CATCHING GAPS WITH HEALTHCARE MAPS CARDIOLOGY AND ONCOLOGY
A Map of Healthcare Needs for Mazowieckie Voivodeship – Cardiology
1 CATCHING GAPS WITH HEALTHCARE MAPS CARDIOLOGY AND ONCOLOGY
Table of Contents
Demographic and Epidemiological Aspects ...... 3
1.1 Voivodeship Population Breakdown ...... 3
1.2 Demographics in counties ...... 9
1.3 New Cases of Cardiac Diseases ...... 15
1.4 Mazowieckie Voivodeship in the national context ...... 18
1.5 Deaths due to cardiac diseases in the region ...... 22
1.6 Hospital morbidity: cardiac diseases in adults...... 32
1.7 Hospital morbidity: cardiac diseases in children ...... 39
Status and Use of Resources: the Analysis ...... 42
2.1 Hospitalisation ...... 43
2.1.1 General Information ...... 43
2.1.2 Adult Cardiology ...... 57
2.1.3 Paediatric Cardiology ...... 74
2.1.4 Adult Cardiac Surgery ...... 77
2.1.5 Paediatric Cardiac Surgery...... 82
2.2 Specialist Outpatient Care ...... 87
2.3 Primary Care (POZ) ...... 92
2.4 Medical Staff ...... 95
Healthcare Needs Forecasts ...... 107
3.1 Projected Population Breakdown for Mazowieckie Voivodeship...... 108
3.2 Projected demographics of counties (poviats) ...... 113
3.3 Incidence Forecast for the years 2015-2025 ...... 143
3.4 Adult Cardiac Surgery Forecast ...... 150
3.5 Paediatric Cardiology and Cardiac Surgery Forecast ...... 155
2 CATCHING GAPS WITH HEALTHCARE MAPS CARDIOLOGY AND ONCOLOGY
Part I
Demographic and Epidemiological Aspects
In 2013, Mazowieckie Voivodeship was inhabited by 5.3 million people, i.e. by 13.8% of all population of Poland (population as at 31 December 2013). It was the largest Polish region in terms of population (Figure 1).
Figure 1: Population in Poland by voivodeship (2013)
millions
Share in population in general
Source: compiled based on data provided by the Central Statistical Office
The population of Mazowieckie Voivodeship was, in demographic sense, older than the population of Poland in general. In 2013, the region was inhabited by almost as many as 820 thousand people aged 65 and more, which accounted for 15.4% of all population (Figure 2). This share was higher than the Poland's total (14.7 %). In turn, the region was inhabited by approx. 1.1 million young people (under 20 years old), which accounted for 20.7% of all population (more by 0.2 pp than the national share). The group aged 20-64 was formed by 3.4 million people, which accounted for 63.9% of all population, and its share for Mazowieckie Voivodeship was lower by 0.8 pp than for Poland in general (Figure 3).
3
Figure 2: Population structure according to sex and age for Mazowieckie Voivodeship (2013) Men (in thousands) Age group Women(in thousands)
Surplus of men over women (in thousands) Surplus of women over men (in thousands)
Source: compiled based on data provided by the Central Statistical Office
4 Figure 3: Population breakdown according to age group in Mazowieckie Voivodeship and in Poland (2013)
Difference in relation to the breakdown of Poland:
Greater share in the Greater share in Poland
voivodeship
Source: compiled based on data provided by the Central Statistical Office
The analysis of population breakdown shows that there are more men then women aged below 30, and that in any other group there are more women than men (Figure 2). It is worth noting that in the group aged 30-39 there was also a surplus of women over men. The differences in the size of the population of women and men are the largest among the elderly (over 60 years of age) and they increase with age. It is related with higher mortality rate for men in Poland (cf. Figure 2, Figure 4).
5 Figure 4: Population breakdown according to sex and age for Mazowieckie Voivodeship and for Poland (2013)
Difference in relation to the breakdown of Poland:
Greater share in the Greater share in Poland voivodeship
Source: compiled based on data provided by the Central Statistical Office
The life expectancy of a newborn in Mazowieckie Voivodeship is slightly bigger than national one (Figure 5). In 2013, this parameter oscillated at 73.4 years for boys and 81.6 years for girls. It is worth noting that it was higher by, respectively, 0.3 and 0.5 year than the corresponding values for Poland. As far as male newborn life expectancy is concerned, Mazowieckie Voivodeship placed itself at 6th position in Poland, and as far as female newborn life expectancy is concerned - at 4th position (among regions arranged from the highest to the lowest life expectancy for both sexes). The situation is quite different in the case of life expectancy of +60-year-olds: it oscillated at 19.5 years for men and 24.2 for women. The parameter is higher for Poland in general by 0.6 year for men and 0.3 year for women. The region placed itself at 3rd position in the case of men and at 5th position in the case of women (Figure 6).
6 Figure 5: Average life span by voivodeship (2013)
Female
Male Years
Source: compiled based on data provided by the Central Statistical Office
Figure 6: Average life expectancy of a 60-year-old by voivodeship (2013)
Years Female Male
Source: compiled based on data provided by the Central Statistical Office
7 In 2013, over 55,400 live children were born in Mazowieckie Voivodeship, and the fertility rate (that is the number of live births per 1,000 women of childbearing age, i.e. 15-49 years of age) exceeded 43 children per one thousand women of childbearing age, placing the voivodeship first in Poland (in descending order) as far as this index is concerned. This result exceeds the national figure by nearly 4 children per one thousand women of childbearing age (Figure7).
Figure 7: Fertility rate and live births by voivodeship (2013)
49
-
Thousands
Births Births perone thousandwomen aged 15
Difference versus average value for Mazowieckie Voivodeship Number of births
Higher average value in the voivodeship
Higher value in the county
In 2013, the population density in Figure 8: Population density by voivodeship Mazowieckie Voivodeship was 150 people (2013) per km2, so that the Voivodeship ranked
third in terms of this index (in descending order) (Figure 8).
Population per 1 km2
Source: compiled based on data provided by the Central Statistical Office
8
1.2 Demographics in counties
According to the administrative division, Mazowieckie Voivodeship is divided into 42 counties, including 5 city counties.
In 2013, the highest number of people inhabited Warsaw (over 1.7 million), which accounted for 32.4% of all Mazovian population. In turn, the lowest number of people (32 thousand) in 2013 inhabited Łosice county, which constituted 0.6% of all Mazovian population. (Figure 9).
Figure 9: Population in the counties of Mazowieckie Voivodeship (2013)
Thousands
Share in population in general
Source: compiled based on data provided by the Central Statistical Office
The results of the analysis of the population structure by sex and age in some of the counties (poviats) of Mazowieckie Voivodeship are similar to those described for the voivodeship as a whole. In certain counties, the surplus in the population of men over women aged under 60 years old is observed. The surplus of women over men dominates the remaining age groups and grows with age. In some counties, this surplus of women is visible in much younger age groups, i.e. over 30 or 34 years old (e.g. in Siedlce City or Pruszków County). In other, the difference is visible only in older age groups, i.e. over 60 years old (e.g. in Ostrów Mazowiecka County or Siedlce County) It is worth noting that the surplus of female population is observed in Warsaw in much younger age groups, i.e. among 20-year-olds. This fact is connected to educational and economic migration of young women. As for the progression of the population ageing process in Mazovian counties, the largest share of people aged at least 65 is observed in the following counties: the city of Warsaw (18,3%), Lipsko (17,3%), Sokołów Podlaski (17%) and
9 Łosice (16,6%), and the smallest in Wołomin (11,9%), Radom (12,2%), Ostrołęka City (12,2%), Legionowo (12,4%), Piaseczno (12,5%) and Ostrołęka (12,6%) (Figure 10-13).
Figure 10: Share of persons under 19 years of age in the population of Mazovian counties (poviats) (2013)
YEAR 2013 Share of the 0- 19 age group
Source: compiled based on data provided by the Central Statistical Office
Figure 11: Share of the 20-44 age group in the population of Mazovian counties (poviats) (2013)
YEAR 2013 Share of the 20-44 age group
Source: compiled based on data provided by the Central Statistical Office
10
11 Figure 12: Share of the 45-64 age group in the population of Mazovian counties (poviats) (2013)
YEAR 2013 Share of the44-64 age group
Source: own compilation based on data from the Local Data Bank of the Central Statistical Office.
Figure 13: Share of the 65 plus age group in the population of Mazovian counties (poviats) (2013)
YEAR 2013 Share of the 65+ age group
Source: compiled based on data provided by the Central Statistical Office
Since there is no data available on the life expectancy at the level of counties, relevant statistics at the level of subregions are presented below (Figure 14 and Figure 15). In 2013, the longest life expectancy of male newborns (e0) in Mazowieckie Voivodeship was recorded in the subregion of the capital city of Warsaw (75.2 y.o.) and female newborns in Ostrołęka-Siedlce subregion (81.9 y.o.). These figures were 1.8 and 0.3 years higher, respectively, than for Mazowieckie Voivodeship in total. This parameter had the lowest value in Ciechanów subregion. In 2013, e0 in this subregion was 71.1 years for men and 80.7
12 years for women. These figures were lower compared to the Voivodeship's total by 2.4 and 0.7 year, respectively. The life expectancy for 60-year-olds (e60) was the highest in the capital city of Warsaw subregion (20.3 years for men and 24.2 for women; similarly as in the Warsaw West subregion), and it was higher by 1 year for men in Mazowieckie Voivodeship and approx. the same for women (Figure 15). e60 parameter was the lowest in Ciechanów-Płock subregion (17.7 years for men and 23.6 years for women; the values were lower than in Mazowieckie Voivodeship in general by 1.6 and 0.6 years respectively).
Figure 14: Average life span in Mazovian subregions (2013)
Female
Male Years
Source: compiled based on data provided by the Central Statistical Office
Figure 15: Average life expectancy of a 60-year-old in Mazovian subregions (2013)
Female
Male Years
Source: compiled based on data provided by the Central Statistical Office
Mazowieckie Voivodeship is highly diversified as far as fertility rate is concerned (number of births per 1,000 women of childbearing age). In 2013, the highest fertility rate was recorded in the following counties: Garwolin, Węgrów, Mińsk Mazowiecki, Wołmin, Siedlce, Siedlce City and Wyszków (Figure 16).
13
Figure 16: Fertility rate and live births in Mazovian counties (poviats) (2013)
49
-
Thousands
Births Births perone thousandwomen aged 15
Difference versus average value for Mazowieckie Voivodeship Number of births
Higher average value in the voivodeship
Higher value in the county
Source: compiled based on data provided by the Central Statistical Office
As mentioned above, in 2013 the population density of Mazowieckie Voivodeship was 150 people per 1 km2, however, the region is highly diversified as far as population density in individual counties is concerned. The most densely populated were city counties: the city of Warsaw (3,334 people per 1 km2), Siedlce City (2,396), Radom City (1,954), Ostrołęka City (1,848) and Płock City (1,395) (cf. Figure 17). The least densely populated were the following counties: Łosice (42), Ostrołęka (42), Maków Mazowiecki and Przasnysz (44), Lipsko (48), Sokołów Podlaski (49) and Żuromin (50).
14 Figure 17: Population density in Mazowieckie Voivodeship (2013)
Population per 1 km2
Source: compiled based on data provided by the Central Statistical Office
1.3 New Cases of Cardiac Diseases
Other diseases 4% 2%2% 7%
8% Ischaemic heart disease
Other rhythm and conduction disturbances 11% 29% Heart failure
Atrial fibrillation and flutter
Acquired heart defects 16% Congenital heart defects
21% Cardiomyopathies
Source: compiled based on data provided by the NFZ
15 The greatest risk of developing a cardiac disease applies to the ischaemic heart disease, which was diagnosed in over 219 thousand patients in 2013. The second highest number of diagnoses concerned other rhythm and conduction disturbances (153.1 thousand) and the third - heart failure (119.5 thousand). The least frequent cardiac disorders are rheumatic heart disease (over 350 cases) and endocarditis (less than 1,570 cases) (Figure 20).
Figure 20: Number of new cardiac cases in Poland in 2013
Ischaemic heart disease
Other rhythm and conduction disturbances
Heart failure
Atrial fibrillation and flutter
Acquired heart defects
Other heart diseases (unspecific, unclassified)
Congenital heart defects
Cardiomyopathies
Pulmonary embolism
Cardiac diseases Cardiac Aortic aneurysm
Other pulmonary vascular diseases
Pericardial diseases
Myocarditis
Endocarditis
Rheumatism
Number of diagnoses in 2013
Source: compiled based on data provided by the NFZ
The highest number of cardiac patients inhabited in 2013 the following voivodeships: Mazowieckie, Śląskie, WIelkopolskie and Małopolskie (Figure 21). Lubuskie, Opolskie, Podlaskie and Świętokrzyskie Voivodeships reported the lowest number of new cases. These values, however, result mainly from the number of people residing in a given voivodeship, which means that voivodeships with a high population number are expected to have a higher number of new cases than the ones less populated. The number of new cases indicates a magnitude of the studied phenomenon. Nevertheless, as absolute values, they cannot be compared between the areas with different population number. Therefore, in addition to the number of new cases, the incidence rate was calculated. This rate, in contrast to the number of new cases, shows a relative value of the number of new cases per 100 thousand residents of an analysed area. It was calculated for each disease separately, as well as in total to establish the total incidence rate in these diseases (including multiple morbidities). The highest incidence rate was observed in Śląskie, Łódzkie, Dolnośląskie and Mazowieckie voivodeships in which, in 2013, about 1 per 100 inhabitants has started a treatment due to a cardiac disease. In these terms, the healthiest voivodeships are as follows: Podkarpackie Voivodeship, Wielkopolskie Voivodeship, Warmińsko-Mazurskie Voivodeship and Małopolskie Voivodeship (Figure 21). The difference between extreme rate values, hence between Łódzkie Voivodeship and Podkarpackie Voivodeship, has reached almost 17%. One should take into account that these values are sensitive to the effect of sex and age structures which also matter in case of cardiac diseases.
16 Figure 21: Number of new cases (left-hand map) and incidence (right-hand map) in selected voivodeships in 2013
Number of new cases New cases per (in thousands) 100 thousand people
Source: compiled based on data provided by the NFZ
In order to present the diversified nature of cardiac diseases, we have calculated incidence rates for selected disorders. Total values for Poland have been presented in Figure 22. For example, the value for ischaemic heart disease (which is by the way the highest) means that in 2013 as many as 569 people per 100 thousand Poles have developed it. In other words, approx. 1 person per 180 got ischaemic heart disease.
Figure 22: Incidence of cardiac diseases in Poland in 2013
Ischaemic heart disease
Other rhythm and conduction disturbances
Heart failure
Atrial fibrillation and flutter
Acquired heart defects
Other heart diseases (unspecific, unclassified)
Congenital heart defects
Cardiomyopathies
Pulmonary embolism
Cardiac diseases Cardiac Aortic aneurysm
Other pulmonary vascular diseases
Pericardial diseases
Myocarditis
Endocarditis
Rheumatism
Diagnoses per 100 thousand inhabitants in 2013 Source: compiled based on data provided by the NFZ
17 1.4 Mazowieckie Voivodeship in the national context
Ischaemic heart disease (ChNS) (I20, I21, I24, I25)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 569.2. The highest incidence rates were recorded in the following voivodeships: Śląskie (684) and Łódzkie (648). The lowest incidence rates were recorded in the following voivodeships: Warmińsko- Mazurskie (464) and Podlaskie (502).
Figure 23: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
Number (in patients thousands) of New cases per 100 thousand inhabitants
Source: compiled based on data provided by the NFZ
Other rhythm and conduction disturbances (I44-I47, I49)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 397.7. The highest incidence rates were recorded in the following voivodeships: Podlaskie (548) and Pomorskie (451). The lowest incidence rates were recorded in the following voivodeships: Warmińsko- Mazurskie (326) and Kujawsko-Pomorskie (341).
18 Figure 24: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
New cases per 100 thousand inhabitants
Number (in patients thousands) of
Source: compiled based on data provided by the NFZ
Heart failure (I50)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 310.4. The highest incidence rates were recorded in the following voivodeships: Łódzkie (407) and Świętokrzyskie (384). The lowest values of the incidence rates were recorded in the following voivodeships: Pomorskie (223) and Zachodniopomorskie (246).
Figure 25: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
Number patients of
New cases per 100 thousand inhabitants
Source: compiled based on data provided by the NFZ
19 Atrial fibrillation and flutter (I48)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 213.5. The highest incidence rates were recorded in the following voivodeships: Podlaskie (270) and Lubelskie (255). The lowest values of the incidence rates were recorded in the following voivodeships: Wielkopolskie (174) and Świętokrzyskie (189).
Figure 26: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
Number patients of
New cases per 100 thousand inhabitants
Source: compiled based on data provided by the NFZ
20 Acquired heart defects (I05-I09, I34-I37)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 149.8. The highest incidence rates were recorded in the following voivodeships: Podlaskie (224) and Śląskie (204). The lowest incidence rates were recorded in the following voivodeships: Warmińsko- Mazurskie (70), Pomorskie (96).
Figure 27: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
Number patients of
New cases per 100 thousand inhabitants
Source: compiled based on data provided by the NFZ
Congenital heart defects (Q20-Q26)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 75.4. The highest incidence rates were recorded in the following voivodeships: Podlaskie (164) and Kujawsko-Pomorskie (105). The lowest values of the incidence rates were recorded in the following voivodeships: Świętokrzyskie (40) and Opolskie (43).
Figure 28: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
Number patients of
New cases per 100 thousand inhabitants
Source: compiled based on data provided by the NFZ
21 Cardiomyopathies (I42, I43)
The incidence rate (number of new cases per 100 thousand people) in Poland in 2013 amounted to 47.9. The highest incidence rate was recorded in Łódzkie Voivodeship (117). The lowest incidence rates were recorded in the following voivodeships: Lubelskie (27), Warmińsko-Mazurskie (29).
Figure 29: Number of new cases (in thousands) according to sex (chart) and incidence (map) per voivodeship (2013)
Female Male
Number patients of
New cases per 100 thousand inhabitants
Source: compiled based on data provided by the NFZ
1.5 Deaths due to cardiac diseases in the region1
Heart diseases in general (I00–I51, Q20–Q26)
Cardiac diseases are the first most frequent cause of death of the inhabitants of Mazowieckie Voivodeship (as it is the case in other regions of Poland). In 2011-2013, they were responsible for 33.5% of deaths in Mazowieckie Voivodeship (31.2% in the case of men and 35.9% in the case of women), and these values are higher than those recorded for Poland in general (28.0%, 27.0% and 29.1% respectively).
The actual death rate of the inhabitants of Mazowieckie Voivodeship due to cancer (341 per 100,000 people) was higher than the national one (by 22.7%), the difference being greater for women (26.6%) than for men (18.7%). Partially, this difference results from an undesirable age structure of the voivodeship population, because age-standardised rates give lower mortality rate surplus of 13.8% in total, 17.1% for women and 10.4% for men, as compared to the national level.
1The Ministry of Health would like to give special thanks to the National Institute of Public Health – National Institute of Hygiene for preparing the analyses in this chapter.
22 The mortality rate due to heart diseases is generally the same for men and women. In years 2011-2013, actual rates for both groups of inhabitants of Mazowieckie Voivodeship amounted to 345.1 and 337.1 per 100,000 people, respectively. Nevertheless, the elimination of age structure differences reveals a significantly higher risk of heart diseases among men, with the standardised rate ratio (M/F) of 1.87 which is similar to the national average of 1.92.
Inhabitants of Przysucha County have the highest risk of heart diseases, with the mortality rate higher by 38% than the voivodeship rate - the same surplus is observed among both men and women. Without the difference between age structure in the county and the entire voivodeship taken into account, the surplus mortality rate - measured by the ratio of actual rates for a county and voivodeship - is 48%. In the following counties: Radom, Szydłowiec, Białobrzegi and Płońsk, the mortality rate is higher than for the voivodeship by more than 25% - with surpluses present in both men and women. It is worth noting that in Wyszków and Wołomin counties, with actual mortality rate below the voivodeship one, the standardised mortality was higher than in the voivodeship by more than 10%.
Figure 30: Deaths due to heart diseases in general (I00—I51, Q20—Q26) (2011— 2013)
Men Total number of Women deaths in the voivodeship: 54,128
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
23
Standardised mortality rate (SMR) Standardisedrate mortality
difference versus rate value for Mazowieckie Voivodeship
Higher value in the voivodeship Higher value in the county Regional rate
Standardised mortality rate (SMR) Standardisedrate mortality
Regional rate Women Men
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
Ischaemic heart disease (I20–I25)
In 2011-2013, ischaemic heart disease was responsible for 36.9% of deaths due to heart diseases in Mazowieckie Voivodeship (39.0% in the case of men and 35.0% in the case of women), and these values are lower than those recorded for Poland in general (41.0%, 43.8% and 38.2% respectively).
The actual death rate of the inhabitants of Mazowieckie Voivodeship due to ischaemic heart disease (126 per 100,000 people) was lower than the national one (by 10.4%), the difference being greater for women (15.9%) than for men (5.8%). This difference mainly results from an undesirable age structure of the voivodeship population, because age-standardised rates give lower mortality rate surplus of 2.8% in total, 7.3% for women and -1.2% for men, as compared to the national level (and hence the standardised mortality rate among men is slightly lower than in Poland generally).
The mortality rate due to ischaemic heart disease is significantly higher for men than for women. In years 2011-2013, actual rates for both groups of inhabitants of Mazowieckie Voivodeship amounted to 134.7 and 118 per 100,000 people, respectively. The elimination of age structure differences reveals even
24 higher surplus mortality rate for men as compared to women, with the standardised rate ratio (M/F) of 2.13 which is similar to the national average of 2.20.
The highest mortality due to ischaemic heart disease was reported in Mława County and it was higher than the voivodeship level by 82%. The surplus was similar for both men and women. Also the actual rate in Mława County was higher than for the voivodeship by 73%. Counties: Grójec, Maków Mazowiecki, Kozienice and Szydłowiec, had the mortality rate due to ischaemic heart disease higher than for the voivodeship by at least 70%. Piaseczno and Radom counties had the standardised rate clearly higher than the average, and the actual rate lower than the voivodeship one.
