Piotr Ponikowski, president of the Polish Cardiac Society, discusses the positive steps Poland is taking to construct an effective program against cardiovascular disease as well as the importance of a structured national prevention strategy. Furthermore, he highlights the importance of the Society acting as a partner with the entire value chain of Polish healthcare and the potential for the nation to be considered a cardiology hub.
Cardiovascular death is the leading killer across the US and Europe, and equally in Poland. How would you describe the Polish cardiovascular environment?
“Poland finds itself in a unique position, and we believe we have the chance to be considered as a hub for cardiovascular activity.”
From the perspective of a cardiologist working everyday with patients, we have experienced positive change and drastic improvements over the last 20 years and we now have a cardiology ecosystem that is significantly better than many years ago. For example, previously we only had very few cardiology centers located in Poland that could compete with the rest of Europe and at present, we have a network that covers the entire nation. Furthermore, there have been large investments made into equipment and training doctors, especially within the field of interventional cardiology and the treatment of acute coronary syndrome.
The system has been designed to provide enough care on an everyday basis to treat cardiovascular patients, and this to some extent has been achieved. Nevertheless, there is always room for improvement, and in a few areas, we want to see certain things changed.
What obstacles have you encountered along the way to develop the cardiology system today?
Past challenges were centred around an under-supply of trained cardiologists and equipment as well as insufficient funds for the reimbursement of drugs in the cardiovascular area, although, as aforementioned, this has improved immensely.
First and foremost, today we have concerns that are paradoxically linked to the success of Polish cardiology as patients are now living considerably longer and we are witnessing more and more elderly patients with comorbidities. Therefore, cases are a lot more complex and they require a much broader approach to treatment, rather than just attacking a single cardiac disorder. This trend is easily explained statistically as there is a rising number of heart failure cases, the end result for many patients after years of chronic issues.
The second issue we are tackling is prevention, and we currently are attempting to place several ongoing projects under one collective umbrella movement. We have met with the Prime Minister to discuss a new national program, “The Heart”, focused on the prevention and treatment of heart failure. This campaign will be directed towards the entire nation and specifically the 12 million Polish people that are at risk of cardiovascular problems, and the one million that are already affected.
How are you educating the wider Polish population to develop a healthier lifestyle?
Establishing the national program for heart failure is not easy, though it is more difficult to alter the daily habits of the Polish people, compared to just treating them directly for a condition. In the past we have made large strides in areas such as dropping smoking rates, and have had some success in the treatment of hypertension and hypocholesteraemia. Nevertheless, this is centred more around treating the issue, rather than changing the overall mentality and promoting a more balanced diet and daily physical activity.
All in all, we must build awareness and are currently constructing a national campaign to be distributed across various platforms across the nation. We are targeting every demographic with this promotional campaign, but most importantly the younger generation. If the Polish youth are able to live healthier, than they will have a significantly lower chance of encountering problems further down the line.
What processes are involved in the hospital system to treat cardiovascular problems?
There has been a push in the healthcare system to create a specialist network of hospitals, and in general this is a good idea, though these centers are at the top of the treatment pyramid and only entail one percent of all cases. What really matters is the base of the pyramid, building up a coordinated system that allows patients that suffer from acute coronary syndrome to be properly treated.
Thus far our approach has been a great success as Poland is one of the European leaders in the interventional treatment of acute coronary syndrome with around 90 percent of patients being treated. Nevertheless, we now face the problem of post-discharge patient movement.
We have developed a structure approach, that has recently commenced and is being funded by the government, that allows patients to receive structured post-discharge care from physicians. Therefore, we are attacking each distinct area of the cardiovascular chain: prevention, treatment and post-discharge. We now view the patient as more of partner, working with us along each step of the path. Nevertheless, there are some patient regulations that have created obstacles, but the early signs of change are extremely encouraging.
How do you view the market access of innovative cardio-medicine here?
We are doing our best to improve the situation in Poland, and there is a large amount of room for improvement. We understand that cardiovascular care is expensive and must be evaluated within the context of available resources, though the Society feels a broader range of products should be available.
This is why the Society must build up a close relationship with governmental agencies and ensure that the Polish Cardiac Society is major stakeholder, and a partner, in the conversation. We understand that every technology is not always required, and want to help Poland understand what the nation needs, and which innovations should be truly valued and rewarded in cardiovascular care.
What potential does Poland have to be a European hub for cardiology?
Poland finds itself in a unique position, and we believe we have the chance to be considered as a hub for cardiovascular activity. The government´s “Morawiecki Plan” is positive step, as it aims to bring R&D to the forefront. We hope that the Polish Cardiac Society can take a leadership role in driving forward our aspect of healthcare innovation. Nevertheless, we can only act as partners as the government must be the ones that create favourable regulatory conditions to break down barriers and stimulate the nation´s wave of innovation.
What is the overriding goal of the Society moving forward?
Firstly, we want to continue the prevention campaign aimed at healthier young people and healthy ageing. Secondly, we want the Polish Cardiac Society to be viewed as a major stakeholder along the communication and treatment of cardiovascular disorders. We must work closely with all parties involved to build a strong value chain of prevention, awareness and management of care so Polish patients can receive world-class cardio-treatment.