Heart to heart

Over the last few months, as people all over the world were stricken with worry over the imminent threat of COVID-19 and media reports from hospitals focused almost exclusively on infectious disease departments, other hospital wards were full of patients fighting the diseases which, regrettably, continue to haunt us as the most common causes of death: the cardiovascular diseases.

In Poland, in the male population, cardiovascular diseases (CVDs) are still a top cause of death among men aged 45+, and the share of CVD-related deaths goes up systematically with age. 1 Among women aged 80+, CVDs are the most common cause of death, accounting for 59 percent of all deaths. Such distribution of deaths by main groups of causes in Poland has not changed for years.

Statistically, one in four people killed by a heart attack die before they are taken to hospital. Why is that? Because they

1 https://www.mp.pl/pacjent/chorobawiencowa/ aktualnosci/217765,zadbaj-o-swoje-serce 2017 report. waited too long before they decided to seek help. In Poland, about 2.5 hours pass between the first symptoms of the heart attack and medical aid. For comparison: on average, it takes about an hour for an ambulance to bring a heart attack patient to hospital. Sadly, the number of heart attack cases in Poland increased by 8% in the last five years, and men outnumber women in the statistics.

Women are naturally equipped with the hormones that protect them from heart attacks – the estrogens. That is the reason why atherosclerosis of the coronary arteries and myocardial infarction are less frequent in young (under 55 years of age) and very young women (under 40 years of age), as compared to men of the same age. Unfortunately, women often suffer from other cardiovascular problems, for example a stroke, which is reported every 8 seconds, on average, in Poland. 2

In the case of a hemorrhagic stroke, mortality rate is as high as 50 percent. In the case of an ischaemic stroke (80% of all stroke cases), 45 percent of the patients have a disability and need assistance in the activities of daily living.

We have all heard about cardiovascular diseases, almost everyone has a relative or a friend with a CDV. A study commissioned by Unum Życie TUiR S.A. has shown that 37 percent of Poles are concerned about the risk of cardiovascular diseases. Awareness is one thing, but the lifestyle we succumb to, even though we should know better, is another thing.

Obesity, prolonged stress, tobacco smoking, sedentary lifestyle, bad sleeping habits, unhealthy and fatty diet, alcohol abuse – that is the list of the most serious sins for which we will have to pay in our own health. The list continues with aversion to regular health check-ups and cholesterol tests, fitness and physical activity... paving the way for atherosclerosis, heart attack or stroke.

As our health deteriorates, we face grave consequences, extremely costly for us and our loved ones: loss of a job or ability to work, resulting in a loss of the source of income. Especially now, when access to health care is more difficult than usually, patients may find it hard to make an appointment and get their medical tests done. This can be the reason why we search for alternatives in a private healthcare facility, which entails additional expenses. And as the budgets get tighter, we may not be able to pay for all the drugs prescribed by a physician... which creates something of a vicious circle. When we lose our source of income, we are more likely to give up rehabilitation or the purchase of equipment necessary for convalescence and home adaptation to the needs of a person after a stroke or heart attack. Financial hardship and forced resignation from some aspects of effective medical treatment add to the stress, and we all know that peace of mind is essential for a patient during convalescence. Luckily, these gloomy prospects need not be materialized. A lot depends on our attitude and actions.

FUTURE IN OUR HANDS

Even a small change in our daily habits and routines can bring us closer to a healthy lifestyle. For a start, we should: • Cut down on sugar, caffeine, alcohol, • Eat low-fat meals, vegetables, fruit, fish, lean meat, • Go for long walks and take up outdoor activities, • Gradually increase the rate of physical activity, in line with the signals sent by our body, which will surely appreciate such a change in lifestyle, • Get enough sleep, • Find time for relaxation and good rest, keeping stress to the minimum. This can help us keep the heart attack at bay, and it can also give us a sense of control over the course of our life and over our health. The heart will certainly pay us back with the currency of fitness, good blood pressure, and better condition – physically and mentally. A sound mind in a sound body, as they say. As a next step,

medical consultation is due. – For full diagnostics, I would suggest a three-stage cycle of complementary tests and examinations. First, patient’s medical history should be taken. It is a detailed and exhaustive fact-finding interview that helps determine the nature of the health problem and the dynamics of the symp toms. It is necessary to differentiate between the causes of specific symptoms, assess the risk of family prevalence, and the risk of a hereditary cardiovascular disease. Based on the conclusions from the patient’s medical history, a decision on additional tests and examinations can be taken (e.g., ECG (electrocardiogram), echocardiography, exercise test). Then, a physical examination should be performed, covering – in its basic scope – the assessment of the vital parameters – says Mariusz Kujawski, MD, Cardiology and Echocardiography Consultant.