Figure 31: Deaths due to ischaemic heart disease (I20–I25) (2011—2013)
Men Total number of Women deaths in the voivodeship: 19,998
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
25
Standardised mortality rate (SMR) Standardisedrate mortality
difference versus rate value for Mazowieckie Voivodeship
Higher value in the voivodeship Higher value in the county Regional rate
Standardised mortality rate (SMR) Standardisedrate mortality
Women Men Regional rate
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
Pulmonary embolism (I26)
In 2011-2013, pulmonary embolism was responsible for 1.8% of deaths in Mazowieckie Voivodeship (1.7% in the case of men and 1.8% in the case of women), and these values are higher than those recorded for Poland in general (2.2%, 2.2% and 2.3% respectively).
The actual death rate of the inhabitants of Mazowieckie Voivodeship due to pulmonary embolism (6 per 100,000 people) was lower than the national one (by 3.2%). The death rate for Mazovian women is equal to the national one and lower for men (by 6.3%). Following the age standardisation, the mortality rate for residents of this region was lower as compared to the national level, with the difference of -8.2% in total, -5.7% for women and 10.7% for men. Thus, the differences observed for actual rates largely depend on an undesirable age structure of the voivodeship population.
The mortality rate due to pulmonary embolism is significantly higher for men than for women. Although in years 2011-2013 the actual rate for men residing in the voivodeship was slightly lower than the rate for women (respectively, 5.9 and 6.1 per 100 thousand people), the elimination of age structure differences reveals clear overmortality of men as compared to women. The standardised rate ratio (M/F)
26 is 1.54 (thus the mortality among men is by 54% higher than among women) and is similar to the national average of 1.60.
Due to the relatively small number of deaths in particular counties, the differences between the values of rates for counties should be interpreted with great caution. However, it should be noted that in Otwock County mortality is 2.5 times higher than the average for Mazowieckie Voivodeship.
Figure 32: Deaths due to pulmonary embolism (I26) (2011—2013)
Total number of Men Women deaths in the voivodeship: 953
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
27
mortality rate (SMR) rate mortality Standardised
difference versus rate value for Mazowieckie Voivodeship
Higher value in the voivodeship Higher value in the county Regional rate
Standardised mortality rate (SMR) Standardisedrate mortality
Women Men Regional rate
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
Heart failure and cardiomyopathies (I42, I50)
In 2011-2013, heart failure and cardiomyopathies were responsible for 45.3% of deaths in Mazowieckie Voivodeship (43.1% in the case of men and 47.4% in the case of women), and these values are higher than those recorded for Poland in general (36.9%, 34.7% and 39.0% respectively).
The actual death rate of the inhabitants of Mazowieckie Voivodeship due to heart failure and cardiomyopathies (154.6 per 100,000 people) was higher than the national one (by 50.8%), the difference being greater for women (54%) than for men (47.3%). Partially, this difference results from an undesirable age structure of the voivodeship population, because age-standardised rates give lower mortality rate surplus of 38.8% in total, 41.8% for women and 35.4% for men, as compared to the national mortality level.
The mortality rate due to heart failure and cardiomyopathies is higher for men than for women. Although in years 2011-2013 the actual rate for men residing in the voivodeship was slightly lower than the rate for women (respectively, 148.8 and 159.9 per 100 thousand people), the elimination of age structure
28 differences reveals clear overmortality of men as compared to women. The standardised rate ratio (M/F) is 1.71 (thus the mortality among men is by 71% higher than among women) and is very similar to the national average of 1.77.
The highest mortality level due to heart failure and cardiomyopathies in years 2011-2013 was observed in Radom County (surplus as compared to the voivodeship level of 73%). A similar surplus was reported for both men and women. The actual rate was also higher than the voivodeship level by 43%. In Siedlce, Żyrardów and Radom counties the mortality was higher than for the voivodeship by more than 65%. It is worth noting that in Siedlce County, with actual mortality rate almost at the voivodeship level, the standardised mortality was higher than in the region by more than 25%.
Figure 33: Deaths due to heart failure and cardiomyopathies (I42, I50) (2011-2013)
Men Total number of Women deaths in the voivodeship: 24,540
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
29
Standardised mortality rate (SMR) Standardisedrate mortality
difference versus rate value for Mazowieckie Voivodeship
Higher value in the voivodeship Higher value in the county Regional rate
Standardised mortality rate (SMR) Standardisedrate mortality
Women Men Regional rate
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
Atrial fibrillation and flutter (I48)
In 2011-2013, atrial fibrillation and flutter were responsible for 1.2% of deaths in Mazowieckie Voivodeship (0.9% in the case of men and 1.4% in the case of women), and these values are similar to those recorded for Poland in general (1.5%, 1.1% and 1.9% respectively).
The actual death rate of the inhabitants of Mazowieckie Voivodeship due to atrial fibrillation and flutter (4 per 100,000 people) was lower than the national one (by 2.4%). The regional death rate value was lower than national for women (by 6.0%) and identical for men. Following the age standardisation, the mortality rate for residents of this region was lower when compared to the national level, with the difference of -12.6% in total, 13.9% for women and -10.4% for men.
The mortality rate due to atrial fibrillation and flutter is significantly higher for men than for women. Although in years 2011-2013 the actual rate for men residing in the voivodeship was slightly lower than the rate for women (respectively, 3.2 and 4.7 per 100 thousand people), the elimination of age structure differences reveals clear overmortality of men as compared to women. The standardised rate ratio (M/F)
30 is 1.36 (thus the mortality among men is by 36% higher than among women) and is slightly higher the national average of 1.25.
Low number of deaths due to atrial fibrillation and flutter does not allow a reliable analysis of the mortality diversification in Mazovian counties.
Figure 34: Deaths due to atrial fibrillation and flutter (I48) (2011- 2013)
Men Total number of Women deaths in the voivodeship: 628
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
31
Standardised mortality rate (SMR) Standardisedrate mortality
difference versus rate value for Mazowieckie Voivodeship
Higher value in the voivodeship Higher value in the county Regional rate
Standardised mortality rate (SMR) Standardisedrate mortality
Women Men Regional rate
Source: based on data provided by the National Public Health Institute – National Institute of Hygiene.
1.6 Hospital morbidity: cardiac diseases in adults
Acute coronary syndromes (I20.0, I21)
In 2013, 12,834 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to Acute Coronary Syndromes. The hospital morbidity rate in the region was lower than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 296.8 per 100 thousand people, and it was lower by 18.9% than the national average (366.0). The difference does not result from the age structure of inhabitants: the age adjusted rate for the region (290.0) was lower than the national one by 20.8%. 14,684 admissions due to Acute Coronary Syndromes were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed.
32 Figure 35: Annual hospital morbidity: acute coronary syndromes (2013)
Acute coronary syndromes (ACS) – raw annual hospital morbidity rate
Morbidity
Acute coronary syndromes (ACS) – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Other forms of ischaemic heart disease (I20 without I20.0, I24, I25)
In 2013, 23,945 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to other forms of ischaemic heart disease. The hospital morbidity rate in the region was higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 553.8 per 100 thousand people, and it was higher by 11.6% than the national average (496.1). The surplus has almost no correlation with the age structure of inhabitants: the age adjusted rate for the region (546.4) was higher than the national one by 10.1%. 26,613 admissions due to other forms of ischaemic heart disease were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed.
33 Figure 36: Annual hospital morbidity: other forms of ischaemic heart disease (2013)
Other forms of ischaemic heart disease – raw annual hospital morbidity rate
Morbidity
Other forms of ischaemic heart disease – standardised annual hospital morbidity
rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Atrial fibrillation and flutter (I48)
In 2013, 9,545 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to atrial fibrillation and flutter. The hospital morbidity rate in the region was higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 220.8 per 100 thousand people, and it was higher by 10.9% than the national one (199.1). The surplus results partially from the age structure of inhabitants: the age adjusted rate for the region (213.8) was higher than the national one by 7.4%. 9,996 admissions due to atrial fibrillation and flutter were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed..
34 Figure 37: Annual hospital morbidity: atrial fibrillation and flutter (2013)
Atrial fibrillation and flutter – raw annual hospital morbidity rate
Morbidity
Atrial fibrillation and flutter – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Figure 38: Annual hospital morbidity: other rhythm and conduction disturbances (2013)
Other rhythm and conduction disturbances – raw annual hospital morbidity rate
Morbidity
Other rhythm and conduction disturbances – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Other rhythm and conduction disturbances (I44-I47, I49)
In 2013, 9,368 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to other rhythm and conduction disturbances. The hospital morbidity rate in the region was higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 216.7 per 100 thousand people, and it was higher by 21.0% than the national average (179.0). The surplus results
35 partially from the age structure of inhabitants: the age adjusted rate for the region (207.5) was higher than the national one by 15.9%. 10,304 admissions due to other rhythm and conduction disturbances were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed.
Heart failure (I50)
In 2013, 22,475 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to heart failure. The hospital morbidity rate in the region was higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 519.8 per 100 thousand people, and it was higher by 12.6% than the national average (461.8). The surplus results partially from the age structure of inhabitants: the age adjusted rate for the region (486.1) was higher than the national one by 5.3%. 22,609 admissions due to heart failure were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed.
Figure 39: Annual hospital morbidity: heart failure (2013)
Heart failure – raw annual hospital morbidity rate
Morbidity
Heart failure – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
36 Figure 40: Annual hospital morbidity: pulmonary embolism (2013)
Pulmonary embolism – raw annual hospital morbidity rate
Morbidity
Pulmonary embolism – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Pulmonary embolism (I26)
In 2013, 1,900 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to pulmonary embolism. The hospital morbidity rate in the region was much higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) for pulmonary embolism was second highest and amounted to 43.9 per 100 thousand people; it was higher by 33.6% than the national average (32.9). The surplus results in a small part from the age structure of inhabitants: the age adjusted rate for the region (42.1) was higher than the national one by 28.0%. 2,018 admissions due to pulmonary embolism were reported by the hospitals in the region. Therefore, there is a certain equality between the number of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region.
Acquired heart defects (I05-I09, I34-I37)
In 2013, 6,770 inhabitants of Mazowieckie Voivodeship were admitted to hospital due to acquired heart defects. The hospital morbidity rate in the region was similar to national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 156.6 per 100 thousand people, and it was higher by 5.2% than the national average (148.8). Almost entire surplus results from the age structure of inhabitants: the age adjusted rate for the region (150.1) was higher than the national one by 0.8%. 7,347 admissions due to acquired heart defects were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed.
37 Figure 41: Annual hospital morbidity: acquired heart defects (2013)
Acquired heart defects – raw annual hospital morbidity rate
Morbidity
Acquired heart defects – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Figure 42: Annual hospital morbidity: congenital heart defects (2013)
Congenital heart defects – raw annual hospital morbidity rate
Morbidity
Congenital heart defects – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
Congenital heart defects (Q20-Q26)
In 2013, 897 inhabitants of Mazowieckie Voivodeship were admitted to hospitals due to congenital heart defects. The hospital morbidity rate in the region was much higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) was the highest in Poland and amounted to 20.7 per 100 thousand people; it was higher by 56.5% than the national average (13.3). This
38 difference results from the population age structure in this voivodeship which is distinct from that of entire country, as age-standardised rate (20.9) was higher from the national one to the same degree - by 57.8% - and it was also the highest in Poland. 1248 admissions due to acquired heart defects were reported by the hospitals in the region. Therefore, a surplus of patients coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of its inhabitants treated outside the region may be observed.
1.7 Hospital morbidity: cardiac diseases in children
Atrial fibrillation and flutter (I48)
In 2013, four children inhabiting Mazowieckie Voivodeship were admitted to hospitals. At the same time, the facilities in Mazowieckie Voivodeship hospitalised five children.
Other rhythm and conduction disturbances (I44-I47, I49)
In 2013, 1,229 children inhabiting Mazowieckie Voivodeship were admitted to hospitals due to other rhythm and conduction disturbances. The hospital morbidity rate for children in the region was much higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 124.9 per 100 thousand people, and it was higher by 54.9% than the national average (80.6) - Figure 43.
1389 admissions of children due to other rhythm and conduction disturbances were reported by the hospitals in the region. Therefore, a surplus of children coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of children inhabiting the region and treated outside thereof may be observed.
Figure 43: Annual hospital morbidity: other rhythm and conduction disturbances (2013)
Other rhythm and conduction disturbances – raw annual hospital morbidity rate
Morbidity
Other rhythm and conduction disturbances – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
39 Heart failure (I50)
In 2013, 17 children inhabiting Mazowieckie Voivodeship were admitted to hospitals due to heart failure. The hospital morbidity rate for children in the region was similar to national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 1.7 per 100 thousand people, and it was equal to the national one (1.7). 16 admissions of children due to heart failure were reported by the hospitals in the region.
Acquired heart defects (I05-I09, I34-I37)
In 2013, 83 children inhabiting Mazowieckie Voivodeship were admitted to hospitals due to acquired heart defects. The hospital morbidity rate for children in the region was higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 8.4 per 100 thousand people, and it was higher by 38.6% than the national average (6.1) - Figure 44. 100 admissions of children due to acquired heart defects were reported by the hospitals in the region. Therefore, a surplus of children coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of children inhabiting the region and treated outside thereof may be observed.
Figure 44: Annual hospital morbidity: acquired heart defects (2013)
Acquired heart defects – raw annual hospital morbidity rate
Morbidity
Acquired heart defects – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
40 Congenital heart defects (Q20-Q26)
In 2013, 1,647 children inhabiting Mazowieckie Voivodeship were admitted to hospitals due to congenital heart defects. The hospital morbidity rate for children in the region was higher than the national one. The hospital morbidity rate (according to the patient’s place of residence) amounted to 167.4 per 100 thousand people, and it was higher by 48.7% than the national average (112.6) - Figure 45.
2,117 admissions of children due to congenital heart defects were reported by the hospitals in the region. Therefore, a surplus of children coming from outside Mazowieckie Voivodeship and hospitalised therein over the number of children inhabiting the region and treated outside thereof may be observed.
Figure 45: Annual hospital morbidity: congenital heart defects (2013)
Congenital heart defects – raw annual hospital morbidity rate
Morbidity
Congenital heart defects – standardised annual hospital morbidity rate
Morbidity
Source: compiled by DAiS based on data provided by the NFZ and Central Statistical Office.
41 CATCHING GAPS WITH HEALTHCARE MAPS CARDIOLOGY AND ONCOLOGY
Part II Status and Use of Resources: the Analysis
42 2.1 Hospitalisation
2.1.1 General Information
In 2013, 575 hospitals provided cardiac treatment within the scope of analysed disorders in Poland2. Figure 46 illustrates the geographic distribution of those healthcare providers, accurate to a county.
Figure 46: Hospitals Providing Treatment to Cardiac Patients (2013)
Number of hospitals
No hospital
Source: compiled by DAiS based on data provided by the NFZ.
In some counties (40), there is no hospital providing cardiological healthcare services within the National Health Fund at all. Nevertheless, these counties are scattered across the country and they are adjacent to counties with at least one hospital that provides cardiological healthcare. In most counties, there is one up to three facilities. The largest number of providers is located in large cities, primarily in Warsaw (28), Katowice (12), Łódź (13), Kraków (11), Wrocław (11) and Poznań (11). A large density of hospitals is present in Śląskie Voivodeship, in which there are many city counties, with more than two treatment providers in most of them.
Out of 575 analysed hospitals accounting for cardiological healthcare services, 263 healthcare providers treated 80% of patients with cardiac diagnoses. Names of these facilities together with the number of patients treated in 2013 are arranged in descending order (Table 29).
2 In this report, in accordance with the decision of the Team for the development of maps of healthcare needs in the field of cardiology and cardiac surgery appointed by the Minister of Health, cardiac diseases are defined as diseases belonging to the following groups of diagnoses according to the ICD-10 classification: ischaemic heart disease (I20, I21, I24, I25), heart failure (I50), atrial fibrillation and flutter (I48), other rhythm and conduction disturbances (I44-I47, I49), cardiomyopathies (I42, I43), congenital heart defects (Q20-Q26), acquired heart defects (I05-I09, I34-I37), pulmonary embolism (I26).
43 Based on the analysis of data from Table 29 , it was concluded that within the analysed period the largest number of patients was treated in Cardinal Wyszyński Institute of Cardiology in Warsaw (over 12.4 thousand). In total, this represents 2.1% of hospitalized patients with a cardiac diagnosis on a national scale.
The next three largest entities in terms of the number of patients for whom cardiological services were provided are the Clinical Hospital No. 7 of the Silesian Medical University in Katowice Independent Public Clinical Hospital Leszek Giec Upper-Silesian Medical Centre, the Silesian Center for Heart Diseases in Zabrze and the John Paul II Specialist Hospital in Cracow. The first admitted almost 10.4 thousand cardiac patients (1.7% of cardiac patients in the country), the second almost 8 thousand patients (1.3%) and the third almost 7.7 thousand patients.
The share of patients of not less than 1% nationwide was observed in one more facility that is Military Memorial Medical Academy – Central Veterans' Hospital in Łódź.
Other facilities admitted lower number of patients, with 38 hospitals having a share not lower than 0.5% of hospitalised patients with cardiac diagnoses treated in Poland.
