In order to reduce mortality of patients from the cardiovascular disease in Vinnytsia region, implementation of the World Bank joint investment subproject «The component of the health care system of Vinnytsia region aimed at improving medical care to patients with cardiovascular pathology» has been proposed.
The objective of the subproject is to reduce acute mortality caused by cardiovascular diseases (heart attacks and coronary heart disease) by improving the efficiency of the secondary health care level.
Serious problems in providing medical care to the population of Vinnytsia region with cardiovascular diseases, especially coronary heart disease and myocardial infarction, have become the basis for the selection of the subproject.
The work on Subproject started in 2013. According to medical statistics, in the year 2012, 365 thousand cases of coronary heart disease, over 100 thousand patients of working age, almost 1.5 thousand acute myocardial infarctions including 435 patients of working age and 1.6 thousand cases of complex arrhythmias were registered among adult population.
General cardiovascular morbidity in the region is 6231 per 10 thousand people, the national rate being 5839. The index in the region is 6.3% higher than in Ukraine. Every year, more than 15 thousand patients with coronary heart disease and 230 - 250 patients with myocardial infarctionin die of coronary heart disease in the region. During each year, 17.1 -18.1 thousand patients with acute coronary syndrome are registered; in 2.0 - 2.5 thousand patients, the drug therapy is ineffective, there are repeated heart attacks that cause mortality to 650 -700 people.
In the recent years, the expected life span has been most significantly affected by the level of adult mortality from cardiovascular diseases, which have become the most common pathology in the region. Excess losses are 5.5 years.
One of the reasons for the high death rate and low quality of medical care is the availability of only one institution with limited resources for provision of medical care to patients with cardiovascular diseases in the region - Multi-type Hospital of Vinnytsia, in which only one angiographic unit and limited human resources are available. Angiograph is used in the latest techniques of treatment of acute coronary syndromes and myocardial infarction. Opportunities for diagnostic and medical interventions for acute conditions are limited. Possibility for routine coronarographies and coronary stenting is 8 times lower than the actual need is.
An adequate recovery of coronary blood flow after percutaneous coronary interventions improves the overall survival of patients with coronary heart disease during a 5-year follow-up (five-year survival rate is 94-98%) compared with the control group (drug therapy, five-year survival rate is 82.0%). The best late fate after percutaneous interventions are found in the coronary stenting group (five-year survival rate is 98%).
Coronary stenting in patients with coronary heart disease does not exclude an acute myocardial infarction in late follow-up period but probably reduces not only the number of myocardial infarctions (during a five-year follow-up the number of acute myocardial infarctions is 2.5%) compared with the control group (during a five-year follow-up the number of acute myocardial infarction is 11.5%), but also decreases the level of fatal myocardial infarctions which has a positive effect on survival of patients.
Proposed Subproject will allow creating the conditions for reduction of mortality in the region, reducing the period of patient's stay in bed and early rehabilitation of patients with cardiovascular disorders through the implementation of novel methods of treatment.
Approximate indicators that allow evaluating the results of the Subproject implementation and achievement of its objectives are:
- reduction in mortality caused by acute cardiovascular diseases by improving the quality of medical care provided at the secondary level;
- strengthening flow management of patients with acute cardiovascular diseases by optimizing the current pathway, ensuring the compliance with local clinical protocols and forming an electronic registry of patients with cardiovascular diseases
- improving the quality of secondary health care and treatment effectiveness by concentrating technologies and improving the skills of medical staff (the creation of a regional center for cardiovascular diseases for 130 beds)
- improving patient satisfaction with medical services by providing short-term yet effective treatment;
- avoidance of disability and maintaining full working capacity in patients with cardiovascular diseases;
- the availability of highly qualified health services to all segments of the population
- the implementation of the Subproject will allow for more efficient use of resources in accordance with the needs of health care based on a single medical space.
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