The report 'Heart failure care in the Central and Eastern Europe and Baltic region: status, barriers, and routes to improvement', is the result of the work of experts from 11 countries in Central and Eastern Europe and the Baltic Sea region: Bulgaria, Croatia, Czechia, Estonia, Hungary , Latvia, Lithuania, Poland, Romania, Serbia, Slovakia and Slovenia.

They analysed available literature and conducted survey research. They compared them to analogous data from five Western European countries: France, Germany, Italy, Spain and the UK.

'Due to the limited amount of published data on heart failure care in the countries under study, in two additional surveys (...) we also collected information on local practices in managing heart failure care. Based on the combined results, literature review and survey results, we have created individual profiles of heart failure care for each country', says Professor Piotr Ponikowski, director of the Institute of Heart Diseases at the University Clinical Hospital in Wrocław and rector of the Wroclaw Medical University.

It turned out that in the countries of Central and Eastern Europe and the Baltic Sea region, three times more people die due to heart failure than in the countries of Western Europe. Researchers have identified five barriers that impede optimal patient care and may contribute to these differences. These are: lack of epidemiological data (including, above all, registers); lack of national heart failure strategies; gaps in healthcare infrastructure and systems; insufficient access to modern methods of treating heart failure and low awareness.

The analysis shows that there are 1.2 million people with heart failure in Poland, and this number continues to grow. Poland is not the worst in terms of morbidity and mortality, but compared to other countries it has an exceptionally high rate of hospitalisation due to heart failure, according to the report.

Professor Jadwiga Nessler, head of the Department of Coronary Disease and Heart Failure, Institute of Cardiology, the Jagiellonian University Medical College, explains that this is an important problem for several reasons. 'Firstly, each hospitalisation due to exacerbation of heart failure significantly worsens the prognosis. Secondly, it is a highly cost-intensive method of care that significantly burdens the budget of the national payer (to put it simply, it reduces the budget that could be allocated, for example, to reimbursement of innovative heart failure therapies)', Nessler says. The third problem is that access to cardiology specialists, heart failure clinics and referral centre care is limited and insufficient, making it difficult to provide optimal care to patients.

The authors of the report propose corrective measures to reduce disproportions in care for people with heart failure between European countries. According to them, the key challenge is to increase the level of financing for health care, including funds allocated to the prevention, diagnosis and treatment of heart failure.

It is important to provide access to innovative therapies, included in the guidelines of scientific societies, with proven safety and effectiveness. The report indicates that patients from the Central and Eastern Europe and the Baltic Sea region currently wait on average 304 days longer for access to innovative therapies than patients from highly developed Western European countries.

According to experts, in Poland the Coordinated Heart Failure Care Programme should be implemented to its full extent and on a nationwide scale, and not as a pilot programme.

'As representatives of medical professions involved in the care of patients with heart failure, we advocate the expansion of outpatient care (AOS) and the use of the potential of heart failure nurse educators', says Professor Izabella Uchmanowicz, head of Division of Internal Medicine Nursing at the Wroclaw Medical University and president of The Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology (ACNAP ESC).

She adds that there is a need to conduct intensive educational activities, including nationwide campaigns dedicated to the primary and secondary heart failure prevention, as well as broader cooperation between scientific societies and patient organizations. (PAP)

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