First-year follow-up costs of myocardial infarction management in Poland from the payer's perspective.

BACKGROUND: Myocardial infarction (MI) remains a major burden for healthcare systems. Therefore, we intended to analyze the determinants of cost management of patients hospitalized for MI in Poland. METHODS: Data on patients hospitalized and discharged with the diagnosis of acute MI were derived from the public payer claims database. Adult patients, reported between October 1, 2017 and December 31, 2019, were included. Costs of hospitalization for acute MI and cumulative one-year follow-up were analyzed. RESULTS: The median (IQR) of the total direct cost was €3804.7 (2674.1-5712.7) per patient and 29% (€1113.6 [380.5-2490.4]) of these were costs related to the use of post-hospitalization healthcare resources. The median cost of cardiovascular disease management was €3624.7 (2582.1-5258.5), and 26% of this sum were follow-up costs. The analysis of the total cost for individual years showed a slight increase in median costs in subsequent years: €3450.7 (2407.8-5205.2) in 2017, €3753.8 (2642.6-5681.9) in 2018, and €3944.9 (2794.8-5844.4) in 2019. Male sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke in addition to hospitalization in a department other than cardiology or internal disease were independently related to the cost of MI patient management. CONCLUSIONS: The high cost of management of MI patients was independently related to sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke as well as hospitalization in other than cardiology or internal disease department.

Telemedicine solutions in cardiology: a joint expert opinion by the Information Technology and Telemedicine Committee of the Polish Cardiac Society, the Section of Noninvasive Electrocardiology and Telemedicine of the Polish Cardiac Society, and the Clinical Research Committee of the Polish Academy of Sciences (short version, 2021).

Telemedicine involves diagnostic, therapeutic and educational services being offered remotely by healthcare professionals to exchange crucial clinical information. It is a rapidly developing form of medical activity and part of medical industry, with advanced technologies already available in Poland. Cardiology is one of the fields in which telemedicine methods were pioneered and introduced into everyday practice. Some of these methods have already become standard procedures for diagnosis and treatment in some Polish centers, with other soon to follow. Clinical study results not only demonstrate reliability and usefulness of telemedicine technologies but also show that their use in clinical practice improves the patients' prognoses and quality of life. Moreover, study results in highly developed countries show a potential cost-effectiveness of telemedicine from the perspective of healthcare systems. There is an unquestionable need to establish clear rules for telemedicine use in Poland, which would ensure their high quality and adequate clinical application. This paper is a summary of the current status of telemedicine solutions used in cardiology, with a particular focus on the Polish healthcare system, and presents both the commonly available solutions and those that are expected to develop rapidly in the near future.

Electrocardiographic algorithms to guide the management strategy of idiopathic outflow tract ventricular arrhythmias.

INTRODUCTION    The current guidelines of the European Society of Cardiology outlined electrocardiographic (ECG) differentiation of the site of origin (SoO) in patients with idiopathic ventricular arrhythmias (IVAs). OBJECTIVES    The aim of this study was to compare 3 ECG algorithms for differentiating the SoO and to determine their diagnostic value for the management of outflow tract IVA. PATIENTS AND METHODS    We analyzed 202 patients (mean age [SD]: 45 [16.7] years; 133 women [66%]) with IVAs with the inferior axis (130 premature ventricular contractions or ventricular tachycardias from the right ventricular outflow tract [RVOT]; 72, from the left ventricular outflow tract [LVOT]), who underwent successful radiofrequency catheter ablation (RFCA) using the 3­dimensional electroanatomical system. The ECGs before ablation were analyzed using custom­developed software. Automated measurements were performed for the 3 algorithms: 1) novel transitional zone (TZ) index, 2) V2S/V3R, and 3) V2 transition ratio. The results were compared with the SoO of acutely successful RFCA. RESULTS    The V2S/V3R algorithm predicted the left­sided SoO with a sensitivity and specificity close to 90%. The TZ index showed higher sensitivity (93%) with lower specificity (85%). In the subgroup with the transition zone in lead V3 (n = 44, 15 from the LVOT) the sensitivity and specificity of the V2-transition­ratio algorithm were 100% and 45%, respectively. The combined TZ index+V2S/V3R algorithm (LVOT was considered only when both algorithms suggested the LVOT SoO) can increase the specificity of the LVOT SoO prediction to 98% with a sensitivity of 88%. CONCLUSIONS    The combined TZ­index and V2S/V3R algorithm allowed an accurate and simple identification of the SoO of IVA. A prospective study is needed to determine the strategy for skipping the RVOT mapping in patients with LVOT arrhythmias indicated by the 2 combined algorithms.

[Treprostinil therapy for distal chronic thromboembolic pulmonary hypertension]. / Obwodowa postac przewleklego zakrzepowo-zatorowego nadcisnienia plucnego. Trudnosci diagnostyczne, nowe mozliwosci terapeutyczne.

We present a case of a 77-year-old female with distal chronic thromboembolic pulmonary hypertension. Diagnostic and therapeutic difficulties are discussed. Clinical and haemodynamic benefits resulting from treprostinil therapy added to continuous anticoagulation are shown.

[Congestive heart failure and continuous murmur in patient after lumbar disc surgery--a case report]. / Zastoinowa niewydolnosc krazenia i szmer maszynowy u chorej po operacji przepukliny dysków ledzwiowych--opis przypadku.

We present a case of a 61-year-old female who was admitted to the hospital with symptoms of congestive heart failure. Diagnosis of arteriovenous fistula was suggested by the echocardiographic signs of high-output state and a continuous murmur heard especially close to the surgical scar from an intervention on the L4-L5 disc that the patient had undergone eight months before. Aortography confirmed arteriovenous fistula between the right common iliac artery and inferior vena cava. After surgical closure of the fistula, normal cardiac function was restored.