Table 2: Hospitals treating approx. 80% of cardiac patients (2013)
Share of Number of Cumulative Item Healthcare provider patients patients percentage nationwide
1 Cardinal Wyszyński Institute of Cardiology Warsaw 12,431 2.1% 2.1%
Clinical Hospital No. 7 of the Silesian Medical University in Katowice Prof. 2 Leszek Giec Upper-Silesian Medical Centre Katowice 10,380 1.7% 3.8%
3 Silesian Center for Heart Diseases Zabrze 7,956 1.3% 5.1%
4 John Paul II Specialist Hospital Kraków-Krowodrza 7,682 1.3% 6.4%
5 Military Memorial Medical Academy – Central Veterans' Hospital Łódź-Polesie 5,846 1.0% 7.4%
6 University Clinical Centre Gdańsk 5,239 0.9% 8.3%
7 Polska Grupa Medyczna Sp. z o.o. Gliwice 5,058 0.8% 9.1%
Central Clinical Hospital of the Ministry of the Interior and Administration in 8 Warsaw Warsaw 4,962 0.8% 9.9%
4 Military Clinical Hospital with Specialist Outpatient Clinic Independent Public 9 Healthcare Centre in Wrocław Wrocław-Krzyki 4,868 0.8% 10.8%
10 Independent Public Clinical Hospital No. 4 in Lublin Lublin 4,852 0.8% 11.6%
Józef Struś Multidisciplinary City Hospital with Care and Curative Institution Poznań-Nowe 11 Independent Public Healthcare Centre located in Poznań at Szwajcarska 3 Miasto 4,700 0.8% 12.4%
Poznań-Stare 12 Karol Marcinkowski University Hospital of Lord’s Transfiguration in Poznań Miasto 4,467 0.7% 13.1%
13 Public Paediatric Central Clinical Hospital Warsaw 4,447 0.7% 13.8%
14 Regional Polyclinical Hospital in Kielce Kielce 4,327 0.7% 14.6%
Kraków- 15 University Hospital in Kraków Śródmieście 3,969 0.7% 15.2%
16 Jadwiga Królowa Provincial Hospital No. 2 in Rzeszów Rzeszów 3,885 0.6% 15.9%
17 Independent Public Regional Polyclinical Hospital Szczecin 3,878 0.6% 16.5%
18 Medical University of Bialystok Clinical Hospital Białystok 3,866 0.6% 17.2%
19 John Paul II Independent Public Provincial Hospital in Zamość Zamość 3,823 0.6% 17.8%
44 20 Independent Public Clinical Hospital No. 2 of Pomeranian Medical University Szczecin 3,541 0.6% 18.4%
Cardinal Stefan Wyszyński Regional Specialist Hospital Independent Public 21 Healthcare Centre Lublin 3,531 0.6% 19.0%
Heliodor Święcicki Clinical Hospital at the Karol Marcinkowski Medical 22 University in Poznań Poznań-Grunwald 3,507 0.6% 19.6%
23 Antoni Jurasz University Hospital No. 1 in Bydgoszcz Bydgoszcz 3,301 0.6% 20.1%
24 Anna Gostyńska Wola Hospital Independent Public Healthcare Centre Warsaw 3,244 0.5% 20.7%
25 Military Institute of Medicine Warsaw 3,239 0.5% 21.2%
26 General Hospital in Nowa Sól Nowa Sól 3,234 0.5% 21.7%
27 Rafał Masztak Grochów Hospital Independent Public Healthcare Centre Warsaw 3,205 0.5% 22.3%
28 Władysław Biegański Provincial Specialist Hospital Łódź-Bałuty 3,139 0.5% 22.8%
29 "Miedziowe Centrum Zdrowia" S.A. In Lubin Lubin 3,104 0.5% 23.3%
30 Mazovian Specialist Hospital in Radom Radom 3,092 0.5% 23.8%
31 Independent Public Healthcare Centre Regional Medical Centre in Opole Opole 3,071 0.5% 24.4%
32 Padre Pio Provincial Hospital in Przemyśl Przemyśl 3,055 0.5% 24.9%
33 Alfred Sokołowski Specialist Hospital Wałbrzych 2,906 0.5% 25.3%
34 Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. Warsaw 2,899 0.5% 25.8%
Independent Public Complex of Healthcare Facilities - Specialist County 35 Hospital in Stalowa Wola Stalowa Wola 2,848 0.5% 26.3%
36 County Hospital in Chrzanów Chrzanów 2,829 0.5% 26.8%
37 Szpital Św. Wincentego a Paulo Sp. z o.o. Gdynia 2,824 0.5% 27.3%
38 Regional Polyclinical Hospital in Konin Konin 2,808 0.5% 27.7%
39 Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. Siedlce 2,779 0.5% 28.2%
40 Regional Specialist Hospital in Biała Podlaska Biała Podlaska 2,765 0.5% 28.6%
41 Regional Specialist Hospital in Olsztyn Olsztyn 2,739 0.5% 29.1%
42 Józef Psarski Mazovian Specialist Hospital in Ostrołęka Ostrołęka 2,710 0.5% 29.6%
43 Edward Szczeklik Specialist Hospital in Tarnów Tarnów 2,704 0.5% 30.0%
44 Nicolaus Copernicus Regional Hospital in Koszalin Koszalin 2665 0.4% 30.5%
45 Jan Biziel University Hospital No. 2 in Bydgoszcz Bydgoszcz 2,632 0.4% 30.9%
Grodzisk 46 John Paul II Independent Public Specialist Western Hospital Mazowiecki 2,614 0.4% 31.3%
American Heart of Poland, 3rd Department of Invasive Cardiology, Angiology 47 and Electrocardiology Dąbrowa Górnicza 2,614 0.4% 31.8%
48 Ludwik Perzyna Regional Polyclinical Hospital in Kalisz Kalisz 2,606 0.4% 32.2%
Ostrowiec 49 Complex of Healthcare Facilities in Ostrowiec Świętokrzyski Świętokrzyski 2,591 0.4% 32.6%
50 Jan Mikulicz-Radecki University Teaching Hospital in Wrocław Wrocław-Krzyki 2,514 0.4% 33.1%
51 Regional Polyclinical Hospital in Płock Płock 2,511 0.4% 33.5%
52 Holy Spirit Specialist Hospital in Sandomierz Sandomierz 2,508 0.4% 33.9%
53 Provincial Hospital in Poznań Poznań Jeżyce 2,480 0.4% 34.3%
54 Regional Polyclinical Hospital in Elbląg Elbląg 2,477 0.4% 34.7%
55 Invasive Cardiology, Electrotherapy and Angiology Centre in Nowy Sącz Nowy Sącz 2,419 0.4% 35.1%
Centrum Medyczne Hcp Sp. z o.o. Non-Public Healthcare Centre Centrum 56 Medyczne HCP - Inpatient treatment Poznań 2,410 0.4% 35.5%
Independent Public Healthcare Centre Provincial Specialist Hospital No. 3 in 57 Rybnik Rybnik 2,407 0.4% 35.9%
58 Regional Specialist Hospital in Wrocław Wrocław 2,398 0.4% 36.3%
45 59 Ludwik Błażek General Hospital in Inowrocław Inowrocław 2,385 0.4% 36.7%
Gorzów 60 WieIospecjalistyczny Szpital Wojewódzki W Gorzowie Wlkp. Sp. z o. o. Wielkopolski 2,377 0.4% 37.1%
Independent Public Healthcare Centre No. 10 Military Research Hospital and 61 Polyclinic Bydgoszcz 2,360 0.4% 37.5%
62 American Heart of Poland, 2nd Department of Cardiology Bielsko-Biała 2,338 0.4% 37.9%
63 Tytus Chałubiński Specialist Hospital in Radom Radom 2,311 0.4% 38.3%
Saint Luke's Provincial Hospital in Tarnów Independent Public Healthcare 64 Centre Tarnów 2,291 0.4% 38.7%
65 Regional Specialist Hospital in Legnica Legnica 2,284 0.4% 39.1%
66 Invasive Cardiology and Angiology Centre Sieradz 2,280 0.4% 39.4%
67 Stanisław Staszic Specialist Hospital in Piła Piła 2,269 0.4% 39.8%
68 Władysław Biegański Regional Specialist Hospital in Grudziądz Grudziądz 2,246 0.4% 40.2%
69 Ludwik Rydygier Regional Polyclinical Hospital in Toruń Toruń 2,234 0.4% 40.6%
70 Regional Specialist Hospital in Włocławek Włocławek 2,198 0.4% 40.9%
71 Józef Dietl Specialist Hospital in Kraków Kraków 2,187 0.4% 41.3%
72 Pomorskie Centra Kardiologiczne Non-Public Healthcare Centre Gdańsk 2169 0.4% 41.7%
73 Szpital Kolejowy im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. Pruszków 2,165 0.4% 42.0%
74 Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 2,153 0.4% 42.4%
75 Independent Public Healthcare Complex in Sanok Sanok 2,139 0.4% 42.7%
76 Saint Adalbert’s General Hospital Gdańsk 2,127 0.4% 43.1%
Independent Public Healthcare Centre of the Ministry of Internal Affairs in 77 Lublin Lublin 2,120 0.4% 43.4%
78 Independent Public Healthcare Complex in Świdnica Świdnica 2,079 0.3% 43.8%
Ostrów 79 Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka Mazowiecka 2,078 0.3% 44.1%
80 American Heart Of Poland Spółka Akcyjna Nysa 2,063 0.3% 44.5%
81 Saint Barbara’s Regional Specialist Hospital No. 5 in Sosnowiec Sosnowiec 2,009 0.3% 44.8%
82 Emil Warmiński Memorial Municipal Hospital in Bydgoszcz Bydgoszcz 1,979 0.3% 45.2%
83 Regional Specialist Hospital in Ciechanów Ciechanów 1,974 0.3% 45.5%
84 "Kliniki Kardiologii Allenort" Sp. z o.o. Iława/Ełk 1,973 0.3% 45.8%
85 Rehabilitation-Cardiology Hospital Kowanówko 1,950 0.3% 46.1%
86 Medical Healthcare Centre in Jarosław Jarosław 1,947 0.3% 46.5%
87 Independent Public Healthcare Centre in Świdnik Świdnik 1,895 0.3% 46.8%
American Heart of Poland, 4th Department of Invasive Cardiology, 88 Electrostimulation and Angiology Kędzierzyn-Koźle 1,894 0.3% 47.1%
89 Brothers Hospitallers of Saint John of God hospital in Łódź Łódź-Górna 1848 0.3% 47.4%
90 Janusz Korczak Regional Specjalist Hospital Słupsk 1,823 0.3% 47.7%
91 Complex of Healthcare Facilities in Gniezno Gniezno 1,819 0.3% 48.0%
92 Nikolay Pirogov Regional Specialist Hospital in Łódź Łódź-Polesie 1811 0.3% 48.3%
Tadeusz Marciniak Lower Silesian Specialist Hospital - Emergency Medical 93 Centre Wrocław 1,801 0.3% 48.6%
94 Gabriel Narutowicz Municipal Specialist Hospital Kraków-Krowodrza 1,801 0.3% 48.9%
95 Independent Public Healthcare Centre Regional Hospital in Zielona Góra Zielona Góra 1,796 0.3% 49.2%
Kraków-Nowa 96 Stefan Żeromski Specialist Hospital Huta 1,795 0.3% 49.5%
97 Szpital w Puszczykowie im. Prof. S.T. Dąbrowskiego S.A. Puszczykowo 1,762 0.3% 49.8%
46 98 Nicolaus Copernicus Specialist Municipal Hospital Toruń 1,744 0.3% 50.1%
99 County Hospital in Radomsko Radomsko 1,725 0.3% 50.4%
100 American Heart Of Poland Spółka Akcyjna Nysa 1,723 0.3% 50.7%
101 Complex of Healthcare Facilities in Końskie Końskie 1,696 0.3% 51.0%
102 John Paul II Provincial Hospital in Bełchatów Bełchatów 1,695 0.3% 51.2%
103 Hospital in Biała Biała 1,662 0.3% 51.5%
104 Cardinal Stefan Wyszyński Regional Hospital Łomża 1,631 0.3% 51.8%
105 Cardinal Stefan Wyszyński Regional Hospital in Sieradz Sieradz 1,630 0.3% 52.1%
106 Blessed Virgin Mary’s Regional Specialist Hospital Częstochowa 1,617 0.3% 52.3%
107 Independent Public Healthcare Centre in Kraśnik Kraśnik 1,610 0.3% 52.6%
108 Kotlina Jelenionórska Regional Hospital Centre Jelenia Góra 1,567 0.3% 52.9%
109 "Pleszewskie Centrum Medyczne w Pleszewie" Sp. z o. o. Pleszew 1,565 0.3% 53.1%
Tomaszów 110 Independent Public Healthcare Complex in Tomaszów Lubelski Lubelski 1,529 0.3% 53.4%
111 Arion Szpitale Sp. z o.o. Lublin 1,524 0.3% 53.6%
County Public Healthcare Centre in Rydułtowy and Wodzisław Śląski Located 112 in Wodzisław Śląski Wodzisław Śląski 1,516 0.3% 53.9%
113 Independent Public Healthcare Centre Specialist Hospital in Zabrze Zabrze 1,491 0.2% 54.1%
114 Szpital Miejski w Rudzie Śląskiej Sp. z o.o. Ruda Śląska 1,490 0.2% 54.4%
115 Międzylesie Specialist Hospital in Warsaw Warsaw 1,474 0.2% 54.6%
116 Jędrzej Śniadecki Independent Public Healthcare Centre Regional Hospital Białystok 1,453 0.2% 54.9%
117 Complex of Healthcare Facilities in Oświęcim Oświęcim 1,435 0.2% 55.1%
118 American Heart Of Poland Spółka Akcyjna Nysa 1,435 0.2% 55.4%
Tomaszów 119 Health Institute in Tomaszów Mazowiecki Mazowiecki 1,414 0.2% 55.6%
120 General Hospital in Jaworzno Jaworzno 1,412 0.2% 55.8%
121 Independent Public Healthcare Centre in Puławy Puławy 1,408 0.2% 56.1%
122 Specialist Hospital in Wejherowo Wejherowo 1,404 0.2% 56.3%
123 Complex of Healthcare Facilities in Kłodzko Kłodzko 1,389 0.2% 56.5%
105 Borderland Military Hospital and Clinic Independent Public Healthcare 124 Centre in Żary Żary 1,374 0.2% 56.8%
Piotrków 125 County Complex of Healthcare Facilities in Piotrków Trybunalski Trybunalski 1,373 0.2% 57.0%
Independent Public Healthcare Centre Regional Specialist Hospital No. 4 in 126 Bytom Bytom 1,367 0.2% 57.2%
127 Regional Specialist Hospital No. 2 in Jastrzębie-Zdrój Jastrzębie-Zdrój 1,361 0.2% 57.4%
Poznań-Stare 128 Non-Public Invasive Cardiology Centre Miasto 1,356 0.2% 57.7%
129 Independent Public Complex of Healthcare Facilities in Wyszków Wyszków 1,350 0.2% 57.9%
130 Non-Public Invasive Cardiology Centre “Ikardia” Nałęczów 1,346 0.2% 58.1%
131 Tomasz Ludyga Katowice 1,339 0.2% 58.3%
132 “Procardia” Non-Public Healthcare Centre Augustów 1,334 0.2% 58.6%
133 Maria Skłodowska-Curie Regional Specialist Hospital in Zgierz Zgierz 1,322 0.2% 58.8%
134 Independent Public Healthcare Centre in Koło Koło 1,311 0.2% 59.0%
Ostrów 135 Complex of Healthcare Facilities in Ostrów Wielkopolski Wielkopolski 1,307 0.2% 59.2%
136 Independent Public Healthcare Centre Radziejów 1,304 0.2% 59.4%
47 137 Independent Public Healthcare Centre in Siedlce Siedlce 1,288 0.2% 59.7%
138 Jędrzej Śniadecki Specialist Hospital in Nowy Sącz Nowy Sącz 1,284 0.2% 59.9%
139 County Hospital in Zawiercie Zawiercie 1,283 0.2% 60.1%
140 County Public Healthcare Centre Starachowice 1,281 0.2% 60.3%
141 Internal Medicine Hospital - ‘Hutniczy’ Częstochowa 1,264 0.2% 60.5%
142 General Independent Public Healthcare Complex in Zgorzelec Zgorzelec 1,255 0.2% 60.7%
143 Pabianickie Centrum Medyczne Sp. Z O.O. Pabianice 1,245 0.2% 60.9%
144 American Heart of Poland, Centre of Cardiology and Angiology of Sudety Polanica-Zdrój 1,242 0.2% 61.1%
145 Independent Public Healthcare Complex in Hrubieszów Hrubieszów 1,230 0.2% 61.3%
146 Jan Karol Łukowicz Specialist Hospital in Chojnice Chojnice 1,228 0.2% 61.5%
147 Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk Płońsk 1,222 0.2% 61.7%
148 Specialist Hospital in Jasło Jasło 1,215 0.2% 62.0%
149 Stanisław Rybicki Regional Polyclinical Hospital in Skierniewice Skierniewice 1,214 0.2% 62.2%
150 „Szpital Tucholski” Sp. z o.o. Tuchola 1,205 0.2% 62.4%
151 Invasive Cardiology, Electrotherapy and Angiology Centre in Krosno Krosno 1,205 0.2% 62.6%
152 American Heart Of Poland Spółka Akcyjna Nysa 1,199 0.2% 62.8%
153 CARINT SCAN MED Sp. z o.o. Kraków-Podgórze 1,195 0.2% 63.0%
Independent Public Healthcare Centre of the Ministry of Internal Affairs in 154 Rzeszów Rzeszów 1,195 0.2% 63.2%
155 Provincial Hospital in Bielsko-Biała Bielsko-Biała 1,193 0.2% 63.4%
Independent Public Healthcare Centre No. 5 Military Research Hospital and 156 Polyclinic in Kraków Kraków-Krowodrza 1,189 0.2% 63.6%
157 Sosnowiecki Szpital Miejski Sp. z o.o. Sosnowiec 1,186 0.2% 63.8%
158 Nicolaus Copernicus Regional Specialist Hospital in Łódź Łódź-Górna 1,182 0.2% 64.0%
159 Centrum Dializa Sp. z o.o. (healthcare provision in: Łask) Łask 1,181 0.2% 64.1%
160 Tytus Chałubiński County Hospital Zakopane 1,175 0.2% 64.3%
161 Complex of Healthcare Facilities in Wadowice Wadowice 1,167 0.2% 64.5%
162 Cardiology Centre of Zgierz Med-Pro Zgierz 1,164 0.2% 64.7%
163 New Hospital in Olkusz Olkusz 1,163 0.2% 64.9%
164 Non-Public Healthcare Centre in Racibórz Racibórz 1,159 0.2% 65.1%
165 Independent Public Healthcare Complex in Leżajsk Leżajsk 1,144 0.2% 65.3%
Polska Grupa Medyczna Sp. Z O.O. Polonia Świata Non-Public Healthcare 166 Centre of Polska Grupa Medyczna Gliwice 1,135 0.2% 65.5%
167 Complex of Healthcare Facilities in Sucha Beskidzka Kraków-Krowodrza 1,131 0.2% 65.7%
168 Independent Public Healthcare Centre in Opole Lubelskie Opole Lubelskie 1,129 0.2% 65.9%
169 Ado-Med. Kliniki. Sp. z o.o. Chełm 1,118 0.2% 66.1%
170 Allenort Kardiologia Sp. z o.o. Warsaw 1,109 0.2% 66.3%
171 PCK Independent Municipal Hospital Białystok 1,103 0.2% 66.4%
172 Oncology Centre of Beskidy - John Paul II Municipal Hospital in Bielsko-Biała Bielsko-Biała 1,096 0.2% 66.6%
173 County Complex of Healthcare Facilities Będzin 1,096 0.2% 66.8%
174 Wielospecjalistyczny Szpital Powiatowy Spółka Akcyjna Tarnowskie Góry 1,086 0.2% 67.0%
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical 175 Service Centre Grójec 1,085 0.2% 67.2%
176 Gliwice Medical Centre Gliwice 1,081 0.2% 67.3%
177 Infant Jesus Clinical Hospital Warsaw 1,070 0.2% 67.5%
48 Independent Public Healthcare Centre of the Ministry of Internal Affairs in 178 Białystok Białystok 1,070 0.2% 67.7%
179 Magodent Sp. z o.o. Warsaw 1,065 0.2% 67.9%
180 Saint John's Hospital Starogard Gdański 1,063 0.2% 68.1%
181 John Paul II Regional Hospital of Podkarpacjie in Krosno Krosno 1,061 0.2% 68.2%
182 Centrum Kardiologii Sp. z o.o. Józefów 1,055 0.2% 68.4%
183 Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. Żyrardów 1,049 0.2% 68.6%
184 Independent Public Complex of Healthcare Facilities Nisko 1,027 0.2% 68.8%
185 Independent Public Regional Specialist Hospital in Chełm Chełm 1,013 0.2% 68.9%
American Heart of Poland, 5th Department of Invasive Cardiology and 186 Angiology - Mielec Mielec 1,011 0.2% 69.1%
Non-Public Healthcare Centre of Cardiovascular Interventions of Podkarpacie 187 in Sanok Sanok 1,005 0.2% 69.3%
188 Ludwik Rydygier Regional Hospital in Suwałki Suwałki 1,003 0.2% 69.4%
189 Medical Centre in Łańcut Łańcut 999 0.2% 69.6%
Kraków-Nowa 190 Ludwik Rydygier Specialist Hospital in Kraków Huta 991 0.2% 69.8%
191 Hospital in Knurów Knurów 982 0.2% 69.9%
192 Kliniki Kardiologii Allenort Sp. z o.o. Szczecinek 980 0.2% 70.1%
193 Arion Med Sp. z o.o. Lublin 976 0.2% 70.3%
194 Complex of Healthcare Facilities - Busko-Zdrój Busko-Zdrój 975 0.2% 70.4%
195 Complex of Healthcare Facilities in Pińczów Pińczów 973 0.2% 70.6%
196 Complex of Healthcare Facilities in Żywiec Żywiec 971 0.2% 70.7%
197 Szpitale Wojewódzkie w Gdyni Sp. z o.o. Gdynia 969 0.2% 70.9%
198 Municipal Polyclinical Hospital Częstochowa 969 0.2% 71.1%
199 Saint Anne’s Hospital in Miechów Miechów 956 0.2% 71.2%
200 “Lux Med” Non-Public Healthcare Centre Rzeszów 956 0.2% 71.4%
201 Independent Public Healthcare Centre in Sokołów Podlaski Sokołów Podlaski 952 0.2% 71.5%
202 Independent Public Healthcare Centre Railway Hospital in Wilkowice-Bystra Wilkowice 951 0.2% 71.7%
203 Complex of Healthcare Facilities in Nysa Nysa 940 0.2% 71.9%
204 County Hospital Complex Oleśnica 928 0.2% 72.0%
205 Sochaczew County Hospital Healthcare Complex Sochaczew 925 0.2% 72.2%
206 Specialist Hospital in Kościerzyna Kościerzyna 922 0.2% 72.3%
Tomaszów 207 Allenort Cardiology Centre Mazowiecki 913 0.2% 72.5%
Regional Complex of Healthcare Facilities, Centre for Treatment of Lung 208 Diseases and Rehabilitation in Łódź Łódź-Bałuty 912 0.2% 72.6%
Regional Ambulance and Medical Transportation Service “Meditrans” 209 Independent Public Healthcare Centre in Warsaw Warsaw 912 0.2% 72.8%
210 Mikołaj Kopernik Hospital Gdańsk 910 0.2% 72.9%
Independent Public Healthcare Centre Edmund Biernacki County Hospital in 211 Opoczno Opoczno 909 0.2% 73.1%
212 Invasive Cardiology, Electrotherapy and Angiology Centre in Oświęcim Oświęcim 906 0.2% 73.2%
213 Józef Rostek District Hospital in Racibórz Racibórz 900 0.2% 73.4%
214 Provincial Hospital Włocławek 894 0.1% 73.5%
215 Complex of Healthcare Facilities in Strzyżów Strzyżów 890 0.1% 73.7%
216 Independent Public Healthcare Centre in Lubartów Lubartów 888 0.1% 73.8%
49 217 Zofia Tarnowska nee Zamoyska Provincial Hospital in Tarnobrzeg Tarnobrzeg 886 0.1% 74.0%
218 Municipal Hospital in Tychy Tychy 885 0.1% 74.1%
219 Intercard Sp. z o. o. Pińczów 874 0.1% 74.3%
220 Regional Hospital in Kołobrzeg Kołobrzeg 862 0.1% 74.4%
221 Complex of Healthcare Facilities Ropczyce 861 0.1% 74.6%
222 Municipal Hospital in Przemyśl Przemyśl 856 0.1% 74.7%
223 Independent Public Healthcare Complex Mińsk Mazowiecki 843 0.1% 74.8%
224 Complex of Healthcare Facilities in Dębica Dębica 842 0.1% 75.0%
Wołomin County Hospital – Independent Complex of Public Healthcare 225 Facilities Wołomin 836 0.1% 75.1%
Dąbrowa 226 Complex of Healthcare Facilities in Dąbrowa Tarnowska Tarnowska 829 0.1% 75.3%
227 Independent Public Healthcare Centre in Radzyń Podlaski Radzyń Podlaski 825 0.1% 75.4%
228 Independent Public Complex of Healthcare Facilities in Staszów Staszów 821 0.1% 75.5%
229 "Pro-Medica” w Ełku Sp. z o. o. Ełk 819 0.1% 75.7%
Specialist Hospital in Brzozów, Bronislaw Markiewicz Subcarpathian Oncology 230 Centre Brzozów 816 0.1% 75.8%
231 Complex of Healthcare Facilities in Włoszczowa Włoszczowa 815 0.1% 75.9%
232 Regional Polyclinical Hospital in Leszno Leszno 813 0.1% 76.1%
233 County Hospital in Limanowa Limanowa 808 0.1% 76.2%
234 Complex of Healthcare Facilities in Cieszyn Cieszyn 808 0.1% 76.4%
235 Regionalne Centrum Zdrowia Sp. z o.o. Lubin 804 0.1% 76.5%
236 Powiatowe Centrum Zdrowia Sp. z o.o. Otwock 803 0.1% 76.6%
237 Megrez Sp. z o.o. Tychy 796 0.1% 76.8%
238 County Hospital in Brzeziny Brzeziny 794 0.1% 76.9%
239 Szpital Specjalistyczny w Kościerzynie Sp. z o.o. Kościerzyna 789 0.1% 77.0%
240 Joseph Glowatzki County Hospital in Strzelce Opolskie Strzelce Opolskie 783 0.1% 77.1%
241 Municipal Polyclinical Hospital in Olsztyn Olsztyn 783 0.1% 77.3%
242 Jerzy Gromkowski Provincial Specialist Hospital Wrocław 776 0.1% 77.4%
Piotrków 243 Nicolaus Copernicus Independent Provincial Hospital in Piotrków Trybunalski Trybunalski 776 0.1% 77.5%
244 Zduńskowolski Szpital Powiatowy Sp. z o.o. Zduńska Wola 775 0.1% 77.7%
245 County Hospital in Jarocin Jarocin 772 0.1% 77.8%
Aleksandrów 246 Powiatowy Szpital w Aleksandrowie Kujawskim Sp. z o.o. Kujawski 770 0.1% 77.9%
247 Complex of Healthcare Facilities in Łowicz Łowicz 769 0.1% 78.1%
248 Complex of Healthcare Facilities in Łęczyca Łęczyca 767 0.1% 78.2%
249 Independent Public Complex of Healthcare Facilities in Gryfice Gryfice 767 0.1% 78.3%
Complex of Healthcare Facilities in Skarżysko-Kamienna Maria Skłodowska- Skarżysko- 250 Curie County Hospital Kamienna 763 0.1% 78.4%
251 Independent Public Healthcare Centre of the Ministry of Internal Affairs in Łódź Łódź-Bałuty 754 0.1% 78.6%
252 Independent Public Healthcare Centre in Węgrów Węgrów 754 0.1% 78.7%
253 Henryk Klimontowicz Specialist Hospital in Gorlice Gorlice 752 0.1% 78.8%
254 Szpital Miejski w Zabrzu Sp. z o.o. Zabrze 752 0.1% 78.9%
Specialist Hospital and Clinic of Elbląg Independent Public Healthcare Centre 255 in Elbląg Elbląg 750 0.1% 79.1%
256 109 Military Hospital and Clinic Independent Public Healthcare Centre Szczecin 743 0.1% 79.2%
50 257 Transfiguration Hospital in Warsaw Independent Public Healthcare Centre Warsaw 741 0.1% 79.3%
258 “ATTIS” Therapeutic, Rehabilitation and Occupational Medicine Centre Warsaw 739 0.1% 79.4%
259 "Głogowski Szpital Powiatowy" Sp. z o.o. Głogów 729 0.1% 79.6%
260 Independent Public Healthcare Centre in Łuków Łuków 729 0.1% 79.7%
261 Nowy Szpital w Świebodzinie Sp. z o.o. Świebodzin 729 0.1% 79.8%
262 Zespół Opieki Zdrowotnej w Świętochłowicach Sp. z o.o. Świętochłowice 725 0.1% 79.9%
263 Independent Public Healthcare Complex No. 1 in Rzeszów Rzeszów 722 0.1% 80.0%
Source: compiled by DAiS based on data provided by the NFZ.