The assessment of vital signs can be done as part of self-examination. It is nothing more than a regular measure ment of weight, waist circumference, BMI (body mass index), blood pressure measurement (importantly: on both arms – the acceptable difference in systolic blood pressure is 20 mmHh). To take the measurement correctly, the person should be in a peaceful and quiet environment, after at least a few minutes of rest, a period of calm after stress or physical effort. Other important vital parameters include: heart rate (HR), saturation – the degree of haemoglobin saturation with oxygen. It is also important to verify that the ankles and the lower legs are not swollen. – Another key step a doctor will order is some additional examinations: peripheral blood count (with quantitative evaluation of blood cells, haemoglobin, platelets), the eGFR creatinine (estimated glomer ular filtration rate of the kidneys), ionogram for the Na (sodium), K (potassium), Mg (magnesium), Ca (calcium), fasting glucose, glycated haemoglobin, liver enzymes (AspAT, AlAT), lipids (cholesterol fractions, e.g.: HDL, LDL and triglycerides), homocysteine, uric acid, basic hormones (TSH, f T 3, f T 4), cortisol, testosterone. For other tests: urinalysis. Additional imaging examinations: chest X-ray, ECG, echocardiogram, abdominal ultrasound – MD Mariusz Kujawski adds. The recommended frequency of examinations and tests depends on the patient’s individual characteristics, but the rule of thumb is: the greater the burden of disease and the risk factors indictive of cardiovascular complications, the more frequent the screening. This is the way to identify the threat at an early stage and quickly administer effective treatment, with minimized risk of cardiovascular events such as myocardial infarction, stroke or sudden cardiac death.

Apart from our physical wellbeing, we should also focus on our peace of mind and future financial security. All the more so when we realize that saving for the future is not one of our top strengths in Poland. According to a study 3 commissioned by Unum Życie, over 37 percent of the respondents had to stop working for a longer period due to health problems, and one in three, statistically, was disabled for 6-12 months. Respondents were asked about their savings in case of illness or accident. It urned out that 65 percent of the respondents had enough money set aside to help them get by for 3 months, at the maximum. Only 15 percent had enough resources to keep them afloat for more than 6 months without income. Under the circumstances, what can we do, financially, to cover all the expenses generated by a health crisis? We can buy an insurance policy, for example. Life insurance is basically a must in every family, but the market also offers cardiology riders. What is the benefit? In the event of a disease included in the coverage (such as stroke, heart attack, cardiomyopathy, primary pulmonary hypertension, ascending aorta aneurysm, among others), the insureds are eligible for a monetary benefit that may be as high as PLN 500 000, to pay for the therapy. Any health crisis can turn a family's life upside down and force the patient's loved ones to reorganise their lives. Fortunately, Assistance services (included in the insurance coverage) come to rescue. They offer a 24-hour access to a helpline to arrange transportation to a hospital or a doctor, medical consultations, sophisticated examinations, even rehabilitation. It is a useful alternative to public health services, especially when we look at the 2018 data, for example. In that year, 1.5 million people who had had a stroke were waiting for rehabilitation services (provided by the NHS). An insurance policy with Assistance services can relieve

the patient and their relatives of this

3 An omnibus survey of a representative sample of Poles aged 18+, N=970, based on the TAPI technique, conducted by Ipsos on behalf of Unum Życie, April 2019. burden, providing not only the funds, but also logistical support and coverage of the cost of examinations, nursing care, medical visits or rehabilitation.

Recently, we have all had a wake-up call in terms of health and security risks. Although not everything can be predicted, a lot is in our hands. Awareness makes a difference. We should take wise decisions to be prepared in emergency, and tackle the challenge with composure and effectiveness.

Author:

press secretary, Unum Życie TUiR S.A.