Dyspnoea, at first related to exertion, later also felt at rest, easy fatigue or swelling - these are typical symptoms of heart failure, which every year locks hundreds of thousands of Poles in their homes. Experts have been talking about an epidemic of heart failure for several years - according to the Ministry of Health, the problem affects around 1.2 million Poles struggling with the condition in various stages. However, so far no visible action has been taken to stop this heartbreaking trend. In the light of the data from the "Heart Failure in Poland" Report, the situation of patients is dramatic, and COVID-19 has made the situation even worse. The consolidated expert and patient community has therefore appealed to the Minister of Health to urgently address the topic of heart failure, as delaying key decisions will result in the majority of patients with the condition dying prematurely in Poland.
facing the struggle with coronavirus, all the more reason to care for this particular group as soon as possible - patients with co-morbidities are at greater risk of severe infection and death due to COVID-19.
Shocking data from the Report
According to 2018 data, one in 10 Poles who died died from heart failure, which ranks this disease entity as the number one direct cause of all deaths in Poland. Every year, 140,000 people with heart failure die - this means that 16 people affected by this condition die every hour!
Just as cardiovascular disease is the leading cause of death in Poland (approx. 45%), heart failure is in the infamous first place among these diseases, being the most common direct cause of death in general - convinces Professor Jarosław Kaźmierczak, MD, PhD, National Consultant in Cardiology.
From the time of diagnosis, as many as 40.6% patients do not survive five years of life. Heart failure has a worse prognosis than heart attack, prostate cancer or colorectal cancer. The report shows that over the past five years in Poland, the costs of health services incurred for heart failure have increased by 125% and in 2019 amounted to nearly PLN 1.7 billion, of which 1.6 billion was consumed by hospitalisations, of which there were more than 300,000! The total overall cost of heart failure in Poland in 2018 was PLN 6.2 billion, which translates into 0.3% of GDP. Including indirect costs of PLN 4.4bn, Social Security costs of PLN 0.3mbn.
The report's conclusions are depressing and testify to how ineffective and unmodern the Polish health care system is in combating the heart failure epidemic - which is probably how this disease entity should be described in view of its prevalence, rapidly increasing prevalence and mortality. It is also sad that, despite the increase in expenditure on treatment, patients are dying on such a huge scale - says Professor Adam Witkowski, MD, President of the Polish Cardiac Society.
In the foreword to the Report, Bartłomiej Chmielowiec - Patient Ombudsman emphasises that the problem of heart failure requires urgent attention and action on the part of decision-makers. He also declares his support for efforts to bring about a better tomorrow for people with heart failure. In turn, Professor Jarosław Kaźmierczak says that the document - is a response to the urgent need for a global improvement in the diagnosis and treatment of heart failure in our country, especially with the use of the latest drug groups. This is because pharmacotherapy is the basis for treating this condition. We cannot wait for drugs to become cheaper before making modern therapies available, as this means too many premature patient deaths. Seeing the urgency, I requested the reimbursement of Flozin earlier this year - even before its registration in Europe, as encouraged by the Minister himself.
The consolidated patient and doctor community appeals!
The report's conclusions show that there are two inseparable pillars for improving the situation of people with heart failure, which can improve patients' prognosis, reduce the number of hospitalisations resulting from exacerbations of the disease and improve their quality of life. These are the introduction of Comprehensive Care for the Heart Failure Patient (CHF) and reimbursement of innovative drug treatment, argues Agnieszka Wolczenko, leader of the Alliance of Cardiac Organisations. Recently, the consolidated medical and patient community made an appeal to the Minister of Health to ensure comprehensive, systemic care for heart failure patients in Poland and access to effective therapies. Specific priority changes were proposed in the letter to the Minister: providing coordinated, comprehensive care for the patient (diversion of patient flow to outpatient treatment, access to cardiac rehabilitation, access to telemedicine solutions, medical care at every stage of treatment) and providing the patient with optimal pharmacotherapy consistent with the guidelines of scientific societies and in line with the latest medical knowledge.
Debate with decision-makers
On 9 December 2020, a debate was held between experts and patients and decision-makers, where recommendations for solutions were presented. The urgent need for action to stop the heart failure pandemic was indicated, also due to the current epidemiological situation. Published CSO data shows that from mid-September to November (week 38-44) 2020 vs the same period, there have been 16,000 more deaths in all years of the last decade, while health ministry data shows that 3,595 COVID-19 patients have died in the same period (i.e. week 38 to week 44). Experts have legitimate concerns that among the 12,500 remaining deaths is a large group of heart failure patients.
Minister Maciej Miłkowski confirmed that the ministry has already received a reimbursement application for dapagiflozin, which will be processed on 13 November. This drug has a 4x lower cost than sacubitril/valsartan with similar clinical effects. At the same time, he pointed out that making a reimbursement decision is not an easy process.
People with heart failure are one group of patients who have not been given the chance to reduce hospitalisation rates and improve disease prognosis over the past eight years. Now there is a chance to reduce hospitalisations by 30% and improve the 5-year survival of patients by up to 20%. They look to the future with hope. Access to modern pharmacotherapy and comprehensive care for heart failure patients is needed now. We should not delay any longer, especially as there is a modern pharmacotherapy with flosins that significantly prolongs life while improving the quality of life - argues Marta Kalużna-Oleksy.
We look forward to making a difference. We hope that our joint activities, carried out in cooperation with the expert community, will bring tangible results - lowering mortality related to heart failure, having a positive impact on the daily lives of patients. Changes must happen quickly, because time is of the essence. This concerns both the organisation of care and access to modern drugs. All the more so because the Ministry of Health has informed me in writing that, following the registration of Flozin in Europe in the autumn of 2020, it will make every effort to have reimbursement in mid-2021. We are holding you to your word! - concludes Agnieszka Volchenko, leader of the Alliance of Cardiovascular Organisations.
Source: Alliance of Cardiovascular Organisations