Geographic distribution of hospitals treating 80% of patients with cardiac diseases (cf. Table 29), accurate to a county, is shown on Figure 47.
The analysed hospitals are located mainly either in city counties or in counties adjacent to them. Of 263 hospitals, 14 were in Warsaw, 7 in Poznań, 10 in Łódź, and 8 in Kraków.
Figure 47: Hospitals treating approx. 80% of cardiac patients (2013)
Number of hospitals
No hospital
Source: compiled by DAiS based on data provided by the NFZ.
51
52 Figure 48: Counties with hospitals treating cardiac patients in Mazowieckie Voivodeship (2013)
Source: compiled by DAiS based on data provided by the NFZ.
Figure 49: Counties with hospitals treating over 1% of cardiac patients regionwide (2013)
Source: compiled by DAiS based on data provided by the NFZ.
In 2013, taking into consideration the entire Mazowieckie Voivodeship, 89,467 patients were treated due to cardiac reasons during 109,453 hospitalisations. On average, the number of hospitalisations per patient in Mazowieckie Voivodeship amounted to 1.2.
53 Table 3: Hospitalisations and cardiac patients in selected hospitals (2013)
Number of Number of Name of the treatment provider City/town hospitalisati patients ons
Cardinal Wyszyński Institute of Cardiology Warsaw 12,431 15,886
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw Warsaw 4,962 6,427
Public Paediatric Central Clinical Hospital Warsaw 4,447 5,435
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre Warsaw 3,244 3,970
Military Institute of Medicine Warsaw 3,239 4,258
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre Warsaw 3,205 4,218
Mazovian Specialist Hospital in Radom Radom 3,092 3,721
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. Warsaw 2,899 3,658
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. Siedlce 2,779 3,614
Józef Psarski Mazovian Specialist Hospital in Ostrołęka Ostrołęka 2,710 3,359
John Paul II Independent Public Specialist Western Hospital Grodzisk Mazowiecki 2,614 3,156
Regional Polyclinical Hospital in Płock Płock 2,511 3,272
Tytus Chałubiński Specialist Hospital in Radom Radom 2,311 2,816
Szpital Kolejowy im. dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. Pruszków 2,165 2,507
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 2153 2,515
Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka Ostrów Mazowiecka 2,078 2,541
Regional Specialist Hospital in Ciechanów Ciechanów 1,974 2,405
Międzylesie Specialist Hospital in Warsaw Warsaw 1,474 1,836
Independent Public Complex of Healthcare Facilities in Wyszków Wyszków 1,350 1,646
Independent Public Healthcare Centre in Siedlce Siedlce 1,288 1,527
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk Płońsk 1,222 1,382
Allenort Kardiologia Sp. z o.o. Warsaw 1,109 1,279
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre Grójec 1,085 1,292
Infant Jesus Clinical Hospital Warsaw 1,070 1,324
Magodent Sp. z o.o. Warsaw 1,065 1,223
Centrum Kardiologii Sp. z o.o. Józefów 1,055 1,253
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. Żyrardów 1,049 1,227
Independent Public Healthcare Centre in Sokołów Podlaski Sokołów Podlaski 952 1,120
Sochaczew County Hospital Healthcare Complex Sochaczew 925 1,089
Regional Ambulance and Medical Transportation Service “Meditrans” Independent Public Healthcare Centre in Warsaw Warsaw 912 1,045
Independent Public Healthcare Complex Mińsk Mazowiecki 843 1,025
Wołomin County Hospital – Independent Complex of Public Healthcare Facilities Wołomin 836 945
Powiatowe Centrum Zdrowia Sp. z o.o. Otwock 803 896
Independent Public Healthcare Centre in Węgrów Węgrów 754 919
Transfiguration Hospital in Warsaw Independent Public Healthcare Centre Warsaw 741 828
“Attis” Therapeutic, Rehabilitation and Occupational Medicine Centre Warsaw 739 820
St. Anne Non-Public Healthcare Centre in Piaseczno Piaseczno 717 827
Independent Public Complex of Healthcare Facilities in Kozienice Kozienice 700 824
Independent Public Complex of Healthcare Facilities in Żuromin Żuromin 583 682
Independent Public Healthcare Centre in Pułtusk Pułtusk 562 702
Independent Public Complex of Healthcare Facilities in Przasnysz Przasnysz 562 661
54 Independent Public Healthcare Facilities Complex Maków Mazowiecki 556 680
Independent Public Complex of Healthcare Facilities in Lipsko Lipsko 527 613
Czerniakowski Hospital Independent Public Healthcare Centre Warsaw 481 532
Medicover Hospital Śródmieście 455 485
Independent Public Healthcare Centre Łosice 455 526
Nowy Dwór Nowy Dwór Medical Centre in Nowy Dwór Mazowiecki Mazowiecki 437 496
Independent Public Complex of Healthcare Facilities in Sierpc Sierpc 408 463
Independent Public Complex of Healthcare Facilities – Iłża Hospital Iłża 384 442
Szpital Solec Sp. z o.o. Warsaw 368 406
Independent Public Healthcare Centre in Mława Mława 367 414
Nowe Miasto Nad Independent Public Healthcare Centre in Nowe Miasto Nad Pilicą Pilicą 350 396
Szpital Powiatowy w Pułtusku Spółka z o.o. Pułtusk 343 385
Mazovian Center for Treatment of Lung Diseases and Tuberculosis Otwock 335 351
Battle of Warsaw 1920 Medical Centre in Radzymin – Independent Public Complex of Healthcare Facilities Radzymin 320 381
Military Institute of Aviation Medicine Warsaw 286 338
St. Anne's Provincial Hospital of Trauma Surgery Warszawa-Ochota 279 324
Independent Public Healthcare Centre in Garwolin Garwolin 273 291
Europejskie Centrum Zdrowia Otwock Sp. z o.o. Warsaw 250 290
Independent Public Complex of Healthcare Facilities in Przysucha Przysucha 240 283
Independent Public Complex of Healthcare Facilities in Pionki Pionki 237 269
Independent Public Complex of Healthcare Facilities in Zwoleń Zwoleń 184 198
Independent Public Complex of Healthcare Facilities in Pruszków Pruszków 173 178
“Sensor Cliniq” Non-Public Healthcare Centre Warsaw 147 157
Professor Witold Orłowski Independent Public Clinical Hospital of the Medical Centre for Postgraduate Education in Warsaw Warsaw 133 139
“Płocki ZOZ” Non-Public Healthcare Centre Płock 92 97
Maria Skłodowska-Curie Institute of Oncology Warsaw 55 56
Warszawa- Independent Public Paediatric Clinical Hospital Śródmieście 52 59
Children’s Memorial Health Institute in Warsaw Warsaw 29 31
Institute of Hematology and Transfusion Medicine Warsaw 28 30
Prof. Jan Bogdanowicz Children's Hospital Independent Public Healthcare Centre Warsaw 12 12
Institute of Mother and Child Warsaw 1 1
Source: compiled by DAiS based on data provided by the NFZ.
The largest number of patients in Mazowieckie Voivodeship was admitted to The Cardinal Wyszyński Institute of Cardiology in Warsaw, i.e. 12.4 thousand patients (13.5% of all patients treated in the region), during 15.9 thousand hospitalisations (14.1% of all hospitalisations in the region). The second facility, Central Clinical Hospital of the MSWiA in Warsaw, treated 5 thousand patients (5.4% of all patients treated in the region) during 6,4 thousand hospitalisations (5.7% of hospitalisations in the region). The third facility, i.e. the Independent Public Central Clinical Hospital in Warsaw, treated 4.4 thousand
55 patients (4.8% of all patients treated in the region) during 5,4 thousand hospitalisations (4.8% of all hospitalisations in the region).
There were 29 (out of 72) healthcare providers who treated more than 1.0% of patients regionwide, and 27 healthcare providers whose share of hospitalisations exceeded 1% of all hospitalisations in the region.
In 2013, around 4% of patients from Mazowieckie Voivodeship were treated outside the region. Most patients (1,523) were treated in Lubelskie Voivodeship, as well as in the following voivodeships: Świętokrzyskie (524), Łódzkie (415), Śląskie (226) and Warmińsko-Mazurskie (201) (Figure 52).
Figure 50: Cardiac patients migrations within Mazowieckie Voivodeship
Share (%) of patients from the county admitted to hospitals in the county
Share (%) of hospitalised patients
Source: compiled by DAiS based on data provided by the NFZ.
In 2013, 9% of patients hospitalised in Mazowieckie Voivodeship originated from another region. Most of them came from Lubelskie Voivodeship (1794 patients), Łódzkie Voivodeship (1541), Podlaskie Voivodeship (893) and Kujawsko-Pomorskie Voivodeship (756) (Wykres 51).
56 Figure 51: Cardiac patients migrations into Mazowieckie Voivodeship
682 patients
893 patients
756 patients
1541 patients
1794 patients
Share (%) of patients from other voivodeships
Share (%) of patients from the voivodeship
Source: compiled by DAiS based on data provided by the NFZ.
Figure 52: Cardiac patients migrations from Mazowieckie Voivodeship
201 patients
415 patients 1523 patients
524 patients
Patients treated outside 226 patients the voivodeship
Share (%) of patients treated outside the voivodeship
Source: compiled by DAiS based on data provided by the NFZ.
2.1.2 Adult Cardiology
The analysis of selected healthcare providers
Further analysis included healthcare providers who treated more than 1% of patients with heart diseases regionwide. The analysis covered the number of beds and inpatient treatments. Figure 53 shows the number of beds at selected cardiology wards. Figure 54 shows the number of beds per 100,000 inhabitants. Table 4 shows the number of beds grouped into cardiology wards of selected healthcare
57 providers in Mazowieckie Voivodeship. In 2012, per 5.32 inhabitants of the region, there were 1388 beds in cardiology wards (26.1/100 thousand inhabitants, national average 20.29/100 thousand inhabitants), 245 in cardiology intensive care wards (4.6/100 thousand inhabitants, national average 3.10/100 thousand inhabitants), 121 in cardiological rehabilitation wards (2.3/100 thousand inhabitants, national average 6.86/100 thousand) and 184 in cardiac surgery wards (3.5/100 thousand inhabitants, national average 2.61/100 thousand). The largest cardiology unit is the Cardinal Wyszyński Institute of Cardiology in Warsaw with 363 hospital beds, which accounts for 17.3% of regional resource base. 31 (out of 42) facilities have at their disposal over 1,0% of beds forming the regional resource base.
Figure 53: Number of beds at selected wards
Cardiology ward
Cardiology intensive care ward
Cardiac surgery ward
Cardiological rehabilitation ward
Paediatric cardiology ward
Paediatric cardiac surgery ward
Angiology ward
Pacemaker implantation ward
Source: compiled by DAiS based on data provided by the CSIOZ.
Figure 54: Beds in selected wards per 100 thousand inhabitants
Cardiology ward
Cardiology intensive care ward
Cardiac surgery ward
Cardiological rehabilitation ward
Paediatric cardiology ward
Paediatric cardiac surgery ward
Angiology ward
Source: compiled by DAiS based on data provided by the CSIOZ and Central Statistical Office.
58
Table 4: Beds in selected wards per hospital (2013)
Healthcare provider / Ward City/town
ward
TOTAL Cardiology ward Paediatric cardiology Cardiology intensive care ward Paediatric cardiology intensive care ward Angiology ward Cardiological rehabilitation ward Cardiology ward Paediatric cardiac surgery ward Pacemaker implantation ward
Cardinal Wyszyński Institute of Cardiology Warsaw 363 272 24 12 55
Public Paediatric Central Clinical Hospital in Warsaw Warsaw 129 72 18 6 33
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw Warsaw 138 57 23 12 10 36
Infant Jesus Clinical Hospital Warsaw 40 16 24
Central Clinical Hospital of the Ministry of Defence Warsaw 94 61 16 17
Szpital Grochowski im. dr med. Rafała Masztaka Spółka z ograniczoną odpowiedzialnością Warsaw 91 77 14
Regional Polyclinical Hospital in Płock Płock 85 69 16
Children’s Memorial Health Institute in Warsaw Warsaw 72 48 24
Mazowiecki Szpital Specjalistyczny Spółka z Ograniczoną Odpowiedzialnością Radom 78 50 9 19
Bródno Clinical Centre Warsaw 62 48 14
Regional Specialist Hospital in Ciechanów Ciechanów 60 31 15 8 6
Specialist Hospital in Siedlce Siedlce 60 52 8
Jozef Psarski Mazovia Specialist Hospital in Ostrołęka - Inpatient and 24h Hospital Healthcare Ostrołęka 52 48 4
Konstancin- "Uzdrowisko Konstancin-Zdrój" Spółka akcyjna Jeziorna 50 50
Hospital in Gorzewo Gorzewo 48 24 24
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 47 37 10
Tytus Chałubiński Specialist Hospital in Radom - Inpatient Healthcare Radom 46 42 4
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre Warsaw 45 39 6
Grodzisk John Paul II Independent Public Specialist Western Hospital Mazowiecki 44 40 4
County Hospital in the Independent Public Complex of Healthcare Facilities in Wyszków Wyszków 40 32 8
Międzylesie Specialist Hospital in Warsaw Warsaw 39 33 6
Independent Public Paediatric Clinical Hospital in Warsaw Warsaw 37 37
59 Ostrów Maria Skłodowska-Curie County Hospital Mazowiecka 36 36
Włodzimierz Roefler Railway Hospital in Pruszków Independent Public Healthcare Centre Pruszków 35 25 5 5
Sochaczew County Hospital Healthcare Complex Sochaczew 31 31
Regional Ambulance and Medical Transportation Service “Meditrans” Warsaw Independent Public Healthcare Centre 28 20 8
MAGODENT Non-Public Healthcare Centre Warsaw 26 20 4 1 1
Independent Public Healthcare Centre in Siedlce Siedlce 23 23
Cardiology Centre - Hospital Józefów 23 19 4
Allenort Hospital Warsaw 23 23
Fryderyk Chopin European Health Centre Otwock 22 18 4
Józef Piłsudski Independent Public Complex of Healthcare Facilities Płońsk in Płońsk 20 20
Short-Term Care Hospital Warsaw 20 20
Medicover Hospital Warsaw 17 13 4
Independent Public Paediatric Clinical Hospital in Warsaw Warsaw 16 16
Solec Hospital Warsaw 16 16
Czerniakowski Hospital Independent Public Healthcare Centre – Hospital Warsaw 15 15
“Zdrowie” Family Clinic Long-Term Care Centre Raciąż 10 10
SENSOR CLINIQ Hospital Warsaw 6 6
Saint Elisabeth’s Hospital, Mokotów Medical Centre Warsaw 5 5
Independent Public Healthcare Centre in Mława Mława 4 4
MAGODENT Non-Public Healthcare Centre Warsaw 1 1 Source: compiled by DAiS based on data provided by the CSIOZ.
Over 14 thousand patients with cardiac diagnoses were treated in internal wards, (18.5% of all cardiac patients), in cardiology wards - over 59.3 thousand patients (78% of all cardiac patients), while in cardiac surgery wards - 3.7 thousand patients (4.9% of all cardiac patients). In hospitals with cardiology and internal medicine wards, 66% to 97.1% of patients with cardiac diagnoses are treated in cardiology wards (Tables 5 and 6).
Table 5: Hospitalisations of cardiac patients in selected hospitals per ward (2013)
Hospital City/town
Other
Internal Cardiology Paediatric Cardiology Cardiology intensive care Paediatric cardiology intensive care Cardiac Surgery Paediatric Cardiac Surgery TOTAL Number of unique patients 11,01 12,90 Cardinal Wyszyński Institute of Cardiology Warsaw 8 1,890 8 12,431
Central Clinical Hospital of the Ministry of the Interior and Administration (MSWiA) Warsaw 4,028 490 638 5,156 4,962
Public Paediatric Central Clinical Hospital Warsaw 1,072 3,175 461 4,708 4,447
60 Anna Gostyńska Wola Hospital Independent Public Healthcare Centre Warsaw 914 2,470 3,384 3,244
Military Institute of Medicine Warsaw 2,910 436 47 3,393 3,239
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre Warsaw 778 2,541 3,319 3,205
Mazovian Specialist Hospital in Radom Radom 671 2,348 195 3,214 3,092
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. Warsaw 307 2,636 2,943 2,899
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. Siedlce 145 2,658 2 2,805 2,779
Józef Psarski Mazovian Specialist Hospital in Ostrołęka Ostrołęka 79 2,641 1 2,721 2,710
Grodzisk John Paul II Western Hospital Mazowiecki 265 2,399 2,664 2,614
Regional Polyclinical Hospital in Płock Płock 93 2,412 18 2,523 2,511
Tytus Chałubiński Specialist Hospital in Radom Radom 337 1,993 3 2,333 2,311
Szpital Kolejowy Im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. Pruszków 745 1,487 2,232 2,165
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 314 1,879 2 2,195 2,153
Independent Public Complex of Healthcare Facilities in Ostrów Ostrów Mazowiecka Mazowiecka 510 1,619 1 2,130 2,078
Regional Specialist Hospital in Ciechanów Ciechanów 153 1,836 5 1,994 1,974
Międzylesie Specialist Hospital in Warsaw Warsaw 231 1,275 1,506 1,474
Independent Public Complex of Healthcare Facilities in Wyszków Wyszków 83 1,281 1,364 1,350
Independent Public Healthcare Centre in Siedlce Siedlce 201 1111 1,312 1,288
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk Płońsk 433 828 2 1,263 1,222
Allenort Kardiologia Sp. z o.o. Śródmieście 871 274 1,145 1,109
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre Grójec 1,084 1 1,085 1,085
Infant Jesus Clinical Hospital Warsaw 208 882 23 1,113 1,070
Magodent Sp. z o. o. Warsaw 1,065 1,065 1,065
Centrum Kardiologii Sp. z o.o. Józefów 1,055 1,055 1,055
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. Żyrardów 1,048 1 1,049 1,049
Sokołów Independent Public Healthcare Centre in Sokołów Podlaski Podlaski 952 952 952
Sochaczew County Hospital Healthcare Complex Sochaczew 925 925 925
Regional Ambulance and Medical Transportation Service “Meditrans” Independent Public Healthcare Centre in Warsaw Warsaw 912 912 912
Mińsk Independent Public Healthcare Complex Mazowiecki 843 843 843
Wołomin County Hospital – Independent Complex of Public Healthcare Facilities Wołomin 836 836 836
Powiatowe Centrum Zdrowia Sp. z o.o. Otwock 800 3 803 803
Source: compiled by DAiS based on data provided by the NFZ.
61 Table 6: Share of cardiac patients in selected hospitals per ward (2013)
Healthcare provider / Ward City/town
Other
Internal Cardiology Paediatric Cardiology Cardiology intensive care Paediatric cardiology intensive care Cardiac Surgery Paediatric Cardiac Surgery Cardinal Wyszyński Institute of Cardiology Warsaw 85.4% 14.6%
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw Warsaw 78.1% 9.5% 12.4%
Public Paediatric Central Clinical Hospital Warsaw 22.8% 67.4% 9.8%
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre Warsaw 27.0% 73.0%
Military Institute of Medicine Warsaw 85.8% 12.8% 1.4%
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre Warsaw 23.4% 76.6%
Mazovian Specialist Hospital in Radom Radom 20.9% 73.1% 6.1%
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. Warsaw 10.4% 89.6%
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. Siedlce 5.2% 94.8% 0.1%
Józef Psarski Mazovian Specialist Hospital in Ostrołęka Ostrołęka 2.9% 97.1% 0.0%
Grodzisk John Paul II Independent Public Specialist Western Hospital Mazowiecki 9.9% 90.1%
Regional Polyclinical Hospital in Płock Płock 3.7% 95.6% 0.7%
Tytus Chałubiński Specialist Hospital in Radom Radom 14.4% 85.4% 0.1%
Szpital Kolejowy Im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. Pruszków 33.4% 66.6%
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 14.3% 85.6% 0.1%
Independent Public Complex of Healthcare Facilities in Ostrów Ostrów Mazowiecka Mazowiecka 23.9% 76.0% 0.0%
Regional Specialist Hospital in Ciechanów Ciechanów 7.7% 92.1% 0.3%
Międzylesie Specialist Hospital in Warsaw Warsaw 15.3% 84.7%
Independent Public Complex of Healthcare Facilities in Wyszków Wyszków 6.1% 93.9%
Independent Public Healthcare Centre in Siedlce Siedlce 15.3% 84.7%
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk Płońsk 34.3% 65.6% 0.2%
Allenort Kardiologia Sp. Z O.O Śródmieście 76.1% 23.9%
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre Grójec 99.9% 0.1%
Infant Jesus Clinical Hospital Warsaw 18.7% 79.2% 2.1%
Magodent Sp. z o.o. Warsaw 100.0%
Centrum Kardiologii Sp. z o.o. Józefów 100.0%
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. Żyrardów 99.9% 0.1%
Sokołów Independent Public Healthcare Centre in Sokołów Podlaski Podlaski 100.0%
62 Sochaczew County Hospital Healthcare Complex Sochaczew 100.0%
Regional Ambulance and Medical Transportation Service “Meditrans” Independent Public Healthcare Centre in Warsaw Warsaw 100.0%
Mińsk Independent Public Healthcare Complex Mazowiecki 100.0%
Wołomin County Hospital – Independent Complex of Public Healthcare Facilities Wołomin 100.0%
Powiatowe Centrum Zdrowia Sp. z o.o. Otwock 99.6% 0.4%
Source: compiled by DAiS based on data provided by the NFZ.
Most patients (28.1 thousand) were hospitalised with the diagnosis "Other forms of coronary heart disease", which accounts for 31% of all cardiological hospitalisations in the region. The second most frequent diagnosis is heart failure (19.3 thousand hospitalisations, which accounts for 21% of all cardiological hospitalisations in the region). The next most common disease entities were: Acute coronary syndrome (ACS) (13.5 thousand hospitalisations, which accounts for 13.5% of all cardiological hospitalisations in the region), other rhythm and conduction disturbances (9.6 thousand hospitalisations - 11%), atrial fibrillation and flutter (9.3 thousand hospitalisations - 10%), acquired heart defects (7.3 thousand hospitalisations - 8%), pulmonary embolism (1.5 thousand - 2% of hospitalisations) and congenital heart defects (1.4 thousand - 2% of hospitalisations).
The largest number of in-patients suffering from coronary heart disease were admitted to the Cardinal Wyszyński Institute of Cardiology in Warsaw - 7.9 thousand (6 thousand - other forms of ischaemic heart disease, 1.8 thousand - ACS), which altogether accounts for 49.6% of hospitalisations due to cardiac reasons in this hospital. The Independent Public Central Clinical Hospital in Warsaw holds the second position with 3 thousand admissions (2 thousand - other forms of coronary heart disease, 1 thousand - ACS), which altogether accounts for 46% of hospitalisations due to cardiac reasons. The next place belongs to the Military Institute of Medicine - 2.6 thousand admissions (1.7 thousand - other forms of coronary heart disease, 1 thousand - ACS), which altogether accounts for 60% of hospitalisations due to cardiac reasons.
There are two hospitals in Mazowieckie Voivodeship where the number of hospitalisations due to acute coronary syndromes exceeds 1000. More than 800 and less than 1000 hospitalisations yearly due to ACS are recorded in 5 hospitals in the region (Table 7 and 8).
63 Table 7: Hospitalisations of cardiac patients in selected hospitals per diagnosis (2013)
Healthcare provider / Scope of treatment
ACS formsOther ischaemic of heartdisease fibrillationAtrial and flutter Other rhythm and conduction disturbances Heartfailure Pulmonary embolism Acquired heart defects Congenital heart defects Hospitalisations in total 15,88 Cardinal Wyszyński Institute of Cardiology 1,838 6,053 1,305 1,769 1,461 42 2,506 996 6
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw 858 2,122 743 699 1,040 162 698 105 6,427
Public Paediatric Central Clinical Hospital 814 1,283 776 539 962 217 816 29 5,435
Military Institute of Medicine 870 1,694 280 384 537 63 387 43 4,258
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre 639 1,323 671 421 976 54 119 15 4,218
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre 496 1,071 431 746 1111 86 31 1 3,970
Mazovian Specialist Hospital in Radom 718 998 455 367 1,069 56 53 6 3,721
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. 825 1,041 391 481 619 114 186 4 3,658
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. 489 1,578 400 460 518 27 109 33 3,614
Józef Psarski Mazovian Specialist Hospital in Ostrołęka 760 969 416 538 566 58 44 8 3,359
Regional Polyclinical Hospital in Płock 608 1,223 481 357 479 46 69 9 3,272
John Paul II Independent Public Specialist Western Hospital 1,336 857 76 204 591 40 52 3 3,156
Tytus Chałubiński Specialist Hospital in Radom 522 650 342 353 800 46 90 13 2,816
Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka 72 640 258 103 1,152 22 293 1 2,541
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre 620 651 199 325 582 62 65 12 2,515
Szpital Kolejowy Im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. 118 486 76 72 1,200 58 478 21 2,507
Regional Specialist Hospital in Ciechanów 537 798 256 212 545 16 40 1 2,405
Międzylesie Specialist Hospital in Warsaw 131 367 312 194 615 51 168 3 1,836
Independent Public Complex of Healthcare Facilities in Wyszków 51 531 124 55 754 23 106 2 1,646
Independent Public Healthcare Centre in Siedlce 28 212 308 349 477 22 78 53 1,527
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk 44 270 50 43 722 48 203 2 1,382
Infant Jesus Clinical Hospital 269 625 47 40 112 149 62 21 1,324
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre 85 118 191 42 799 17 39 1 1,292
Allenort Kardiologia Sp. z o.o. 101 702 177 203 1 10 75 10 1,279
Centrum Kardiologii Sp. z o.o. 430 505 66 209 38 3 2 1,253
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. 34 303 61 25 640 12 152 1,227
Magodent Sp. z o.o. 33 728 113 216 49 7 68 9 1,223
Independent Public Healthcare Centre in Sokołów Podlaski 59 105 151 146 397 u 250 1 1,120
Sochaczew County Hospital Healthcare Complex 104 171 193 55 445 20 101 1,089
Source: compiled by DAiS based on data provided by the NFZ.
64 Table 8: Hospitalisations of cardiac patients in selected hospitals per diagnosis (2013)
Healthcare provider / Scope of treatment ischaemic heart
ACS Other forms of disease fibrillationAtrial and flutter Other rhythm disturbances and conduction Heartfailure Pulmonary embolism Acquired heart defects Congenital heart defects Cardinal Wyszyński Institute of Cardiology 11.6% 38.1% 8.2% 11.1% 9.2% 0.3% 15.8% 6.3%
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw 13.3% 33.0% 11.6% 10.9% 16.2% 2.5% 10.9% 1.6%
Public Paediatric Central Clinical Hospital 15.0% 23.6% 14.3% 9.9% 17.7% 4.0% 15.0% 0.5%
Military Institute of Medicine 20.4% 39.8% 6.6% 9.0% 12.6% 1.5% 9.1% 1.0%
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre 15.1% 31.4% 15.9% 10.0% 23.1% 1.3% 2.8% 0.4%
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre 12.5% 27.0% 10.9% 18.8% 28.0% 2.2% 0.8% 0.0%
Mazovian Specialist Hospital in Radom 19.3% 26.8% 12.2% 9.9% 28.7% 1.5% 1.4% 0.2%
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. 22.6% 28.5% 10.7% 131% 16.9% 3.1% 5.1% 0.1%
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. 135% 437% 11.1% 12.7% 14.3% 0.7% 3.0% 0.9%
Józef Psarski Mazovian Specialist Hospital in Ostrołęka 22.6% 28.8% 12.4% 16.0% 16.9% 1.7% 1.3% 0.2%
Regional Polyclinical Hospital in Płock 18.5% 37.4% 14.7% 10.9% 14.6% 1.4% 2.1% 0.3%
John Paul II Independent Public Specialist Western Hospital 42.3% 27.2% 2.4% 6.5% 18.7% 1.3% 1.6% 0.1%
Tytus Chałubiński Specialist Hospital in Radom 18.5% 23.1% 12.1% 12.5% 28.4% 1.6% 3.2% 0.5%
Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka 2.8% 25.2% 10.2% 4.1% 45.3% 0.9% 11.5% 0.0%
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre 24.7% 25.9% 7.9% 12.9% 23.1% 2.5% 2.6% 0.5%
Szpital Kolejowy Im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. 4.7% 19.4% 3.0% 2.9% 47.9% 2.3% 19.1% 0.8%
Regional Specialist Hospital in Ciechanów 22.3% 33.2% 10.6% 8.8% 22.7% 0.7% 1.7% 0.0%
Międzylesie Specialist Hospital in Warsaw 7.1% 20.0% 17.0% 10.6% 33.5% 2.8% 9.2% 0.2%
Independent Public Complex of Healthcare Facilities in Wyszków 3.1% 32.3% 7.5% 3.3% 45.8% 1.4% 6.4% 0.1%
Independent Public Healthcare Centre in Siedlce 1.8% 13.9% 20.2% 22.9% 31.2% 1.4% 5.1% 3.5%
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk 3.2% 19.5% 3.6% 3.1% 52.2% 3.5% 14.7% 0.1%
Infant Jesus Clinical Hospital 20.3% 47.2% 3.5% 3.0% 8.5% 11.3% 4.7% 1.6%
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre 6.6% 9.1% 14.8% 3.3% 61.8% 1.3% 3.0% 0.1%
Allenort Kardiologia Sp. z o. o. 7.9% 54.9% 13.8% 15.9% 0.1% 0.8% 5.9% 0.8%
Centrum Kardiologii Sp. z o.o. 34.3% 40.3% 5.3% 16.7% 3.0% 0.2% 0.2%
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. 2.8% 24.7% 5.0% 2.0% 52.2% 1.0% 12.4%
Magodent Sp. z o.o. 2.7% 59.5% 9.2% 17.7% 4.0% 0.6% 5.6% 07%
Independent Public Healthcare Centre in Sokołów Podlaski 5.3% 9.4% 13.5% 13.0% 35.4% 1.0% 22.3% 0.1%
Sochaczew County Hospital Healthcare Complex 9.6% 15.7% 17.7% 5.1% 40.9% 1.8% 9.3%
Source: compiled by DAiS based on data provided by the NFZ.
Among the entities that admitted over 1% of in-patients in the region, 20 healthcare providers performs coronary angiography (a total of 24.5 thousand) and 25 performs coronary angioplasty (a total of 15,973 thousand). Pacemaker implantations are performed in 19 hospitals (a total of 5.2 thousand), Implantable
65 Cardioverter Defibrillator (ICD) implantations (a total of 1 thousand procedures) in 17 hospitals, Cardiac Resynchronisation Therapy (CRT) implantations (a total of 449) in 12 hospitals, ablation of arrhythmias (a total of 2,000 procedures) in 14 hospitals, and heart valve surgery (a total of 927) in 6 hospitals. Table 9 and Table 10. Table 9: Hospitalisations of cardiac patients in selected hospitals per procedure (2013)
Hospital
ICD
Coronary angiography Coronary angioplasty Pacemaker CRT Alation surgeryValve Other or no procedure Hospitalisations in total 15,88 Cardinal Wyszyński Institute of Cardiology 4,611 2,297 1,006 305 210 591 447 7,592 6
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw 1310 1,002 335 56 36 123 146 3,388 6,427
Public Paediatric Central Clinical Hospital 1,434 714 325 102 38 325 118 2,837 5,435
Military Institute of Medicine 1,815 862 181 67 31 84 123 1,549 4,258
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre 1,442 973 233 43 22 156 2,113 4,218
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre 1,248 426 775 162 59 9 1,586 3,970
Mazovian Specialist Hospital in Radom 1213 611 181 42 14 152 26 1,924 3,721
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. 1,144 933 336 40 17 1,710 3,658
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. 1,455 865 302 30 1,664 3,614
Józef Psarski Mazovian Specialist Hospital in Ostrołęka 1,425 680 230 20 4 1,544 3,359
Regional Polyclinical Hospital in Płock 696 619 180 22 1,810 3,272
John Paul II Independent Public Specialist Western Hospital 1,814 1,105 178 24 4 4 961 3,156
Tytus Chałubiński Specialist Hospital in Radom 549 339 172 37 4 71 1,797 2,816
Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka 2,541 2,541
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre 1,068 614 284 31 11 4 1,045 2,515
Szpital Kolejowy Im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. 2,499 2,507
Regional Specialist Hospital in Ciechanów 586 662 1,159 2,405
Międzylesie Specialist Hospital in Warsaw 304 37 120 5 1,393 1,836
Independent Public Complex of Healthcare Facilities in Wyszków 1,646 1,646
Independent Public Healthcare Centre in Siedlce 141 14 1,372 1,527
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk 1,382 1,382
Infant Jesus Clinical Hospital 503 265 745 1,324
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre 1,292 1,292
Allenort Kardiologia Sp. z o.o. 472 142 61 257 67 95 1,279
Centrum Kardiologii Sp. z o.o. 810 605 92 15 3 133 75 1,253
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. 1,226 1,227
Magodent Sp. z o.o. 662 294 26 108 355 1,223
Independent Public Healthcare Centre in Sokołów Podlaski 1,120 1,120
Sochaczew County Hospital Healthcare Complex 1,089 1,089
Source: compiled by DAiS based on data provided by the NFZ.
66 Table 10: Share of hospitalisations of cardiac patients in selected hospitals per procedure
Healthcare provider / Procedure
ICD
Coronary angiography angioplasty Coronary Pacemaker CRT Alation surgeryValve Other or no procedure Cardinal Wyszyński Institute of Cardiology 29.0% 14.5% 6.3% 1.9% 1.3% 3.7% 2.8% 47.8%
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw 20.4% 15.6% 5.2% 0.9% 0.6% 1.9% 2.3% 52.7%
Public Paediatric Central Clinical Hospital 26.4% 13.1% 6.0% 1.9% 0.7% 6.0% 2.2% 52.2%
Military Institute of Medicine 42.6% 20.2% 4.3% 1.6% 0.7% 2.0% 2.9% 36.4%
Rafał Masztak Grochów Hospital Independent Public Healthcare Centre 34.2% 23.1% 5.5% 1.0% 0.5% 3.7% 50.1%
Anna Gostyńska Wola Hospital Independent Public Healthcare Centre 31.4% 10.7% 19.5% 4.1% 1.5% 0.2% 39.9%
Mazovian Specialist Hospital in Radom 32.6% 16.4% 4.9% 1.1% 0.4% 4.1% 0.7% 51.7%
Mazowiecki Szpital Bródnowski w Warszawie Sp. z o.o. 31.3% 25.5% 9.2% 1.1% 0.5% 46.7%
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. z o.o. 40.3% 23.9% 8.4% 0.8% 46.0%
Józef Psarski Mazovian Specialist Hospital in Ostrołęka 42.4% 20.2% 6.8% 0.6% 0.1% 46.0%
Regional Polyclinical Hospital in Płock 21.3% 18.9% 5.5% 0.7% 55.3%
John Paul II Independent Public Specialist Western Hospital 57.5% 35.0% 5.6% 0.8% 0.1% 0.1% 30.4%
Tytus Chałubiński Specialist Hospital in Radom 19.5% 12.0% 6.1% 1.3% 0.1% 2.5% 63.8%
Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka 100.0%
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre 42.5% 24.4% 11.3% 1.2% 0.4% 0.2% 41.6%
Szpital Kolejowy Im. Dr Med. Włodzimierza Roeflera w Pruszkowie Sp. z o.o. 100.0%
Regional Specialist Hospital in Ciechanów 24.4% 27.5% 48.2%
Międzylesie Specialist Hospital in Warsaw 16.6% 2.0% 6.5% 0.3% 75.9%
Independent Public Complex of Healthcare Facilities in Wyszków 100.0%
Independent Public Healthcare Centre in Siedlce 9.2% 0.9% 89.8%
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk 100.0%
Infant Jesus Clinical Hospital 35.0% 20.0% 56.3%
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre 100.0%
Allenort Kardiologia Sp. z o.o. 36.9% 11.1% 4.8% 20.1% 5.2% 7.4%
Centrum Kardiologii Sp. z o.o. 64.6% 48.3% 7.3% 1.2% 0.2% 10.6% 6.0%
Centrum Zdrowia Mazowsza Zachodniego Sp. z o.o. 100.0%
Magodent Sp. z o.o. 54.1% 24.0% 2.1% 8.8% 29.0%
Independent Public Healthcare Centre in Sokołów Podlaski 100.0%
Sochaczew County Hospital Healthcare Complex 100.0%
Source: compiled by DAiS based on data provided by the NFZ.
The analysis of selected cardiac surgical procedures (Table 9 and Table 10) shows that:
18 out of 29 facilities perform more than 500 coronary angiographies annually (range from 304 to 4,611),
16 out of 20 facilities perform more than 300 coronary angioplasty procedures annually (range from 5 to 2,297),
67 16 out of 19 facilities perform more than 100 pacemaker implantations annually (range from 26 to 1,006),
5 out of 17 facilities perform 50 or more ICD implantations annually (range from 5 to 305),
5 out of 12 facilities perform more than 30 cardiac resynchronisation therapies (CRT) annually (range 3-210),
8 out of 14 facilities perform more than 100 ablation procedures of arrhythmias annually (range 4-591),
4 out of 6 facilities perform more than 100 heart valve surgeries annually (range from 26 to 447).
Analysis of Provided Services
To compare the activity of entities which provide cardiological healthcare services in Mazowieckie Voivodeship, first we analysed the number of hospitalisations due to cardiac reasons. All hospitalisations due to cardiac reasons financed within DRGs were considered. Reported healthcare services have been divided into two groups: (1) conservative treatment DRGs and (2) surgical treatment DRGs3.
Figure 55 presents the ratio of conservative treatment DRGs to surgical treatment DRGs reported by healthcare providers active in Mazowieckie Voivodeship in 2013. In total, more conservative treatment DRGs than surgical treatment DRGs were reported. The regional ratio was 1.6:1, which means that on average there was 1 surgical treatment DRG per 1.6 conservative treatment DRGs. Among healthcare providers acting in Mazowieckie Voivodeship, there were significant discrepancies in the number and nature of provided treatment. Some healthcare providers acting in Mazowieckie Voivodeship reported only conservative treatment DRGs. There were also such facilities that reported over 2 times more surgical treatment DRGs than conservative treatment DRGs.
Figure 55: Ratio of reported conservative treatment DRGs to surgical treatment DRGs
Mazowieckie
Conservative hospitalisation Conservative
Surgical hospitalisation Ratio of conservative treatment DRGs to surgical treatment DRGs 2:1,1:2 1:1 Ratio for the voivodeship
Source: compiled by DAiS based on data provided by the NFZ.
3Surgical treatment DRGs are marked with “*” in 1a index.
68 The conservative treatment DRGs reported by healthcare providers were analysed in terms of the average length of stay (hereinafter referred to as ALOS). The appropriate data was presented in Figure 56. The axis shows ALOS of patients in the given healthcare provider as well as ALOS in the voivodeship. Presented data does not take into consideration in-patients (reported with conservative treatment DRG); thus, it may distort the conclusions. In order to properly interpret the data, the number of such patients was presented in Figure 57 (yellow field, values shown on right axis). This approach, among other things, enabled the observation that the healthcare provider with the highest ALOS statistics hospitalised relatively small number of patients.
Figure 56: ALOS (for adults) with regard to conservative treatment DRGs per hospital (2013)
ALOS (left axis) ALOS in the voivodeship (right axis)
Source: compiled by DAiS based on data provided by the NFZ.
Figure 57: Average length of stay (adults) and the number of hospitalised patients for selected healthcare providers within reported conservative treatment DRGs (2013)
number of births (right axis) ALOS (left axis) ALOS in the voivodeship (right axis)
Source: compiled by DAiS based on data provided by the NFZ.
69 The differences in analysed statistics might result from a varied structure of hospitalised patients within treatment DRGs. However, even after assuming the regional structure in terms of cardiac cases for each healthcare provider, the differences are still noticeable (Figure 58). Upon adjustment, ALOS for the majority of healthcare providers would not be significantly changed, which was presented using the red part of bars. As far as the healthcare provider with the highest average length of stay is concerned, the standardisation increased the ALOS value even more. It means that the average length of stay at this facility results mainly from the structure of cardiac diseases treated by this healthcare provider.
Figure 58: Average length of stay - adults (standardised by the voivodeship disease structure) and the number of hospitalised patients (yellow area) for selected healthcare providers within reported conservative treatment DRGs (2013)
before standardisation after standardisation
Source: compiled by DAiS based on data provided by the NFZ.
One of the elements of surgical treatment is the performance of coronary angioplasty. It is used particularly in acute coronary syndromes (ACS) and it serves the purpose of dilating blood vessels. In Poland, the percentage of angioplasty in ACS to ACS in total was 63%, which means that on average 63 out of 100 ACS cases were treated using angioplasty procedure. In Mazowieckie Voivodeship, the performance of angioplasty was reported in 20 entities. For this region, the percentage of angioplasty in ACS to ACS in total was 59%, which means that on average 59 out of 100 ACS cases were treated using angioplasty procedure. This rate varied significantly between entities - in one of them angioplasty was hardly use in ACS treatment, while in other facilities on average 85 out of 100 ACS cases were treated with angioplasty.
Figure 59: Angioplasty in ACS to ACS cases ratio
70 % of angioplasty in ACS voivodeship average national average among all ACS cases
Source: compiled by DAiS based on data provided by the NFZ.
Cardiological rehabilitation
One type of measures for the process quality are rates based on the structure of surgeries and procedures performed on patients. These might indicate important associations between the way the patients were treated (i.e. what kind of surgeries/procedures they were subjected to) and their health condition. One example of such associations in cardiology might be the effect of cardiological rehabilitation on the patient’s condition in the future.
As has been demonstrated in many research studies, cardiological rehabilitation significantly decreases the death risk among patients with diagnosed ischaemic heart disease (IHD). O’Connor et al. (1989) investigated the effect of cardiological rehabilitation on the mortality on the group of about 4.5 thousand US patients with a history of myocardial infarction and concluded that cardiological rehabilitation can decrease the 3-year mortality among heart attack survivor even by 20%. Similar results are presented by Suaya et al. (2009) who, based on Medicare data, estimated the relationship between mortality and rehabilitation for IHD patients at the age of 65+. They conclude that cardiological rehabilitation in this age groups leads to a 21-34% drop in the 5-year mortality (depending on the selected analytical method).
