Access to selected diagnostic procedures in the management of heart failure patients in Poland - POLKARD 2005.
BACKGROUND
Polish heart failure surveys from 1999 and 2005 indicated that non-invasive and invasive diagnostic procedures in heart failure patients are underused, mostly due to limited availability.


OBJECTIVE
To assess the access to procedures used for the diagnosis and treatment of heart failure in randomly selected outpatient clinics and hospital wards in Poland.


METHODS
The study was undertaken in 2005, as a part of the National Project of Prevention and Treatment of Cardiovascular Diseases - POLKARD. The data on non-interventional and interventional procedures were collected from 400 primary care units, 396 secondary outpatient clinics and 259 hospitals, and included cardiology or internal medicine departments. Additionally, the last five patients with diagnosed heart failures were identified, who visited outpatient clinics or were discharged from the hospitals, and their medical records of diagnostic procedures were analysed.


RESULTS
Echocardiography was not available in approximately 10% of hospital wards and 13-37% of outpatient clinics, both primary and secondary. Generally, the waiting time for echocardiography in Poland varied from region to region. A one-month waiting time was declared by more than 50% of secondary outpatient clinics and only 11-18% of primary care units, regardless of the community size. On the first day of hospital admission, echocardiography was performed in approximately 10% of patients of internal medicine wards and up to 36% of patients in cardiology departments. The assessment of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) was generally performed only in a few hospitals, usually in cardiology departments. In primary care units, it was practically not available. Percutaneous coronary interventions, pacemaker or cardioverter-defibrillator implantations were available in approximately 20% of city hospitals, 30-40% of province hospitals, and 60-70% of clinical wards of medical universities.


CONCLUSIONS
These data show limited availability of echocardiography in primary care units. It is necessary to continue actions for better accessibility and frequency of performing interventional procedures in patients with heart failure in Poland.
Wizner
Barbara
B
Department of Internal Diseases and Gerontology, Jagiellonian University Collegium Medium, Krakow, Poland. bwizner@cm-uj.krakow.pl
Dubiel
Jacek S
JS
Opolski
Grzegorz
G
Fedyk-Łukasik
Małgorzata
M
Zdrojewski
Tomasz
T
Marchel
Michał
M
Stompór
Małgorzata
M
Turek
Paweł
P
Czech
Marcin
M
Wyrzykowski
Bogdan
B
Mogilnaya
Irina
I
Jendrzejewski
Jarosław
J
Grodzicki
Tomasz
T
D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data; D014850:Waiting Lists