The in-hospital mortality following myocardial infarction has decreased substantially over the last two decades in Poland. However, according to the available evidence approximately every 10th patient discharged after myocardial infarction (MI) dies during next 12 months. We identified the most important barriers (e.g. insufficient risk factors control, insufficient and delayed cardiac rehabilitation, suboptimal pharmacotherapy, delayed complete myocardial revascularisation) and proposed a new nation-wide system of coordinated care after MI. The system should consist of four modules: complete revascularisation, education and rehabilitation programme, electrotherapy (including ICDs and BiVs when appropriate) and periodical cardiac consultations. At first stage the coordinated care programme should last 12 months. The proposal contains also the quality of care assessment based on clinical measures (e.g. risk factors control, rate of complete myocardial revascularisation, etc.) as well as on the rate of cardiovascular events. The wide implementation of the proposed system is expected to decrease one year mortality after MI and allow for better financial resources allocation in Poland.

The definition of heart failure (HF) phenotypes is relatively new. There is scarce evidence on the true characteristics of patients with HF in the Polish population, which are classified into three categories. The presented study provides a broad characterization of the relevant phenotypes of patients hospitalized for HF. Furthermore, the information retrieved from the electronic database was validated for the diagnosis of HF, which makes a significant difference compared to studies based on the electronic registry. Furthermore, we identified predictors for each HF subtype. Conclusions: To our knowledge, this is the first publication on different subtypes of HF with a confirmed diagnosis, providing a broad description of hospitalized patients with HF of the Polish population.

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Background: Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland. Methods: We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause. Results: The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44–4.88]), consultation with a cardiologist (7.32 [6.83–7.84]), implantable cardioverter-defibrillator (1.40 [1.22–1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22–2.03]) but lower odds of emergency (0.88 [0.79–0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83–0.93]) and coronary artery bypass grafting (0.82 [0.71–0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% ( P <0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% ( P <0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures. Conclusions: Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.

It is important to monitor equity of access to health services in all countries. We assessed the levels of out-of-pocket (OOP) health spending in three European countries: Denmark, Germany and Poland. Using data from national databases (i.e., Statistics Denmark, German Socio-Economic Panel, and National Statistical Office of Poland) for the period 2000-2010, we applied common methods to assess the rate of households with 'catastrophic' OOP health spending and the concentration of health spending in income-ordered groups of citizens. 20.3 per cent of Polish households experienced 'catastrophic' expenditure defined by OOP health spending/income ratio >10 per cent, compared to 1.0 per cent of households in Germany and 3.2 per cent of households in Denmark. 8.8 per cent of Polish households experienced 'catastrophic' expenditure defined by OOP health spending/capacity to pay ratio >40 per cent, compared to 0.4 per cent of households in Germany and 0.8 per cent of households in Denmark. Concentration indexes for OOP on drugs in 2010 were 0.01978 and -0.114 for Denmark and Poland, respectively. The rate of households with 'catastrophic' OOP expenditure in Poland is much higher than in both Denmark and Germany; health spending in Poland is concentrated among the worst-off groups of citizens while in Denmark and Germany they are distributed more equitably.