To verify whether a similar correlation occurs also in Poland, we analysed the 4-year mortality among patients with ACS diagnose (regardless of the cause) who in 2010 underwent coronary angioplasty procedures (PCI) according to age and diagnosis (UA, STEMI, NSTEMI - as previously defined). The study was based on the data from National Health Fund database. Only patients who were discharged from hospital alive were included. If a given patient in 2010 had more than one PCI procedure, only the first one was included in the 4-year mortality analysis. Patients were assigned to a rehabilitation group if within 90 days from the PCI procedure they at least once participated in cardiological rehabilitation. To ensure the comparability of mortality rates for patients with and without rehabilitation, only patients who survived 90 days after the first coronary angioplasty procedure in 2010 were taken into account. The analysis design is similar to the one described by Goel et al. (2015).
Figures 61 and 60 show the results of proposed analysis by diagnosis and age group, respectively, while Table 11 presents the number of patients in selected groups, share of patients who within 90 days after the procedure participated in cardiological rehabilitation, mortality rates in both rehabilitation and non-
71 rehabilitation groups, as well as differences (in percent points and percentages) between 4-year mortality rates in groups with and without rehabilitation.
The data indicate that for every diagnosis and in every age group the mortality among patients without rehabilitation was significantly higher than among rehabilitated patients (regardless of the number of months post the procedure). It should be noted that the mortality in each group of patients has a relatively even distribution, i.e. the relation between the number of months post PCI and the mortality is linear. Of all the patients, those with STEMI diagnosis were rehabilitated most frequently, while those with UA the least (in all age groups). Also, it can be observed that older patients participate in cardiological rehabilitation less frequently. For all diagnoses, the share of rehabilitated patients negatively correlates with the patient’s age. Rehabilitation seems to have the strongest effect on mortality in STEMI diagnosis. However, regardless of the diagnosis, in all diagnosis-age group pairs the mortality in the group without rehabilitation was at least by about 30% higher than in the rehabilitated group.
Moreover, the conducted analysis indicates a possible association between the mortality and the fact of participating in rehabilitation among patients who underwent coronary angioplasty. Therefore, it is justified to postulate more frequent performance of cardiological rehabilitation following the PCI procedures as well as more frequent rehabilitation of older patients who are also subject to the demonstrated relationship between rehabilitation and lower mortality and among whom only a minority participates in such services. Naturally, one cannot exclude the possibility that the rates vary not because of the rehabilitation itself, but due to the structure of patients who were and were not rehabilitated (in terms of sex, types of diseases, comorbidities, place of service, etc.); however, the obtained results should not be neglected and an attempt should be made to introduce beneficial changes to the healthcare system in the field of cardiac diseases.
Table 11: Mortality rates after 4 years post PCI for a cohort from 2010
Mortality (%) among Mortality (%) non-rehabilitated among Difference Share (%) of patients (4 years rehabilitated in Diagnosis Age group Number of patients rehabilitated post PCI) patients (4 years Difference in % percentage patients post PCI) points
Total 58,875 19.7 16.8 8.3 8.5 102.4
0-54 11012 28.5 6.0 3.3 2.8 83.8
Total 55-64 19,131 23.4 10.5 6.2 4.4 71.0
65-74 14844 17.2 17.0 11.2 5.9 52.4
75+ 13,888 10.5 30.8 20.7 10.1 48.9
Total 14,647 8.7 13.3 8.8 4.5 51.8
0-54 2,097 11.1 5.3 4.3 1.0 23.8
UA 55-64 4,818 9.7 8.6 6.7 2.0 29.5
65-74 4,387 8.2 13.7 10.0 3.7 36.7
75+ 3345 6.3 24.0 16.2 7.8 48.2
Total 28,089 25.8 16.9 7.6 9.3 123.2
0-54 6,378 34.9 5.7 3.2 2.4 75.4
72 STEMI 55-64 9,384 30.1 10.4 5.8 4.6 80.2
65-74 6310 23.3 18.4 10.6 7.8 73.9
75+ 6017 12.4 32.5 21.5 11.0 51.3
Total 16139 19.1 20.2 9.8 10.4 106.0
0-54 2,537 26.9 7.5 3.1 4.5 145.1
NSTEMI 55-64 4,929 23.9 12.9 6.9 6.1 88.5
65-74 4,147 17.6 19.1 13.0 6.1 46.8
75+ 4,526 11.0 33.7 21.3 12.4 58.4
Source: compiled by DAiS based on data provided by the NFZ.
Figure 60: Mortality during 4 years post PCI in groups with and without rehabilitation by diagnosis
0-54 years 55-64 years
Mortality (%) Mortality Mortality (%) Mortality
Patient
Rehabilitated Non-rehabilitated Number of months post PCI Number of months post PCI
65-74 years over 75 years
Mortality (%) Mortality Mortality (%) Mortality
Number of months post PCI Number of months post PCI
Source: compiled by DAiS based on data provided by the NFZ.
Figure 61: Mortality during 4 years post PCI in groups with and without rehabilitation by age
73 UA
Total
Mortality (%) Mortality Mortality (%) Mortality
Patient
Rehabilitated Non-rehabilitated Number of months post PCI Number of months post PCI
STEMI
NSTEMI
Mortality (%) Mortality Mortality (%) Mortality
Number of months post PCI Number of months post PCI
Source: compiled by DAiS based on data provided by the NFZ.
2.1.3 Paediatric Cardiology
In Poland, hospital treatment of patients with cardiac problems, mainly congenital heart defects (CHD), at the age of < 18 is performed at centres with different referral level.
Paediatric cardiology centres of the first level are those which do not perform cardiological procedures for congenital heart defects, centres of the second level perform only procedures within paediatric interventional cardiology for congenital heart defects, centres of the third level, apart from the interventional treatment, perform cardiac surgeries for congenital heart defects and centres of the fourth level are those which fulfil the criteria for a third-level centre and function as either academic centres or institutes.
Additionally, due to the varied number of interventional procedures for congenital heart defects between the centres, haemodynamic laboratories, according to the previously described rules, have been divided into classes where class A included laboratories with less than 100 interventional cardiology procedures performed annually in CHD patients under 18 years of age and class B with more than 100 procedures (G. Brzezińska-Rajszys, R. Gil, A. Witkowski. System szkolenia adeptów kardiologii interwencyjnej w Polsce, w Kardiologia interwencyjna. G. Brzezińskiej-Rajszys, M. Dąbrowski, W. Rużyłło, A. Witkowski. Wydawnictwo Lekarskie PZWL Warszawa 2009).
According to the principle of comprehensive treatment for cardiac problems in patients aged below 18 years, it is expected that centres with the third referral level should perform cardiac electrotherapy procedures. In Poland, there are 11 centres performing interventional cardiology procedures for congenital heart defects in patients at the age of < 18. Not all voivodeships have their centres;
74 nevertheless, distribution of these centres makes it possible to secure patients’ urgent needs. The overall evaluation of healthcare needs of children with cardiac problems, mainly with congenital heart defects, and of the use of resources should be analysed together with cardiosurgical data. Based on the data from the literature, it is assumed that the prevalence of congenital heart defects among newborns is 8/1,000, taking into account the number of live births in 2013 in particular voivodeships.
In Mazowieckie Voivodeship, 41 entities admitted cardiac patients below 18 years of age (Figure 62). The highest number of hospitalisations of newborns was reported for the Children’s Memorial Health Institute in Warsaw which together with the second entity with the highest number of hospitalisations (Independent Public Paediatric Clinical Hospital) admitted 99% of all newborn in-patients with cardiac problems in Mazowieckie Voivodeship (Table 12).
Figure 62: Number of centres admitting children with cardiac diseases (2013)
Number of cardiological centres
Source: compiled by DAiS based on data provided by the NFZ.
Table 12: Number of hospitalisations of newborns (2013)
Hospital City/town Number of Percentage of hospitalisations hospitalisations
Children’s Memorial Health Institute in Warsaw Warsaw 114 55.9%
Independent Public Paediatric Clinical Hospital Warsaw 88 43.1%
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. Z O.O. Siedlce 1 0.5%
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 1 0.5%
Source: compiled by DAiS based on data provided by the NFZ
The number of hospitalisations of infants (29 to 365 days old) is 809 in total, of which 96.9% is accounted for by two centres: Independent Public Paediatric Clinical Hospital in Warsaw with 412 hospitalisations (50.9%) and the Children’s Memorial Health Institute in Warsaw with 372 hospitalisations (46%) (Table 13).
Table 13: Number of hospitalisations of infants (2013)
75 Hospital City/town Number of Percentage of hospitalisations hospitalisations
Independent Public Paediatric Clinical Hospital Warsaw 412 50.9%
Children’s Memorial Health Institute in Warsaw Warsaw 372 46.0%
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. Z O.O. Siedlce 14 1.7%
Regional Polyclinical Hospital in Płock Płock 4 0.5%
Regional Specialist Hospital in Ciechanów Ciechanów 2 0.2%
Prof. Jan Bogdanowicz Children's Hospital Independent Public Healthcare Centre Warsaw 2 0.2%
Józef Psarski Mazovian Specialist Hospital in Ostrołęka Ostrołęka 1 0.1%
John Paul II Independent Public Specialist Western Hospital Grodzisk 0.1% 1 Mazowiecki
Mazovian Specialist Hospital in Radom Radom 1 0.1%
Source: compiled by DAiS based on data provided by the NFZ
The number of hospitalisations of children (1 to 17 years old) is 3532 in total, of which 77.2% is accounted for by two entities: Independent Public Paediatric Clinical Hospital in Warsaw (1462 hospitalisations) and the Children’s Memorial Health Institute in Warsaw (1265 hospitalisations).
Table 14: Number of hospitalisations of children (2013)
Hospital City/town Number of Percentage of hospitalisations hospitalisations
Independent Public Paediatric Clinical Hospital Warsaw 1,462 41.3%
Children’s Memorial Health Institute in Warsaw Warsaw 1,265 35.7%
Prof. Jan Bogdanowicz Children's Hospital Independent Public Healthcare Centre Warsaw 179 5.1%
Mazowiecki Szpital Wojewódzki w Siedlcach Sp. Z O.O. Siedlce 93 2.6%
Powiatowe Centrum Zdrowia Spółka z Ograniczoną Odpowiedzialnością Otwock 59 1.7%
Józef Psarski Mazovian Specialist Hospital in Ostrołęka Ostrołęka 52 1.5%
Tytus Chałubiński Specialist Hospital in Radom Radom 48 1.4%
Grodzisk 47 1.3% John Paul II Independent Public Specialist Western Hospital Mazowiecki
Regional Specialist Hospital in Ciechanów Ciechanów 44 1.2%
Cardinal Wyszyński Institute of Cardiology Warsaw 33 0.9%
Independent Public Healthcare Centre in Garwolin Garwolin 33 0.9%
Regional Polyclinical Hospital in Płock Płock 25 0.7%
Józef Piłsudski Independent Public Complex of Healthcare Facilities in Płońsk Płońsk 18 0.5%
Independent Public Complex of Healthcare Facilities in Przasnysz Przasnysz 17 0.5%
Independent Public Complex of Healthcare Facilities in Wyszków Wyszków 16 0.5%
Independent Public Healthcare Centre in Mława Mława 13 0.4%
St. Anne Non-Public Healthcare Centre in Piaseczno Piaseczno 11 0.3%
Nowy Dwór Medical Centre in Nowy Dwór Mazowiecki Nowy Dwór 0.3% 11 Mazowiecki
Ostrów 0.3% 10 Independent Public Complex of Healthcare Facilities in Ostrów Mazowiecka Mazowiecka
Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre Warsaw 9 0.3%
Mazovian Specialist Hospital in Radom Radom 9 0.3%
76 Institute of Mother and Child Warsaw 7 0.2%
Sokołów 7 0.2% Independent Public Healthcare Centre in Sokołów Podlaski Podlaski
Wołomin County Hospital – Independent Complex of Public Healthcare Facilities Wołomin 7 0.2%
Independent Public Healthcare Centre Łosice 6 0.2%
Independent Public Healthcare Complex Mińsk 0.2% 6 Mazowiecki
“Płocki ZOZ” Non-Public Healthcare Centre Płock 5 0.1%
Independent Public Complex of Healthcare Facilities in Kozienice Kozienice 5 0.1%
Sochaczew County Hospital Healthcare Complex Sochaczew 5 0.1%
Allenort Kardiologia Sp. Z O.O Śródmieście 4 0.1%
“Sensor Cliniq” Non-Public Healthcare Centre Warsaw 4 0.1%
Independent Public Complex of Healthcare Facilities in Lipsko Lipsko 4 0.1%
Independent Public Healthcare Centre in Siedlce Siedlce 4 0.1%
Independent Public Complex of Healthcare Facilities in Sierpc Sierpc 4 0.1%
Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw Warsaw 3 0.1%
Centrum Kardiologii Sp. z o.o. Józefów 3 0.1%
Specialist Hospital / Specialist Outpatient Clinic and Emergency Medical Service Centre Grójec 3 0.1%
Military Institute of Medicine Warsaw 3 0.1%
Independent Public Healthcare Centre in Węgrów Węgrów 2 0.1%
Public Paediatric Central Clinical Hospital Warsaw 1 0.0%
Independent Public Complex of Healthcare Facilities – Iłża Hospital Iłża 1 0.0%
Independent Public Complex of Healthcare Facilities in Żuromin Żuromin 1 0.0%
Source: compiled by DAiS based on data provided by the NFZ
2.1.4 Adult Cardiac Surgery
In Poland, in years 2013 and 2014, there were 31 centres of adult cardiac surgery (in 2015 this number dropped to 30). In each voivodeship, there is at least one centre, in the majority of provinces there are severalof them4. The number of adult cardiosurgical procedures in Poland is stable, although the structure of performed procedures leans towards valvular surgery and combined surgery (Figures 63 and 64). In 2013, 24,939 cardiosurgical procedures were performed, 22,290 of which were performed in adults. The number of cardiosurgical procedures per one thousand inhabitants of the region is presented on Figures 65 and 66.
4 All public cardiac surgery centres throughout the country have the possibility of conducting extracorporeal oxygenation (ECMO).
77 Figure 63: Number of cardiosurgical procedures in adults in Poland (1997-2014)
Cardiosurgical procedures in adults in Poland in years 1997-2014
Source: National Registry of Cardiac Surgery Procedures (KROK) and report “Kardiochirurgia Polska 2014” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl). Figure 64: Trends of changes in basic types of cardiosurgical procedures (1995-2013)
Surgeries of coronary heart disease Surgeries of valvular defects Surgeries of congenital defects Surgeries of valvular defects + CABG
Source: National Registry of Cardiac Surgery Procedures (KROK) and report “Kardiochirurgia Polska 2013” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
Figure 65: Number of cardiosurgical procedures in adults per 100 thousand inhabitants in selected voivodeships in 2013
Source: National Registry of Cardiac Surgery Procedures (KROK) and report “Kardiochirurgia Polska 2013” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
78 Figure 66: Number of cardiosurgical procedures in adults per 100 thousand inhabitants in selected voivodeships in 2014
Source: National Registry of Cardiac Surgery Procedures (KROK) and report “Kardiochirurgia Polska 2014” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
The present analysis has been conducted based on the data from the Polish National Registry of Cardiac Surgery Procedures (KROK) and report “Kardiochirurgia Polska” for 2013 and 2014, authored by: B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl)5. The KROK Registry activity is established in the Regulation of the Minister of Health of 17 October 2013 (Dz.U. item 1233). The Registry includes complete data from all public and non-public centres of paediatric and adult cardiac surgery in Poland. Providing these data is obligatory. The data are verified twice a year and in a continuous manner in terms of mortality with the Polish National Register of Death (NFZ) after all cardiosurgical procedures.
As a part of adult cardiac surgery, there are life-saving, urgent and scheduled cardiac surgeries performed for acquired heart defects, congenital heart defects in adults, ischaemic heart disease and related complications, aortic aneurysms, massive pulmonary embolism, heart tumors in adults. It also encompasses heart assistance with the use of intra-aortic balloon pump and ECMO as well as TAVI and other endovascular procedures. Certain procedures, including hybrid ones, require particular patient’s safety and an experienced cardiac surgeon. Minimally invasive procedures are an important and recommended area of activity. What is essential, apart from being a response to patients expectations, they reduce the number of complications as well as facilitate rehabilitation and faster recovery.
Transplantations of organs, including heart, lungs and both heart and lungs, are performed only by centres with special accreditation issued by the Minister of Health upon the request from the Polish National Transplant Council (KRT). This guarantees save realisation of the programme and care for patients with severe and irreversible damage of these organs. One additional element of the heart transplant programme is the ventricular assist device (VAD) programme using new technologies available in Poland, including implantable ventricular assist devices as well as so called external ventricular assist devices. It is in these referral centres that the transplant qualification and the selection
5 The National Registry of Cardiac Surgery Procedures takes into account the activity of public and non-public interventional cardiology centres where specific procedures of interventional cardiology are conducted in line with the prior qualification according to the current guidelines performed and documented by a HEART TEAM involving a cardiologist and a cardiac surgeon as well as other specialists, if required due to patient’s state, to ensure patient’s safety and appropriate selection of a treatment method.
79 of a particular treatment method take place. A patient with implanted VAD either stays in hospital or is subjected to outpatient/home care, depending on the type of device and the course of treatment.
Tables 15 and 16 show data on equipment and staff resources in adult cardiac surgery in Poland as well as the number of procedures performed in years 2013-2014.
Table 15: Equipment and staff resources in adult cardiac surgery in 2013 and 2014
2011 2014
Number of centres 31 32
Operating theatres 72 70
ICU positions 319 340
Cardiosurgical beds 909 941
Independent scientists 47 50
Cardiac surgeons 239 249
Cardiac anaesthesiologists 207 205
Perfusionists 174 167 Source: National Registry of Cardiac Surgery (KROK) and report “Kardiochirurgia Polska” for 2013 and 2014 authored by: B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
Table 16: Selected types of procedures in 2013 and 2014
Status and Use of Resources: the Analysis 2013 2014
Cardiosurgical procedures in adults in total 24,703 25,233
Coronary bypass surgeries 13,775 13,412
Surgeries of acquired defects (valvular) 5,175 5260
Combined surgeries 2,426 2,325
Thoracic aortic aneurysms 1,470 1,562
Aortic dissection type A 533 623
Infective endocarditis 268 196
Surgeries per operating theatre 342.09 360.47
Surgeries per 100 thousand inhabitants 64.17 65.57
Source: National Registry of Cardiac Surgery (KROK) and report “Kardiochirurgia Polska” for 2013 and 2014 authored by: B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
Adult cardiac surgery in the voivodeship
Tables 17 and 18 show data on resources in cardiac surgery in the region as well as information on the number of selected procedures in cardiac surgery centres.
80 Table 17: Status and Use of Resources: the Analysis (2013-2014)
Status and Use of Resources: the Analysis 2013 2014
Number of centres 6 6
Operating theatres 11 11
ICU positions 69 73
Cardiosurgical beds 162 165
Independent scientists 9 9
Cardiac surgeons 38 41
Cardiac anaesthesiologists 49 48
Perfusionists 34 34
Cardiosurgical procedures in adults in total 3,921 3,954
Coronary bypass surgeries 2,098 2,017
Surgeries of acquired defects (valvular) 947 921
Combined surgeries 351 368
Thoracic aortic aneurysms 277 304
Aortic dissection type A 82 77
Infective endocarditis 56 35
Surgeries per operating theatre 356.5 359.5
Surgeries per 100 thousand inhabitants 73.8 74.12
Source: National Registry of Cardiac Surgery (KROK) and report “Kardiochirurgia Polska” for 2013 and 2014 authored by: B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
Table 18: Main types of procedures performed in cardiac surgery centres (2013-2014)
Centre Year Cardiac Coronary Acquired Combined Thoracic Aortic Infective surgeries bypass defects surgeries aortic dissection endocarditi in total surgeries (valvular) aneurysms type A s
Institute of 2013 1,903 903 490 183 151 7 10
Cardiology 2014 1,879 803 509 177 175 8 5 Department of Cardiac Surgery and Transplantology Warszawa-Anin
Central Clinical 2013 612 265 144 92 54 59 34
Hospital of the 2014 690 300 168 91 67 47 17 Ministry of the Interior and Administration in Warsaw
Medical University 2013 540 294 131 36 31 6 6
of Warsaw 2014 472 281 92 48 29 11 7
2013 448 285 95 12 17 0 4
81 Military Institute of 2014 430 313 76 24 9 3 4 Medicine Central Clinical Hospital of the Ministry of Defence (MON)
Allenoit Hospital - 2013 307 186 64 21 16 4 2
Warszawa-Wilanów 2014 310 198 48 15 20 5 2
Mazovian Specialist 2013 205 165 23 7 8 6 0
Hospital in Radom 2014 173 122 28 13 4 3 0 Source: National Registry of Cardiac Surgery (KROK) and report “Kardiochirurgia Polska” for 2013 and 2014 authored by: B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
2.1.5 Paediatric Cardiac Surgery
The analysis of paediatric cardiac surgery situation in Poland is based on the data from the Polish National Registry of Cardiac Surgery Procedures which is an obligatory registry for all paediatric and adult cardiac surgery centres in Poland since 2006. The Registry comprises data from public and non- public centres and it is established in the Regulation of the Minister of Health and funded by the Ministry of Health (MZ). The data in the Registry are complete and are verified in terms of mortality with the Polish National Register of Death. The analysis is based on the report entitled “Kardiochirurgia Polska 2014”.
In Poland, there are 9 centres of paediatric cardiac surgery, including one non-public, in which in 2014 a total of 2,730 congenital heart defect operations were performed, including 1,860 operations in extracorporeal circulation and 870 without it. These facilities have 12 operating theatres and 66 intensive postoperative therapy stations. In paediatric centres, there are 43 specialists employed in the field of cardiac surgery, including 11 independent researchers, as well as 34 cardiac anaesthesiologists and 30 perfusionists.
The number of performed congenital heart defects operations has not changed significantly since 2008 (2,215). In 2014, the highest number of congenital heart defect surgeries, i.e. 2,730, was performed in Poland (for comparison, in 2013, 2,445 such procedures were performed). Names of the facilities where cardiosurgical procedures were performed in patients aged below 18 and the exact number of patients in selected age groups are presented in Table 19.
Table 19: Hospitals performing cardiac surgeries in patients aged below 18 (2013)
Newborns Infants (30- 1-18 Patients No. Name City/town (1-30 days) 365 days) y.o. 0-18 y.o.
1 Children’s Memorial Health Institute Warsaw 95 139 180 414
2 Polish Mother’s Memorial Hospital Research Institute Łódź 87 173 137 397
Pomeranian Traumatology Centre Regional Specialist 3 Hospital Gdańsk 84 139 146 369
4 University Children's Hospital Kraków 97 139 131 367
82 5 K. Marcinkowski Medical Academy Poznań 49 100 116 265
5 Upper Silesian Child Health Centre Katowice 56 87 58 201
Non-Public Healthcare Centre Lower Silesia Centre for Heart 7 Diseases “Medinet” Wrocław 20 84 43 152
a Silesian Center for Heart Diseases Zabrze 12 65 66 143
9 Independent Public Paediatric Clinical Hospital Warsaw 24 83 30 137
Source: National Registry of Cardiac Surgery Procedures (KROK) and report entitled “Kardiochirurgia Polska 2013” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
Geographical distribution of the above-mentioned hospitals is presented in Figure 67.
Figure 67: Hospitals providing cardiosurgical services to patients aged below 18
Paediatric Cardiac Surgery Centres
Source: National Registry of Cardiac Surgery Procedures (KROK) and report entitled “Kardiochirurgia Polska 2013” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
The number of procedures for congenital heart defects in adults above 18 years of age was 211 and these were performed in adult cardiac surgery centres, mainly in the Institute of Cardiology in Warsaw and Silesian Centre for Heart Diseases in Zabrze.
Taking into account the prevalence of congenital heart defects, i.e. about 8 per 1000 live births, as well as the number of births in Poland in 2014 (about 350 thousand), we can assume that approximately 2800 children are born in Poland with congenital heart defects. This number is close to the number of surgeries performed. At the same time, we encounter a situation where 20 - 25% of congenital defects occurring in newborns are duct dependent, which means that they require life-saving surgery in the first days after birth. For many years, the number of these surgeries has been fairly constant and has ranged between 550 - 650.
83 Performing the most complex heart surgery in newborns is distributed very unevenly. They are carried out mainly in 4 centres, i.e.: the Children’s Memorial Health Institute (IP CZD) in Warsaw, the University Children's Hospital in Kraków, Polish Mother’s Memorial Hospital Research Institute (ICZMP) in Łódź, the Upper Silesian Child Health Centre in Katowice. The most difficult and the most risky Norwood procedures in hypoplastic left heart syndrome are performed mainly in 3 centres, i.e. IP CZD, ICZMP and in Prokocim. These 3 centres and the COPERNICUS Podmiot Leczniczy Sp. z o.o. In Gdańsk belong to the so-called group High Volume Centers, in which over 350 congenital heart defects operations are performed annually. They show the highest burden in terms of both the number of all procedures and the number of surgeries with extracorporeal circulation, including Norwood procedures, for congenital heart defects in newborns.
The specificity of Polish cardiac surgery is the fact that children with all, even the most complex types of congenital heart defects, including the ones with a univentricular heart, are born and treated surgically. The percentage of operations in neonates with a univentricular heart compared to all operated neonates is 30%. The most frequently performed heart surgery in a newborn in Poland in 2014 was the Norwood procedure. This is due to the fact that the right to terminate a pregnancy in case of the most severe congenital heart defects is hardly ever exercised. In Poland, treatment results for children with congenital heart defects are statistically analysed in detail and compared between national centres as well as with European and global data. The results are very good and are an effect of concentrating the most difficult cases in the largest centres.
At the same time, we observe two undesirable phenomena. The most complex congenital heart defects, including univentricular heart, require a multi-stage treatment. Procedures scheduled within subsequent stages have to be performed on patients at a certain age. The largest centres have such a burden of surgical treatment for newborns requiring immediate life-saving surgery that the waiting lists for scheduled reoperations are becoming disturbingly long. Currently, in Poland, there are several hundred children who are waiting for subsequent stages of complex treatment for congenital heart defects.
Unquestionable achievements in Polish paediatric cardiac surgery include the introduction of ventricular assist devices for children, about 5 years ago, as well as heart transplants in children and adolescents.
In Poland, there are more congenital heart defect procedures in children per 1 million inhabitants performed with very good results than in Germany. However, the rising number of adult and adolescent patients who underwent different surgeries for congenital heart defects becomes an increasing problem on a national scale. These patients belong to a so-called GUCH group - Grown Up with Congenital Heart Disease. There are 80 - 100 thousand of such patients. Due to their history of surgical procedures and cardiological interventions, they require specialist medical care. Most of them have various heart rhythm disturbances as well as acquired age-related cardiac problems, including ischaemic heart disease, hence many require subsequent reoperations, diagnostic tests. These patients require a well-organised multidisciplinary healthcare system with experience in both congenital heart defects treatment as well as adult cardiology. Unfortunately, at present, apart from two centres, i.e. the Institute of Cardiology and the centre in Zabrze, we do not have such a system.
84 Paediatric cardiac surgery in the voivodeship
There are two centres of paediatric cardiac surgery in Mazowieckie Voivodeship, in Warsaw: - IP CZD - the centre with the highest referral level - with the following resources and their utilisation:
Table 20: Hospital resources and their use
Operating theatres 2
ICU positions 10
Cardiosurgical beds 24
Independent scientists 3
Cardiac surgeons 8
Surgeons 10
Cardiac anaesthesiologists 5
Perfusionists 5
The paediatric cardiac surgery centre in IP CZD is the largest clinical and academic centre in Poland with the highest referral level and it is one of the most recognisable Polish paediatric cardiac surgery centres on an international scale. It has just had its infrastructure upgraded in6terms of operating theatres and intensive care, and it performs the most difficult cardiac surgery procedures for congenital defects in newborns and children, including heart transplants and ventricular assist device (VAD), thereby providing services for patients from Mazowieckie voivodeship, neighbouring regions as well as the entire country.
Hospitalisation Standard Time spent at ICU Standard deviation time7 deviation
Surgeries of congenital heart defects 371
with extracorporeal circulation 277
without extracorporeal circulation 138
Neonatal surgeries with extracorporeal 65 circulation
Neonatal surgeries without extracorporeal 30 circulation
Neonatal surgeries in total 95 19.5 14.55 10.4 14.03
Infant surgeries 139 15.4 15.93 6.8 15.33
1-18 y.o. 180 11.9 13.08 3.5 10.89
Source: National Registry of Cardiac Surgery Procedures (KROK) and report entitled “Kardiochirurgia Polska 2013” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
6 Data of 2015. 7 Time (in days) from the surgery until discharge
85 - Independent Public Paediatric Clinical Hospital - the centre with the second referral level - with the following resources and their utilisation:
Table 21: Hospital resources and their use
Operating theatres 2
ICU positions 7
Cardiosurgical beds 15
Independent scientists 1
Cardiac surgeons 2
Surgeons 4
Cardiac anaesthesiologists 4
Perfusionists 2
Hospitalisation Standard Time spent at ICU Standard time8 deviation deviation
Surgeries of congenital heart defects 137
with extracorporeal circulation 292
without extracorporeal circulation 45
Neonatal surgeries with extracorporeal 2 circulation
Neonatal surgeries without extracorporeal 22 circulation
Neonatal surgeries in total 24 13.7 31.63 10.8 31.56
Infant surgeries 83 13.6 11.69 7.7 7.62
1-18 y.o. 30 13.0 11.77 5.8 10.19
Source: National Registry of Cardiac Surgery Procedures (KROK) and report entitled “Kardiochirurgia Polska 2013” authored by B. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
Independent Public Paediatric Clinical Hospital is a centre with the second referral level and it performs a limited scope of CHD procedures in children, excluding surgeries with extracorporeal circulation in neonates and most complex surgical procedures, including those in children with univentricular heart.
In Mazowieckie Voivodeship, the needs of children with CHD are fulfilled at the highest level by the cardiac surgery centre in IP CZD. This applies also to a significant number of children from neighbouring regions and the entire country. There is a gross disproportion in both the number and the type of performed procedures, especially in neonates, between IP CZD and Independent Public Paediatric Clinical Hospital. At this very moment (2015), the said centre is being moved to a new place with modern infrastructure which ought be utilised to a much greater extent.
8 Time (in days) from the surgery until discharge
86
2.2 Specialist Outpatient Care
Healthcare providers in Poland
In 2013, in Poland there were 2,424 Specialist Outpatient Care Facilities (AOS) where cardiological treatment was provided9. Figure 68 shows the geographic distribution thereof. Colours on the map indicate the number of centres in a selected county. The darker the colour is, the more centres are located in a given county. A healthcare provider with many centres within one county was counted only once. If a healthcare provider had centres in different counties, then it was counted in each of them. The map contains only specialist outpatient care facilities having a contract with the public payer (NFZ).
Figure 68: Counties with specialist outpatient care facilities treating cardiac patients in Poland (2013)
Number of hospitals
No hospital
Source: compiled by DAiS based on data provided by the NFZ.
In each of the 367 counties in Poland, there was at least one AOS providing cardiological healthcare. The greatest number of healthcare providers was located in large cities: Warsaw (106), Łódź (62), Poznań (61), Kraków (59) and Wrocław (55).
The average number of AOS in a county was 6.6 and the median was 4, which means that in at least a half of the counties the number of AOS providers was not higher than 4 and in at least a half it was not lower than 4.
9 Number of healthcare providers who admitted patients with cardiac diagnoses. This is different from the number of AOS having a contract in the field of cardiology and cardiac surgery.
87
88 Healthcare providers in the voivoideship
In Mazowieckie Voivodeship, in 2013, cardiological outpatient services were provided by 254 AOS facilities. Figure 69 shows the geographic distribution of these facilities in the region. The values on the map indicate the number of service providers in a county. There are two counties in Mazowieckie Voivodeship without any AOS. The greatest number of AOS facilities was situated in Warsaw (106), which accounted for 42% of all cardiology facilities in the region. A large number of AOS (13) was also reported in Radom and Wołomin county.
Figure 69: Counties with entities providing cardiological services within AOS in Mazowieckie Voivodeship (2013)
Number of AOS entities
none
Source: compiled by DAiS based on data provided by the NFZ.
Figure 70 shows migrations of patients receiving cardiological services within AOS in Mazowieckie Voivodeship. 98% of patients treated in Mazowieckie Voivodeship were inhabitants thereof. Arrows indicate the share of patients from a selected voivodeship as per all patients who migrated into Mazovian region to use services provided by AOS. For legibility purposes, a 5% cut-off was applied. This means that the map does not show the migration from voivodeships inhabitants of which constituted less than 5% of all the patients from other voivodeships treated in Mazovian region. In total, 10,332 patients migrated to entities in Mazowieckie Voivodeship area. The highest share of these migrations was accounted for by inhabitants of Lubelskie Voivodeship.
89 Figure 70: Migrations of patients receiving cardiological services within AOS in Mazowieckie Voivodeship (2013)
Share (%) of patients from other voivodeships
Share (%) of patients from the voivodeship
Source: compiled by DAiS based on data provided by the NFZ.
Figure 71 shows migrations of patients to entities providing cardiological services within AOS from Mazovian counties. Th red colour indicates patients from a given county who received the services in the county of residence. Other colours indicate six counties which were the most frequent places of migrations for patients within the region. The orange colour denotes patients migrating to other counties.
Most of the patients used cardiological services within AOS in their county of residence. A tendency can be observed of using such services in a near, big city (Radom, Siedlce) and migrating from entire voivodeship to Warsaw.
Figure 71: Migrations of cardiac patients to entities providing AOS services from Mazovian counties (2013)
No. of patients per county:
Patients treated in:
county of residence City of Warsaw City of Radom City of Siedlce City of Ostrołęka City of Płock Ciechanów County Other
Source: compiled by DAiS based on data provided by the NFZ.
90 Figure 72 and Table 2210show the largest entities providing in 2013 cardiological services within AOS in Mazowieckie Voivodeship.11Most of these entities (7) were located in Warsaw, while one was located in Radom.
Figure 72: AOS entities treating more than 2% of all unique cardiac patients in Mazowieckie Voivodeship (2013)
Source: compiled by DAiS based on data provided by the NFZ.
Table 22: AOS entities treating more than 2% of all unique cardiac patients in Mazowieckie Voivodeship (2013)
Number No. Healthcare provider of % of patients from patients the voivodeship
1 Cardinal Wyszyński Institute of Cardiology 22,482 11.71%
2 Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw 11,196 5.83%
3 Public Paediatric Central Clinical Hospital 8,476 4.41%
4 Children’s Memorial Health Institute in Warsaw 8,249 4.30%
5 Anna Gostyńska Wola Hospital Independent Public Healthcare Centre 6,263 3.26%
6 “Cepelek” Central Military Outpatient Clinic Independent Public Healthcare Centre 4,823 2.51%
7 Warszawa Wola – Śródmieście Independent Public Healthcare Centre 4,576 2.38%
8 Mazovian Specialist Hospital in Radom 4,435 2.31%
Source: compiled by DAiS based on data provided by the NFZ.
10 The percentage of patients regionwide is defined as a ratio between the number of patients admitted with analysed cardiac diagnoses and the number of unique cardiac patients in the voivodeship. Accordingly, the sum of this variable is greater than 100%. This is due to the fact that a patient admitted in two different centres was included in a numerator twice - for both centres, but only once in the nominative. 11 AOS entities which treated more than 2% of all unique cardiac patients in the voivodeship were considered the largest ones. As one centre can have departments in different counties, their sum on the map is higher than indicated in the table as the ones treating over 2% of all unique patients.
91 2.3 Primary Care (POZ)
In May 2015, Mazowieckie Voivodeship maintained 678 registered primary care centres. Figure 73 shows the number of POZ entities in selected Mazovian counties. The highest number of POZ centres was reported in the city of Warsaw (129).
Figure 73: Number of primary care facilities in Mazovian counties (2015)
Number of primary care facilities
Source: compiled by DAiS based on data provided by the NFZ.
Analysis of Provided Services
Table 23 shows the number of services provided by primary care physicians in 2012 to inhabitants of Mazowieckie Voivodeship, including selected age groups. Figure 74 shows this phenomenon in percentages. Among all service recipients, women prevail in all age groups, except the youngest group where men are in majority. For 65+ age group this share amounted to 65%.
Table 23: Structure of provided healthcare services by gender and age groups in Mazowieckie Voivodeship (2012)
0-6 7 19 20-39 40-65 65+ total
Total 1,659,003 1,016,845 1,474 445 3,877 068 2,439,343 10,466,704
Female 788,815 516,836 855,586 2,292 657 1,495,093 5,948 987
Male 870,188 500,009 618,859 1,584 411 944,250 4,517 717
Source: compiled by DAiS based on data provided by the NFZ.
92 Figure 74: Structure of provided healthcare services by age groups in Mazowieckie Voivodeship (2012)
Source: compiled by DAiS based on data provided by the NFZ.
Figure 75: Structure of provided healthcare services by gender and age groups in Mazowieckie Voivodeship (2012)
Female Male
Source: compiled by DAiS based on data provided by the NFZ.
In Mazowieckie Voivodeship, over 60% of all individuals who were provided with primary care physician services were above 40 years of age.
Table 24 shows health service utilisation rate in selected age groups. The average number of services per one resident in Mazowieckie Voivodeship is 4.3. Women receive healthcare services more often (5.3 services on average) than men (3.4 services per inhabitant).
Table 24: Utilisation rate of primary healthcare services by age and gender groups in Mazowieckie Voivodeship (2012)
0-6 7-19 20-39 40-65 65+ total
Total 9.58 3.20 1.97 4.24 7.79 4.32
Female 8.87 3.17 2.24 5.25 14.60 5.32
Male 10.33 3.23 1.69 3.31 3.97 3.42
Source: compiled by DAiS based on data provided by the NFZ.
93 Figures show the structure and number of services per number of inhabitants and POZ entities.
The highest share, as compared to all services provided to inhabitants of Mazowieckie Voivodeship, is in the city of Warsaw (25.8%), while the lowest in Zwoleń county (0.7%) (Figure 76).
The highest number of primary care services is provided for Łosice county inhabitants (4.4). The lowest number of primary care services per person is observed in the following counties: Wołomin, Warsaw- West, Radom and Radom City (2.9).
Figure 76: Number of primary care services of a physician per inhabitant in Mazovian counties (2012)
Number of healthcare services per inhabitant
Source: compiled by DAiS based on data provided by the NFZ.
The number of services per one entity providing primary care services varies between the counties of Mazowieckie Voivodeship. On average, the highest number of primary healthcare services was provided in Gostynin County (57.8 thousand), whereas the lowest in Lipsko County (16.1 thousand). Figure 77).
94 Figure 77: Number of primary care services (in thousands) of a physician per one primary care facility in Mazovian counties (2012)
Number of primary care services
Source: compiled by DAiS based on data provided by the NFZ.
2.4 Medical Staff12
Cardiologists
In 2013, there were 638 cardiologists registered in the NIL database who were employed in Mazowieckie Voivodeship13. They constituted about 17.55% of all cardiologists employed in Poland. This was the seventh highest result nationally (Figure 78).
12 The Ministry of Health directs special acknowledgements to the Supreme Medical Chamber for sharing data on the medical staff, which were used to prepare the analyses contained in this chapter. 13 The number of physicians is not an unique number: if a physician works in several voivodeships, they are taken into account in each of them. The same applies in the case of specialisation, if the doctor has several specialisations, he is taken into account in each of them.
95
Figure 78: Number of cardiologists in individual voivodeships in 2013
Number of physicians
Source: compiled by DAiS based on data provided by the Polish Chamber of Physicians and Dentists
In Mazowieckie Voivodeship, in 2013, the number of cardiologist per 100 thousand adults was 14.98. It was the fourth highest number in Poland (Figure 79).
Figure 79: Number of cardiologists per 100,000 adults in individual voivodeships in 2013
physicians per 100 thousand adults thousand 100 per physicians
difference versus rate value for the country
higher value in higher value in the Poland voivodeship
Source: based on data provided by the Supreme Medical Chamber and Central Statistical Office
In 2013, a cardiologist in Mazovian region had a contract signed with more than one (1.57) healthcare provider contracted with the public payer on average. It was the fourth highest result in Poland (Figure 80).
96 Figure 80: Number of contracts with healthcare providers contracted with the public payer per one physician in individual voivodeships in 2013
Average number of contracts per 1
physician
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber and the NFZ
Similarly as for the entire country, in Mazowieckie Voivodeship, in 2013, most professionally active cardiologists were between 40 and 45 years old. The median for the region was 43 years of age (Figure 81 and Figure 82).
Figure 81: Age structure of cardiologists in Poland in 2013
Number of physicians of Number
Source: compiled based on data provided by the Supreme Medical Chamber
97
Figure 82: Age structure of cardiologists in the voivodeship in 2013
Number of physicians Number
Source: compiled based on data provided by the Supreme Medical Chamber
Cardiac Surgeons
In 2013, there were 69 cardiac surgeons registered in the NIL database who were employed in Mazowieckie Voivodeship14. They constituted about 18.85% of all cardiac surgeons employed in Poland. This was the highest result nationally (Figure 83).
Figure 83: Number of cardiac surgeons in individual voivodeships in 2013
Number of physicians
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber
In Mazowieckie Voivodeship, in 2013, the number of cardiac surgeons per 100 thousand adults was 1.62. It was the second highest number in Poland (Figure 84).
14 The number of physicians is not an unique number: if a physician works in several voivodeships, they are taken into account in each of them. The same applies in the case of specialisation, if the doctor has several specialisations, he is taken into account in each of them.
98
99
Figure 84: Number of cardiac surgeons per 100,000 adults in individual voivodeships in 2013
thousand adults thousand
physicians per 100 per physicians
difference versus rate value for the country
higher value in higher value in the Poland voivodeship
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber and Central Statistical Office
In 2013, a cardiac surgeon in Mazovian region had a contract signed with more than one (1.42) healthcare provider contracted with the public payer. It was the sixth highest result in Poland (Figure 85).
Figure 85: Number of contracts with healthcare providers contracted with the public payer per one physician in individual voivodeships in 2013
Average number of contracts per 14 physician
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber and the NFZ
In Mazowieckie Voivodeship, in 2013, there were 11 professionally active cardiac surgeons in each of the following age ranges: 30-35, 30-45, 45-50. The median for this region was 43 years of age (Figure 86 and Figure 87).
100
Figure 86: Age structure of cardiac surgeons in Poland in 2013
Number of physicians Number
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber
Figure 87: Age structure of cardiac surgeons in the voivodeship in 2013
Number of physicians Number
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber
Paediatric cardiologists
In 2013, there were 18 paediatric cardiologists registered in the NIL database who were employed in Mazowieckie Voivodeship15. They constituted about 18.75% of all cardiologists employed in Poland. This was the highest result nationally (Figure 88).
15 The number of physicians is not an unique number: if a physician works in several voivodeships, they are taken into account in each of them. The same applies in the case of specialisation, if the doctor has several specialisations, he is taken into account in each of them.
101 Figure 88: Number of paediatric cardiologists in individual voivodeships in 2013
Number of physicians
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber
In Mazowieckie Voivodeship, in 2013, the number of paediatric cardiologist per 100 thousand minors was 2.01. It was the third highest result in Poland (Figure 89).
Figure 89: Number of paediatric cardiologists per 100,000 minors in individual voivodeships in
2013
minors physicians per 100 thousand thousand 100 per physicians
difference versus rate value for the country
higher value in higher value in the
Poland voivodeship
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber and Central Statistical Office
In 2013, a paediatric cardiologist in Mazovian region had a contract signed with more than one (1.62) healthcare provider contracted with the public payer on average. It was the ninth highest result in Poland (Figure 90).
102 Figure 90: Number of contracts with healthcare providers contracted with the public payer per one physician in individual voivodeships in 2013
Average number of contracts
per 1 physician
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber and the NFZ
In Mazowieckie Voivodeship, in 2013, there were 5 professionally active paediatric cardiologists in each of the following age ranges: 45-50, 50-55.
