Narodowy Program Wyrównywania Dostępności do Profilaktyki i Leczenia Chorób Układu Sercowo-Naczyniowego POLKARD na lata 2013–2016

Objectives

POLKARD 2013–2016 is Poland’s National Programme for Equalising Access to Prevention and Treatment of Cardiovascular Diseases. Its central aim is to reduce equipment-related inequalities in access to highly specialised cardiovascular prevention, diagnosis, treatment and rehabilitation, thereby contributing to lower cardiovascular morbidity, mortality, disability and the economic consequences of premature death.[1][2]The programme responds to cardiovascular disease as a major health, social and economic burden, responsible for more than 45% of deaths in Poland and a leading cause of premature mortality.[3]

• Improve access to specialised cardiology, cardiac surgery, paediatric cardiology, neurology, neurological rehabilitation, vascular surgery, internal medicine and stroke services through the purchase or replacement of essential equipment.[1][2][4]
• Strengthen diagnostic and treatment capacity for acute coronary syndromes, cardiac rhythm disorders, heart failure, vascular disease, stroke and post-stroke rehabilitation.[5][4][6][7]
• Reduce cardiovascular risk through nationwide education and information activities addressing smoking, unhealthy diet, obesity, physical inactivity, hypertension, hypercholesterolaemia and other modifiable lifestyle-related factors.[1][8][9][2]
• Expand early detection through screening for abdominal aortic aneurysm and lower-limb arterial atherosclerosis, with referral pathways for people requiring specialist assessment or treatment.[10][11][12]
• Develop epidemiological knowledge and specialist standards for venous leg ulceration, including improved access to diagnosis, treatment and counselling.[13][14][15]
• Maintain national information systems for cardiac surgery and acute coronary syndromes, and use epidemiological studies to monitor cardiovascular risk factors, mortality and hospitalisation.[4][16][17]
• Provide selected innovative treatment, including transcatheter MitraClip repair for high-risk patients with severe symptomatic mitral regurgitation who are not eligible for cardiac surgery.[4][18]

Implementation

The programme combines capital investment, prevention, screening, specialist clinical care and epidemiological surveillance. The Minister of Health finances health-policy tasks, while healthcare providers and selected organisations deliver equipment, education, screening, registry and research activities.[1][19][20]Health benefits are generally financed by the National Health Fund, whereas organisational initiatives, new healthcare solutions, health education and necessary equipment may be supported through the Minister of Health’s budget.[19]

• Equip hybrid operating rooms in experienced cardiac surgery and interventional cardiology centres with digital angiography and supporting anaesthetic, ventilation, extracorporeal-circulation, haemofiltration, counterpulsation, infusion, defibrillation and transport equipment.[21]Develop at least one suitable multidisciplinary hybrid centre in each voivodeship to support round-the-clock care for acute coronary syndromes, stroke, acute ischaemia, embolism, aneurysms and thrombosis.[22]
• Purchase specialised equipment for vascular surgery and interventional radiology, including motorised C-arm X-ray systems for endovascular procedures; equip stroke units and interventional stroke centres with diagnostic, ventilation, anaesthesia, monitoring and information technology equipment; and supply rehabilitation departments with feedback, motor-training and virtual-reality technologies.[6][23][24]
• Strengthen internal medicine departments lacking cardiac intensive-monitoring capacity through haemodynamic monitors and central-monitoring computer stations, supported by blood-pressure monitoring, pulse oximetry and electrocardiography.[7][25]
• Deliver abdominal aortic aneurysm screening using ultrasound for men aged over 65 with at least three cardiovascular risk factors, provide follow-up for identified cases, and arrange specialist referrals or surgical qualification where indicated.[11][12]
• Implement lower-limb atherosclerosis detection in two stages, initially across Lubusz, Greater Poland, West Pomeranian, Lower Silesian, Opole and Silesian voivodeships before extending nationally.[12][13]
• Use primary healthcare screening, epidemiological questionnaires, specialist referral and a coordinating centre to assess venous leg ulceration; finance vascular-clinic consultations and investigations while avoiding duplication with services covered by National Health Fund contracts.[15]
• Conduct the WOBASZ II national health survey using questionnaires, clinical and laboratory measurements to assess cardiovascular risk factors, nutrition, quality of life, social support, depression and medicine use across regions.[16]
• Select implementing organisations through competitive procedures, with task-specific criteria published in competition notices and a Competition Committee appointed by the Minister of Health.[18][20]
• Assign operation of the National Register of Cardiac Surgery Operations to the Children’s Memorial Health Institute and the Nationwide Registry of Acute Coronary Syndromes to the Silesian Centre for Heart Diseases in Zabrze.[26]
• Require implementers to contribute at least 15% towards equipment and apparatus purchases where the specialist equipment exceeds 10,000 złoty per unit.[19]

For 2016, planned expenditure comprised 844,911 Polish złoty for current tasks and 18,725,092 Polish złoty for capital expenditure.[27]Continuation after programme support is expected primarily from hospital founding bodies and directors, National Health Fund contracts and subsequent programme editions.[26]The available material does not specify a consolidated performance framework, reporting timetable or formal accountability arrangements beyond registries, epidemiological monitoring and competitive selection.[28][20][26]

