EAPC Country of the Month - Poland

National CVD Prevention Coordinator for Poland:

Piotr Jankowski
Professor, Cardiologist
Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
Department of Cardiology, University Hospital, Kraków, Poland

email

Health care | Risk factors | Prevention methods | Prevention activities | Cardiac Rehab. | Future

Documents to download

• Full report
• CV and Publications P.Jankowski

Health Care

The Polish health system relies on the principle of solidarity: the National Health Fund covers the cost of the health services required by a person in case of illness regardless of the amount of social tax paid by that person.

The fundamental role of primary health care is disease prevention, treatment, assistance, coordination and the integration of different services. Currently, the whole population is covered by a network of primary care physicians. In 2010, Poland had 2.1 practising physicians per 1000 inhabitants, well below the European Union (EU) average. Furthermore, the number of practising nurses per 1000 inhabitants in the country, i.e. 4.9 was also below the EU average. Health and medical care costs account for about 7% of Poland's gross domestic product (GDP). The average for the EU is 9.8%.

Risk factors

The average life span in Poland is 72.7 years for men (about 4.7 years lower than the EU) and 81.2 years for women (about 2.0 years lower compared to the EU average). The sex-based difference in the average life span has not changed significantly over the last 20 years. The age-standardised death rate (SDR) for cardiovascular diseases has decreased since 1991 by 48%. Nevertheless, it is still 50% higher compared to the average SDR in the EU (58% higher in men and 43% higher in women).

Prevention methods and main actors

The main authorities acting in the prevention area are:

• Ministry of Health: Formulates and evaluates policies for health and the strategic planning of health services.

• National Institute of Public Health - National Institute of Hygiene: Plays a fundamental role as the central government’s expert and supervisory institution

• Chief Sanitary Inspectorate: The main tasks, among others, includes prevention of smoking and overweight

• Agency for Health Technology Assessment in Poland: This body identifies the best treatment methods and the effective use of resources.

Prevention activities

• World Heart Day: In 2013, nationwide celebration of the World Heart Day was organised in Lublin, 2012 it was held in Kraków, and 2011 in Sopot, etc. The activities include walks, health checks and education. Additionally, many branches of the Polish Cardiac Society organise regional events.

• World No Tobacco Day & World Hypertension Day: Both events are celebrated in Poland every year

• Campaigns promoting physical activity: A number of events and campaigns promoting physical activity are organised each year.

• "Schools in movement": The year 2013 was announced by the Ministry of Education as the year of "Schools in movement". This campaign promotes physical activity and healthy food in schools and kindergartens.

• "Fruits at school": This campaign promotes healthy food at schools. In addition, in most schools pupils are given "second breakfast" consisting of fruits, vegetables and milk or fruit juice several times a week. The most important goal of the initiative is to change eating habits of children.

• The Polish Forum for Prevention of Cardiovascular Disease: This project was initiated by the Polish Cardiac Society, and is now supported by a number of other associations. The main goals are unification, promotion, and dissemination of guidelines on prevention of cardiovascular disease, education of policy makers, physicians and patients.

• "Remember about the heart!": This project aims at the promotion of healthy lifestyle and prevention of cardiovascular disease. The project addresses both adults and children.

• The Optimal Model of Comprehensive Rehabilitation and Secondary Prevention: (see below)

Cardiac Rehabilitation

First stage of rehabilitation usually starts in the cardiology or cardiac surgery departments. The second stage is usually provided by specialised rehabilitation centres. Most of them are hospital-based and provide in-hospital or outpatient rehabilitation, or both. There are also some centres providing only outpatient rehabilitation. The number of these centres is now increasing. Nevertheless, still the vast majority of patients participating in cardiac rehabilitation participate in an in-hospital programme.

The content and duration of the programmes may differ between centres but the in-hospital rehabilitation usually lasts 2-4 weeks whereas outpatient rehabilitation about 12 weeks. About 20% of all patients undergoing heart surgery or suffering from an acute coronary syndrome participate in a stage II rehabilitation programme. This proportion is higher (over 30%) in some big cities and differs significantly across the country.

In order to improve access to and quality of secondary prevention and rehabilitation programmes the Polish Cardiac Society proposed "the Optimal Model of Rehabilitation and Secondary Prevention". This idea covers not only patients after heart surgery or acute coronary syndrome but also patients with heart failure and stable coronary artery disease. Additionally, the experts proposed quality assurance of the service provided to the patients based on the level of risk factors control 6 months after the end of the program.

Aims for the future

• We plan to develop national registers of lifestyle and risk factor parameters and to encourage joint cardiovascular prevention activities within the healthcare system (in primary, cardiac and geriatric care settings).

• We plan to increase proportion of patients after heart surgery or an acute coronary syndrome or with heart failure participating in the rehabilitation programmes.

• We aim at creating the possibility for patients with stable coronary artery disease (CAD) to participate in an education programme.

• The young population should be seen as the main target of the national projects aiming at changing lifestyle of the population.

• Finally, we should aim at a smoke-free country by the year 2030.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology