of diabetes, Chronic Kidney Disease (CKD) and heart failure with reduced left ventricular ejection fraction. With reference to the current ESC guidelines, we hope that patients with heart failure with preserved ejection fraction, who are often unfairly judged to be 'lighter patients' in the public mind, will also soon gain access to this treatment. The possibility of prolonging the life of this group of patients with the best possible quality of life, and thus preventing exacerbations and deterioration in the physical, cognitive-emotional and socio-occupational areas, is an effective and cost-efficient prevention of the burden: clinical, social and financial - for patients, their relatives and the state as a whole. Every group of heart failure patients deserves the most effective treatment possible. This strategy pays off for everyone," notes Professor Małgorzata Lelonek.
With reference to the latest guidelines of the European Society of Cardiology, the experts of the Polish Society of Cardiology listed the technologies whose reimbursement status in Poland/availability should be optimised as soon as possible: vlasin, ARNI, vercyguat, electrodeless pacing, defibrillation waistcoat, LVAD, mitral valve regurgitation treatment system, heart transplantation. In selected technologies, there is currently an administrative process aimed at extending the reimbursement of individual solutions or the procedure of guaranteed benefits.
All data quoted are from the Report "Heart Failure in Poland 2014-2021". The publication is available at: www.niewydolnosc-serca.pl