Heart disease kills 450,000 Ukrainians annually

Some 2.4 million new cases of cardiovascular disorders are registered in the nation’s hospitals annually. In recent years, the incidence of heart disease has increased one and a half times, killing 450,000 Ukrainians annually.

Experts of the Amosov Research Institute of Cardiovascular Surgery believe that well over 35,000 patients need heart surgery. These include patients with congenital and acquired heart disease, ischemic disease, and arrhythmia. Each year six thousand Ukrainian children are diagnosed with congenital heart disease, while nearly forty thousand children aged under fourteen suffering from heart disorders are registered.

Such a high incidence is due to the Ukrainians’ lifestyle, carelessness about one’s health, belated diagnosis, and socioeconomic factors. In other words, growing cardiovascular disease incidence in Ukraine is due to constant mental and emotional stress, bad habits, and intake of foodstuffs rich in salt, fat, and cholesterol.

However, it is noteworthy that Ukraine has seen some positive shifts in the sphere of medical assistance provided to heart patients. Specialized inpatient care is becoming more accessible to rural population, and new effective drugs appear on the market. Moreover, Ukraine has the required laws that provide for prevention and treatment of cardiovascular disease, and the Program of Prevention and Treatment of Arterial Hypertension is implemented. The Amosov Research Institute of Cardiovascular Surgery and regional centers perform up to 6,000 heart surgeries annually with a mortality rate of 3.6%, which quite meets European standards. But the fact remains that only 6,000 patients undergo surgery of 35,000 patients who need it, while the remaining 29,000 never live to receive the required treatment.

The Day approached the experts with the question of what should be done in Ukraine to reduce the spread of cardiovascular disease, what problems the doctors face, and what progress they have made.

COMMENTARY

Andriy PIDAYEV, Ukraine’s Health Minister:

“The high incidence of cardiovascular disease is a global problem. However, Ukraine has higher disability and death rates from cardiovascular disease among younger patients. The scale of the disease is quite extensive: it kills 130 working age Ukrainians each day. This causes significant losses of human and economic potential and shortens life expectancy. Also worrying are forecasts that do not predict any improvements in the situation, unless we take scientifically founded steps backed with adequate funding and government support.

“Currently, the major reason behind the spread of cardiovascular disease is the fact that many people are overweight and lack physical workout. Moreover, a vast majority of Ukraine’s population is subject to constant mental and emotional stress. Preventing cardiovascular disease is a national priority in Ukraine, which is evidenced by a number of nationwide programs such as the Health of the Nation Program, Arterial Hypertension Prevention and Treatment Program, along with measures to develop heart surgery.

“The developed countries have succeeded in creating a system of preventing, early diagnosis, and treatment, which helped to significantly reduce mortality. However, it is not advisable to blindly follow in their footsteps, since our country has a number of social, economic, medical, and demographic factors that make it different. At present, Ukraine should develop its own system suited to our national resources. We should work in three major directions, that is, increasing public awareness of heart disease and encouraging preventive treatment, enhancing medical services, and upgrading equipment.

“As for increasing public awareness and encouraging preventive treatment, this should be done on the widest possible scale, since a vast majority of Ukrainians is in the high-risk group. It should be made clear that combating cardiovascular disease is not the province of medics alone, since early diagnosis and effective treatment depend to a great extent on the level of public awareness.

“Speaking of enhancing medical services, emphasis should be made on outpatient facilities, since their proper functioning can help reduce mortality from cardiovascular disorders.

“As far as equipment and resources are concerned, above all else we must make sure that the registered patients have at least one electrocardiogram and echocardiogram performed once a year, along with blood tests for lipids and sugar. Moreover, we must start the production of drugs that have been proven capable of reducing mortality and complications in patients.”

Hennady KNYSHOV, director of the Amosov Research Institute of Cardiovascular Surgery, academician of the Ukrainian National Academy of Sciences:

“Despite the accessibility of Ukrainian cardio surgery and the professional level of our medics, we understand that it is time to restructure the existing mechanisms. Of course, we need financial backing from the government: we must upgrade our equipment, which is hopelessly outdated in some respects; we must increase salaries of surgeons and assistant personnel. But even if our needs are funded in full, we will be able to improve the level of heart surgery, but not solve the problem altogether. We keep increasing the number of surgeries, set goals and achieve results, which meet European standards according to many indices. However, even despite the high incidence of heart disease in Ukraine, the fact remains that neither our institute nor the regional centers have any patients on the waiting lists: we operate on all patients that are referred to us. There are a few reasons behind this, low awareness of the population being one of them. The common belief is that heartache and high blood pressure are therapeutic problems. Many cardiologists go along with the patients and prescribe drugs to treat the disorders and monitor the course of the disease at a time when surgery is needed. The institute can perform nearly five thousand surgeries a year, which is the maximum we can handle. This is why we should expand the regional centers in Donetsk, Zaporizhzhia, Dnipropetrovsk, Lviv, Kharkiv, and Odesa. There are plans to open a similar center in Cherkasy. Precisely these structural divisions should perform simple surgeries, while the institute will do research, introduce new methods, and perform complex surgeries.”

Illia YEMETS, director of the Research and Practical Medical Center of Children’s Cardiology and Cardio Surgery:

“The government and parliament pay special attention to children’s cardio surgery. This has made it possible to open a separate Center of Children’s Cardiology and Cardio Surgery and significantly improve the functioning of this direction of heart surgery. Over UAH 10 million worth of equipment has been bought for the center, which had its resuscitation unit, diagnostics department, and artificial blood circulation laboratory reequipped. Owing to the new opportunities created for the children’s cardio surgery service, the center has seen significant improvements: since September 1, 2003 it has performed 92 surgeries and provided consultations to 392 patients. Congenital heart disease is a complex pathology that has been on the rise of late. Before the center was opened, only 20 to 30% of all children under one year who need surgery could undergo one. However, thus far we have solved only some of the problems. We have extensive plans that will make it possible to reduce mortality and disability among children with congenital heart disease. We would like to develop the cardiologic service across Ukraine, pursue research in the sphere of similar pathologies, introduce screening for expectant mothers, build major inpatient units, where we could monitor postoperative patients.”