Kiev. Ukraine. Ukraine Gate – February 12, 2021 – Health
According to the State Statistics Service, from January to October 2020, more than 325,000 people died of cardiovascular diseases in Ukraine. This figure exceeds the number of deaths from oncology and COVID -19 during this period several times! In addition, it is known that people with cardiovascular problems are generally more vulnerable to the virus, they are more likely to have complications. And COVID -19 provokes some cardiovascular diseases that occur later after recovery. How to treat children and adults with congenital or acquired pathology and whether it is possible to reduce mortality from cardiovascular diseases in Ukraine?
We are talking about this with Andriy Maksymenko, chief physician of the Center for Pediatric Cardiology and Cardiac Surgery.
Who suffers the most from cardiovascular disease? What age group is in the maximum risk zone?
It is impossible to single out any one group – cardiovascular diseases can appear at any age. They are the main cause of death and disability not only in our country but all over the world. In Ukraine, almost 70% of people die from their consequences.
Cardiovascular pathology can be congenital and acquired, which occurs with age. Every year in Ukraine from 4 to 6 thousand children with heart defects are born. Usually the reason for this is a genetic predisposition, genetic and chromosomal abnormalities, chronic or transmitted during pregnancy, the mother’s disease. May affect the fetus and drugs or toxins through alcohol, smoking and other external factors.
If we talk about the acquired pathology, the changes occur under the influence of numerous factors: lifestyle associated with low physical activity, frequent stressful situations, unbalanced diet, comorbidities (diabetes, thyroid dysfunction, liver), alcohol consumption and smoking, exposure to toxic substances in hazardous work or due to unsatisfactory environmental situation. Genetic predisposition to these diseases also plays an important role.
Your Center provides cardiac care to both children and adults. What is the difference between approaches to their treatment?
The main difference is the pathology itself, which the doctor faces. Children are characterized by congenital heart defects, which differ from the acquired pathology by a huge variety of structural and functional changes. There are more than 250 different heart and vascular defects, and they can be combined. Therefore, an individual approach is required in each case when it comes to the choice of surgical and medical treatment.
And in general, the heart and vascular system of a child is not the same as in adults. For example, there is no single blood pressure, heart rate, vascular resistance and oxygen demand for children. The parameters of the cardiovascular system change with each year of life. Therefore, each age group has its own indicators that correspond to the norm.
The same classes of drugs are used for the treatment of children as for the treatment of adults. However, the dose should be selected individually, based on the characteristics of blood circulation in heart disease and the changes we expect to receive when prescribing the drug, body weight and the body’s response to the drug.
Adult patients, who are more prone to acquired pathology of the cardiovascular system, often need related specialists due to concomitant diseases of other organs. Usually, the older a person is, the more concomitant problems need attention to determine the optimal treatment tactics.
By the way, our Center has a special approach to decision-making, which allows you to combine the experience and knowledge of doctors of different specialties to determine the best treatment tactics for each patient. It is called the Heart Team: team members discuss and jointly develop an individual action plan, taking into account all the parameters and characteristics of the patient’s condition. This approach is common in the world’s best clinics, we have been practicing it for many years in providing care to children, and have now been successfully used in adult patients. This is a new approach for specialized clinics in Ukraine, which has been successfully and effectively implemented in our institution.
What else is special about the Center What are the main directions of his work?
We are one of the leading cardiac surgery centers in Europe. This is a unique medical institution both in terms of the age composition of patients (from a few hours from birth to 97 years), and in terms of the level of complexity of the operations performed here.
Every year we conduct almost 40 thousand consultations (including 15 thousand adults and 25 thousand children) and more than 3 thousand surgical interventions. During the 17 years of its existence, the team of the Center has conducted more than 600 thousand consultations and more than 35 thousand operations.
We are the undisputed №1 in Ukraine in the detection and treatment of congenital heart defects. The director of the Center, Ilya Mykolayovych Yemets, is the founder of neonatal cardiac surgery in Ukraine. He developed and implemented a number of revolutionary methods of treating birth defects in very young children.
For many years, the center has been the main clinic in Ukraine in the coordination of pregnancy and childbirth in women with prenatally diagnosed heart defects. Early detection of cardiac pathology, fetal diagnosis (when examining the fetus in the mother’s body – ed.) Can save children who previously died in the first minutes after birth. And now our specialists perform surgical correction immediately in the delivery room.
Many years ago, we launched a program to help adult patients with congenital heart disease. Working with this cohort of people requires specific knowledge of congenital malformations inherent in pediatric cardiologists and experience with acquired heart disease in adults. This combination requires the training of individual specialists in cardiology and cardiac surgery for congenital heart disease in adults.
In addition, the Center is actively developing an Adult Clinic that specializes in the treatment of acquired heart defects. We pay great attention to the latest minimally invasive technologies, cooperate with Swiss colleagues. We have been developing the Longevity Cardio program for several years to help the most difficult elderly patients with cardiovascular disease.
What heart diseases are most common in Ukraine for children and adults?
Unfortunately, cardiovascular disease is one of the dominant causes of child morbidity and mortality in Ukraine. Among these diseases, more than 80% are congenital heart defects.
Hypertension is the most common among adult patients, as is coronary heart disease, which causes heart attacks, and cerebrovascular disease.
Under what conditions are a full life possible for people with cardiovascular diseases?
A full life is possible, but its quality depends on the cardiovascular pathology and the type of intervention. By the way, regular examinations and timely therapy can prevent complications and/or exacerbation of the disease. Timely surgery, adherence to the doctor’s recommendations, correct therapy, rehabilitation, prevention and treatment of comorbidities, lifestyle changes, and habits – all this will not only prolong life but also improve the overall condition and feelings of the patient.
What should be done to promote the culture of medical examinations in Ukraine?
I think it is necessary to actively inform people about the benefits of preventive examinations that can prevent disease and reduce possible negative risks.
Access to medical examinations should also be simplified. Queues and incorrect prioritization are the main factors that cause many people to miss or miss surveys.
And how, in your opinion, it is possible to reduce mortality from cardiovascular diseases in Ukraine?
I think that the mortality rate depends on factors that can affect each of us. After all, everyone is responsible for their own health: they choose habits, diet, and join the physical culture. Also, professional doctors, constant self-development of specialized specialists, and an effective health care system in general – all this creates better conditions for the treatment of such diseases.
At the state level, scientific developments in the field of cardiology should be stimulated and more attention should be paid to the material and technical condition of hospitals that provide cardiological and cardiac surgery. It is also necessary to improve industry standards, in particular, the creation of a rational route for the patient at all levels of care: from the family doctor to a cardiologist.
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