Monitoring & Evaluation

POLKARD 2013–2016 combines programme monitoring with epidemiological surveillance, clinical registries, screening and service-capacity data. Medical registers are intended to record disease occurrence, health status, diagnosis, treatment, treatment progress and related risks, while national registries cover cardiac surgery and acute coronary syndromes.[29][4][17][26]However, the material does not set out a consolidated performance framework, common reporting timetable, evaluation methodology, targets or formal accountability arrangements for the programme as a whole.[28][2][20][26]

• Monitor cardiovascular risk factors through national studies, including WOBASZ II, which uses questionnaires, clinical measurements, laboratory testing and analyses of nutrition, quality of life, social support, depression and medicine use.[16][17]
• Collect data from approximately 4,500 participants in 2013 towards a target sample of 7,000 people across eight provinces, to assess risk-factor prevalence, control and treatment and changes over an eight-year period.[16]
• Track premature and overall cardiovascular mortality and hospitalisation by age, sex and disease entity; historical data show cardiovascular mortality among people aged 25–64 fell from 251 to 198.7 deaths per 100,000 men and from 75 to 56.7 per 100,000 women between 2002 and 2011.[30][16]
• Use hospital activity and outcome measures, including admissions by diagnosis, hospitalisation rates, average length of stay and in-hospital mortality. In 2011, there were 1,082,652 cardiovascular hospitalisations, including 291,012 for ischaemic heart disease, 169,239 for heart failure and 124,839 for cerebrovascular disease.[30][31][32]
• Report specialist-service indicators, including planned and unplanned coronary surgery, patients treated in cardiology and cardiac-surgery wards, paediatric activity and inpatient stay. In 2008, 9,647 planned and 3,793 unplanned coronary operations were recorded.[33]
• Monitor implementation of screening programmes through coverage, follow-up, referrals and treatment qualification. The abdominal aortic aneurysm programme envisages screening 20,000 men and annually following 800 men, with a target 45% reduction in mortality associated with ruptured aneurysm.[11]
• Assess lower-limb arterial atherosclerosis prevalence, primary-care diagnostic effectiveness and participants’ cardiovascular risk factors; evaluate venous leg ulceration using primary-care screening, patient questionnaires and information submitted to a coordinating centre.[12][13][15]
• Draw more extensively on information from the Central Statistical Office and the Social Insurance Institution.[28]Data limitations include multi-year delays in availability and the absence of a dedicated Central Statistical Office publication on cardiovascular-disease statistics.[34]
• Use competitive selection procedures for financed tasks, with criteria specified in individual competition notices; the Children’s Memorial Health Institute operates the National Register of Cardiac Surgery Operations and the Silesian Centre for Heart Diseases in Zabrze operates the Nationwide Registry of Acute Coronary Syndromes.[20][26]

Costing & Financing

POLKARD is financed principally from the budget of the Minister of Health, with health benefits generally assigned to the National Health Fund.[29][19]The 2013–2016 programme financing total is stated as 59,360,041.10 Polish złoty, although future annual funding is subject to one-year budget planning and Ministry decisions.[29][35]The programme is predominantly capital-based because implementers cannot generally fund essential equipment from their own resources; resources for cardiovascular prevention and treatment have been characterised as insufficient relative to needs.[36][37]

• Allocate 10,516,909.10 Polish złoty in 2013, 13,344,129 Polish złoty in 2014, 15,929,000 Polish złoty in 2015 and 19,570,003 Polish złoty in 2016 from the Minister of Health budget.[29]
• Plan 844,911 Polish złoty for current expenditure and 18,725,092 Polish złoty for capital expenditure in 2016.[27]Capital allocations include hybrid operating rooms, paediatric cardiology haemodynamic equipment, vascular-surgery imaging, stroke-care and rehabilitation equipment, and internal-medicine monitoring systems.[27][20]
• Maintain a capital-led expenditure profile: capital tasks represented 70% of POLKARD expenditure in 2003–2005, 75% in 2006–2008 and 77% in 2009.[37]Implementers used 94% of allocated funds in 2009–2010 and 87% in 2012.[37]
• Require implementers to contribute at least 15% towards equipment and apparatus purchases where specialist equipment costs more than 10,000 Polish złoty per unit.[19]Local government participation is envisaged for health education and diagnostic and treatment infrastructure.[19]
• Exclude services reimbursed under National Health Fund contracts from programme-funded implementation costs, including relevant screening and venous leg-ulcer activities.[11][13][15]
• Fund MitraClip repair from current expenditure during 2013–2015, but plan no 2016 allocation after its inclusion among guaranteed highly specialised services, in order to avoid duplicate financing.[18]
• Recognise a wider economic burden: a European Society of Cardiology estimate places annual cardiovascular-disease treatment costs in European countries above 169 billion euros.[35]The material does not specify a quantified programme funding gap, detailed economic assumptions or resource-mobilisation strategy beyond ministerial, National Health Fund, local-government and implementer contributions.[35][18][19]