Figure 91: Age structure of paediatric cardiologists in Poland in 2013
Number of physicians of Number
Source: compiled by DAiS based on data provided by the Supreme Medical Chamber
In 2015, there were 166816cardiology nurses in Poland, 283 of which were registered in Mazowieckie Voivodeship. This region held the fourth position in Poland in terms of the number of nurses per 100 thousand people (Figure 92 and Figure 93).
16 Nurses specialising in cardiology nursing may work at different wards than those compliant with their field of specialisation. In addition, in wards with a cardiological profile, apart from nurses with the specialist title in cardiology nursing, nurses also work without additional qualifications acquired as part of postgraduate education. Therefore, the numbers presented in the graph (number of nurses with the specialist title in cardiology nursing) should not be interpreted as the actual number of nurses employed in the given field.
103 Figure 92: Number of nurses with the specialist title in cardiology nursing in individual voivodeships in 2015
Number of nurses
Source: compiled by DAiS based on data provided by the Central Register of Nurses and Midwives (CRPiP)
104 Figure 93: Number of nurses with the specialist title in cardiology nursing per 100 thousand
people in individual voivodeships in 2015
nurses per 100 thousand people thousand 100 per nurses
difference versus rate value for the country
higher value in the higher value in Poland voivodeship
Source: compiled by DAiS based on data provided by the Central Register of Nurses and Midwives and GUS
In Mazowieckie Voivodeship, in 2015, most cardiology nurses were between 45 and 49 years old (Figure 94 and Figure 95).
Figure 94: Age structure of nurses with the specialist title in cardiology nursing in Poland in
2015
Number of nurses Number
Source: compiled by DAiS based on data provided by the Center of Postgraduate Education for of Nurses and Midwives
105 Figure 95: Age structure of nurses with the specialist title in cardiology nursing in the
voivodeship in 2015
Number of nurses Number
Source: compiled by DAiS based on data provided by the Center of Postgraduate Education for of Nurses and Midwives
106 CATCHING GAPS WITH HEALTHCARE MAPS CARDIOLOGY AND ONCOLOGY
Part III Healthcare Needs Forecasts
107 3.1 Projected Population Breakdown for Mazowieckie Voivodeship
According to the latest demographic forecast, by 2029 the population of Mazowieckie Voivodeship will have increased by 84 thousand, i.e. by 1.6%, while the Polish population will have decreased in the same period by 1.17 million people, i.e. by 3% (Figure 96).
Figure 96: Population in voivodeships in selected years covered by the forecast (2018, 2024 and
2029)
millions
Share in population in general
Source: compiled based on data provided by the Central Statistical Office
The demographic structure of Mazovian population in the next several years will be changing in a similar way to the population structure in Poland in general. It is expected that the share of population below 20 years of age as well as at the age of 45-64 will slightly change. These shares were about 21% and 26% in 2014, respectively, and will be 19% and 29% in 2029. Significant changes, however, will be noticeable among people aged 20-44 and above 64. (Figure 96 and Figure 97). According to the demographic forecast, there will be a significant drop in a share of population aged 20-44 (from 38% to 30% in 2029) as well as a considerable increase in a share of people above 64 years of age: from 16% to 22% within the considered period (Figure 97 and Figure 98).
108 Figure 97: Projected population breakdown according to sex and age in 2029 for Mazowieckie Voivodeship
Men (in thousands) Age group Women (in thousands)
Surplus of women over men (in thousands) Surplus of men over women (in thousands)
Source: compiled based on data provided by the Central Statistical Office
Figure 98: Projected population breakdown by basic age groups in Poland and Mazowieckie Voivodeship in years 2016-2029
Poland Mazowieckie Voivodeship
Source: compiled based on data provided by the Central Statistical Office
109 Figure 99: Projected population breakdown by age groups in Mazowieckie Voivodeship in selected years of prognosis (2016, 2018, 2024 and 2029)
Difference in relation to Poland’s population breakdown
Greater share in the voivodeship Greater share in Poland
Source: compiled based on data provided by the Central Statistical Office
Figure 100: Projected population breakdown by sex and age in Mazowieckie Voivodeship (a share and a number of people in thousands) in selected years of prognosis (2016, 2018, 2024 and 2029)
Source: compiled based on data provided by the Central Statistical Office
110 In 2014, the fertility rate in Mazowieckie Voivodeship amounted to over 44 births per thousand women of childbearing age, while according to the demographic forecast, in Mazowieckie Voivodeship it is to be expected to decline to the level of almost 38 in 2029. Also, it is projected that approx. 12.6 thousand children less will be born, which means a decrease from 57.1 thousand children in 2014 to 44.5 thousand children in 2029. Given the forecast, Mazowieckie Voivodeship will change its position compared to other voivodeships in terms of fertility rate to rank third (Figure 101).
Figure 101: Projected fertility rate and live births in Polish voivodeships in 2029
49
-
Thousands
Births per one thousand women aged 15 Birthsper aged thousand women one
Difference versus average value for Poland Number of births (right axis) Higher average value in Poland Higher value in the voivodeship
Source: compiled based on data provided by the Central Statistical Office
The observed number of deaths in a given population is a resultant of its size, health condition and age structure. Therefore, comparing the number of deaths is inadvisable, while comparing general (raw) death rates between different regions ought to be taken with great caution. Mazowieckie Voivodeship will not change significantly its central position in Poland in term of the death rate (Figure 102 and Figure 103). Nevertheless, it is expected that, due to population ageing, the death rate in this region will systematically rise till 2029.
111 Figure 102: Projected number of deaths (in thousands) by voivodeships in selected years of
prognosis (2016, 2018, 2024 and 2029)
Projected number ofProjected(in deaths number thousands)
Source: compiled based on data provided by the Central Statistical Office
Adult Cardiac Surgery Forecast
112 Figure 103: Projected death rates (per 100 thousand people) by voivodeships in selected years
of prognosis (2016, 2018, 2024 and 2029)
Death rate (per 100 thousandDeathpeople) (per 100 rate
Source: compiled based on data provided by the Central Statistical Office
3.2 Projected demographics of counties (poviats)
According to the demographic prognosis, by 2029 the number of inhabitants in some Mazovian counties will have decreased, while in other will have increased (Figure 104). The largest decrease in the population number should be expected in the following counties: Lipsko (by 12%), Sokołów Podlaski, Przysucha (by 10%), Radom City, Płock City, Żuromin, Ostrołęka City (by 9%), Maków Mazowiecki, Łosice, Ostrów Mazowiecka (by 8%). Whereas the population of the following counties will increase: Piaseczno (by 20%), Wołomin (by 18%), Grodzisk Mazowiecki (by 15%), Legionowo (by 16%), Ożarów Mazowiecki (by 13%), Pruszków (by 9%), Mińsk Mazowiecki (by 8%), Otwock (by 6%).
113 Figure 104: Population in counties of Mazowieckie Voivodeship in selected years of prognosis
(2018, 2024 and 2029)
Thousands
Share in population in general
Source: compiled based on data provided by the Central Statistical Office
Over the considered prognostic period, the changes in the demographic structure of population in Mazovian counties will occur in a similar way to the entire voivodeship. It is expected that the share of people aged 20 and 45-64 will be relatively constant, while there will be a significant drop in the share of individuals at the age 20-44 in favour of individuals above 65, as in the demographic forecast. By 2029, the biggest changes in shares of particular age groups should be expected in city counties, as well as, among others, in the following counties Ciechanów, Gostynin and Lipsko (Figure 105).
By 2029, the highest share of people above 65 years of age will have been observed in: Lipsko County (26.8%), Płock City (26.5%), Radom City (26.4%), Gostynin County and Sokołów Podlaski County (25.2%). The lowest number of individuals older than 65 in 2029 will have occurred in the following counties: Wołomin (17.8%), Piaseczno (18.1%) and Ostrołęka (18.5%) (see Figure 105). Figure 106 shows the projected demographic situation in counties with sex and age group breakdown.
114 Figure 105: Projected population breakdown by age in counties of Mazowieckie Voivodeship in selected years of prognosis (2016, 2018, 2024 and 2029)
Białobrzegi County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Ciechanów County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
115 Garwolin County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Gostynin County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
116 Grodzisk Mazowiecki County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Grójec County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
117 Kozienice County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Legionowo County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
118 Lipsko County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Łosice County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
119 Maków Mazowiecki County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Mińsk Mazowiecki County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
120 Mława County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Nowy Dwór Mazowiecki County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
121 Ostrołęka County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Ostrów Mazowiecki County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
122 Otwock County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Piaseczno County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
123 Płock County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Płońsk County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
124 Pruszków County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Przasnysz County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
125 Przysucha County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Pułtusk County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
126 Radom County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Siedlce County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
127 Sierpc County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Sochaczew County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
128 Sokołów Podlaski County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Szydłowiec County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
129 Warsaw-West County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Węgrów County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
130 Wołomin County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Wyszków County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
131 Zwoleń County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Żuromin County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
132 Żyrardów County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Ostrołęka County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
133 Płock City County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Radom County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
134 Siedlce County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Capital City of Warsaw County
difference versus the structure of the voivodeship
Higher share in the county Greater share in the voivodeship
Source: compiled based on data provided by the Central Statistical Office
135 Figure 106: Projected population breakdown by sex in counties of Mazowieckie Voivodeship in selected years of prognosis (2016, 2018, 2024 and 2029)
Białobrzegi County
Ciechanów County
136 Garwolin County Legionowo County
Gostynin County Lipsko County
Łosice County Grodzisk Mazowiecki County
Grójec County Maków Mazowiecki County
Kozienice County Mińsk Mazowiecki County
137 Mława County Piaseczno County
Nowy Dwór Mazowiecki County Płock County
Płońsk County Ostrołęka County
Ostrów Mazowiecki County Pruszków County
Otwock County Przasnysz County
138
Przysucha County Sochaczew County
Pułtusk County Sokołów Podlaski County
Radom County Szydłowiec County
Siedlce County Warsaw-West County
Węgrów County Sierpc County
139
Wołomin County Ostrołęka County
Płock City County
Wyszków County
Radom County
Zwoleń County
Siedlce City County
Żuromin County
Capital City of Warsaw County
Żyrardów County
Source: compiled based on data provided by the Central Statistical Office
140 Over the considered period of prognosis, the fertility rate in Mazowieckie Voivodeship will decrease to 38 births per one thousand women of childbearing age (Figure 107). In 2029, the highest rate will be characteristic of the following counties: Garwolin, Siedlce, Węgrów, Mińsk Mazowiecki, Łosice, Ostrołęka, Wyszków and Przasnysz, while the lowest of Warsaw-West, Capital City of Warsaw, Radom City and Lipsko County. (cf. Figure 107).
Figure 107: Projected fertility rate and live births in Mazovian counties (poviats) (2029)
49
-
Thousands
women aged 15 aged women
Births per one thousand thousand one per Births
Difference versus average value for Mazowieckie Voivodeship Number of births Higher average value in the voivodeship Higher value in the county
Source: compiled based on data provided by the Central Statistical Office
The observed number of deaths in a given population is a resultant of its size, health condition and age structure. Therefore, comparing the number of deaths is inadvisable, while comparing general (raw) death rates between different regions ought to be taken with great caution. Figure 108 and Figure 109 show the number of deaths and raw death rate for selected years of prognosis (2016, 2018, 2024 and 2029). In the analysed voivodeship, the majority of counties will experience a rise (smaller or larger) in the death rates which is related to the population ageing. The highest death rate is projected for Lipsko, Sokołów Podlaski, Przysucha i Łosice counties. On the other hand, the lowest values for this rate will be observed in Wołomin, Piaseczno and Legionowo counties.
141 Figure 108: Projected number of deaths (in thousands) by counties of Mazowieckie Voivodeship
in selected years of prognosis (2016, 2018, 2024 and 2029)
Projected number of deaths number Projected
Source: compiled based on data provided by the Central Statistical Office
142 Figure 109: Death rates (per 100 thousand people) by counties of Mazowieckie Voivodeship in
selected years of prognosis (2016, 2018, 2024 and 2029)
Projected deaths per 100 thousand people thousand 100 per deaths Projected
Source: compiled based on data provided by the Central Statistical Office
3.3 Incidence Forecast for the years 2015-2025
Based on the incidence rates from 2013, the incidence forecast has been prepared for years 2015-2025. As the incident rates for cardiac diseases were assumed as constant in time, the estimations are based mostly on the demographic prognosis17. Another assumption made to develop the prognosis concerned the lack of effect of the medical progress on cardiac incidence. Moreover, it was assumed that there will be no changes in the population behaviour which would affect the exposure to cardiac disease risk factors.
According to estimations, the number of new patients with cardiac diseases will increase in the following years. In 2015, there will be 377 thousand18 patients suffering from at least one cardiac complaint, and this number will increase up to 426 thousand in 2025. This means an increase by almost 13% in 10 years (cf. Figure 110).
17 The report was prepared based on the demographic prognosis by the Central Statistical Office http://demografia.stat.gov.pl/bazademografia/Prognoza.aspx 18 The number reflects the number of patients, hence if a patient was diagnosed with more than one cardiac disease within a year, they were included in these estimations only once.
143
Figure 110: Projected total number of new cardiac cases in 2015-2025
Number of patients/cases (in thousands) (in of patients/cases Number
Number of new Number of new patients cases Source: compiled based on data provided by the NFZ.
Analysing incidence in territorial aspects, the highest numbers of cardiac patients in 2015 should be expected in the following Voivodeships: Mazowieckie, Śląskie, Wielkopolskie and Małopolskie. The lowest values will be recorded in the following voivodeships: Świętokrzyskie, Podlaskie, Opolskie and Lubuskie (cf. Figure 111). The number in Mazovian region is over 5.5 times higher than the lowest incidence (Lubuskie region). This will be the case in 2025, except that the lowest incidence is projected for Opolskie Voivodeship.
Figure 111: Projected cardiac diseases incidence by voivodeships in years 2015 and 2025
Projected number Projected number of of new cases (in new cases (in thousands) thousands)
Source: compiled based on data provided by the NFZ.
Within a decade, an increase in the incidence should be expected in all voivodeships. The highest gains will be observed in the northern, north-western and south-eastern part of Poland (see Figure 112). Wielkopolskie and Pomorskie voivodeships have the highest projected increase of 16%. The estimated
144 growth in the number of new patients with cardiac diseases will be just slightly lower in the following voivodeships: Zachodniopomorskie, Lubuskie, Warmińsko-Mazurskie, Małopolskie and Podkarpackie (15%). The lowest increase, of less than 10%, will occur in Łódzkie, Opolskie and Świętokrzyskie voivodeships. The differences in the incidence result mainly from the varied demographic structure of voivodeships.
Figure 112: Increase (%) in the total number of new cardiac cases in 2015-2025
Projected change
Source: compiled based on data provided by the NFZ.
As already mentioned, for each cardiac disease separate incidence rates were estimated. Thanks to that, the number of new cases may be calculated for each disease separately. Figure113 presents the projected number of new cases of each disease in 2015 and 2025. The dominant problem in Poland will be still the ischaemic heart disease. According to the forecast, 226 thousand people will be affected by it in 2015 and 258.1 thousand in 2025. The biggest absolute changes concern the most widespread diseases, i.e. ischemic heart disease or heart failure.
145 Figure 113: Projected number of new cardiac cases per disease
Ischaemic heart disease
Other rhythm and conduction disturbances
Heart failure
Atrial fibrillation and flutter
Acquired heart defects
Other heart diseases (unspecific, unclassified)
Cardiomyopathies
Pulmonary embolism
Aortic aneurysm
Congenital heart defects
Other pulmonary vascular diseases
Pericardial diseases
Myocarditis
Endocarditis
Rheumatism
Number of cases (in thousands)
Source: compiled based on data provided by the NFZ.
The relative increase in the number of new cases of selected diseases in 2015-2025 is shown in Figure 114. In the case of heart failure and aortic aneurysm, the projected increase is estimated at over 1/4 cases. While in absolute numbers the ischemic heart disease presented the highest increase in incidence, in relative terms, it places on the 8th position (14%). It is worth noting that according to the forecast, the number of new cases of myocarditis and the number of patients with detected congenital heart disease will decrease. The explanation for the obtained results may be the fact that these diseases are characteristic for young patients, which results in a smaller number of projected cases in the context of the increasing ageing process of the population.
146 Figure 114: Changes in cardiac diseases incidence between 2015 and 2025
Heart failure
Aortic aneurysm
Atrial fibrillation and flutter
Other pulmonary vascular diseases
Pulmonary embolism
Cardiomyopathies
Acquired heart defects cardiac diseases
Ischaemic heart disease
Other heart diseases (unspecific, unclassified)
Endocarditis
Other rhythm and conduction disturbances
Pericardial diseases
Rheumatism
Myocarditis
Congenital heart defects
An increase in the number of new cases between 2015 and 2025
Source: compiled based on data provided by the NFZ.
As these estimations are mostly based on the projected demographic structure of population, changes in the incidence will result from changes in the population size, age structure, sex proportion and place of residence. As can be seen in Figure 115, the number of patients in younger age groups in 2015-2025 will become lower. The number of new patients will be the lowest, however, between 55 and 64 years of age. Individuals who are in this group in 2015 in ten years will be in a next one (65-74), hence the frequency of heart diseases will significantly increase in this age group.
Figure 115: Changes in patients’ age structure between 2015 and 2025
Age group Age
An increase in the number of new cases between 2015 and 2025
Source: compiled based on data provided by the NFZ.
147 One of the essential elements used in epidemiological analyses is incidence, defined as the number of newly diagnosed patients in a given year (Rothman, Greenland, 2005)19 Determining the value of this indicator allows to calculate the risk of developing a given cardiac disease and to assess the threat of this particular cardiac disease in a population. Cardiovascular diseases (CVD), including the cardiac diseases in question, for years have been the main cause of death in Poland. The number of deaths due to CVD among Poles is higher than the average in the European Union (Wojtyniak et al., 2012)20 This provides the basis for analysing the epidemiological situation, as well as forecasting future incidence rates. This type of prognosis allows to estimate the future healthcare needs of the population, along with a related response. Cardiac diseases most often occur in the elderly, therefore, when dealing with the ageing process of the population, an increase in the number of new cases of cardiac diseases should be expected. During the next decade, the number of cases of heart failure, aortic aneurysm and atrial fibrillation and flutter will increase the fastest. As for the growth in absolute terms, the highest will occur for the most common diseases, i.e. heart failure and ischaemic heart disease. The projected increase in the number of new cases in the following years differs between voivodeships. The differences most probably arise from the predicted demographic characteristics of the population in a given region, i.e. the age and sex distribution, as well as the place of residence. Other factors that may influence the differences between voivodeships are the residents’ lifestyle and medical care accessibility.
Cardiac Treatment Forecast
Based on the data reported to NFZ for years 2009-2014, an empirical model of the performance of procedures in cardiac diseases treatment has been developed. For each cohort of patients, based on the data, the number and timing of performed procedures were determined with the breakdown by: cardiac diseases (as per cardiac groups), age groups, voivodeship of treatment, sex and patient’s place of residence. Each cohort had its 4-year treatment pathway established using the newest available data (for the 2nd, 3rd and 4th year of treatment the information was extended with the treatment methods in patients from previous cohorts, i.e. patients diagnosed in 2012, 2011 and 2010, respectively). Based on the actual performance of procedures in 2013 in newly diagnosed patients and returning patients, rates were determined to take into account the latter group21. The projected demand for procedures in cardiac diseases treatment was established based on the empirical model of treatment, as well as on the previously presented incidence forecast for years 2016, 2018, 2024, 2029. It was assumed that patients diagnosed in a given voivodeship will be treated therein; the model defines the needs of residents of a given voivodeship, and in its basic version, it does not take migration into consideration. Table 25 presents the demand for procedures in the voivodeship.
19 Rothman K. J., Greenland S. (2005) Measures of Disease Frequency, in: Ahrens W., Pigeot I., Handbook of Epidemiology, Springer, s. 58-68. 20 Wojtyniak B., Goryński P., Moskalewicz B. (2012) Sytuacja zdrowotna ludności Polski i jej uwarunkowania, National Institute of Public Health – National Institute of Hygiene 21 In case of coronary angiography, the information was extended with unreported coronary angiographies - if a patient underwent a procedure which, due to medical reasons, required prior coronary angiography, and no coronary angiography was reported in 365 days before the said procedure, it was assumed that the coronary angiography was performed together with the procedure and it was not reported because of financial settlement issues.
148 Table 25: Projected demand for cardiac procedures in the voivodeship (2016, 2018, 2024, 2029)
voivodeship Projected procedures (in thousands) Mazowieckie
Projected year PCI implantation/exchange ablation EPS valve surgery CABG
ICD CRT of a pacemaker 2016 15.89 1.16 0.46 5.03 2.64 1.93 1.38 2.71
2018 16.35 1.20 0.48 5.19 2.67 1.94 1.41 2.79
2024 17.98 1.31 0.53 5.93 2.73 1.97 1.54 3.07
2029 19.41 1.40 0.56 6.66 2.78 1.99 1.67 3.31
Source: compiled based on data provided by the NFZ
In order to perform certain procedures, the appropriate equipment is essential. It applies in particular to haemodynamic laboratories with haemodynamic tables. Therefore, the above demand for procedures requiring haemodynamic laboratories was compared with the presently reported number of tables. Based on the arrangements with the National Consultant, two scenarios were prepared - the number of tables needed, based on the demand for procedures, assuming an average of 2,000 treatments per table per year (desired value), and the number of tables needed resulting from the demand for procedures, assuming an average of 3,000 treatments per table per year (a value indicating the urgent need to expand the infrastructure). Table 2622shows a change in demands for tables under these assumptions in time. Also, the table demonstrates the difference between these values and currently reported number of tables. Taking into account the quality of source data regarding the number of tables used in the voivodeship, caution is recommended. It is possible to adjust the forecast with the procedure’s level of complexity (e.g. with coronary angiography to PCI conversion factor of 2:3), however, due to the lack of established standards, in the basic prognosis they were considered equivalent23.
Table 26: Projected demand for procedures requiring haemodynamic laboratories and for haemodynamic tables (2016, 2018, 2024, 2029)
Projected Projected number of Demand for tables with Difference to the year procedures (in thousands) the number of assumed presently reported treatments per table number (32) coronary PCI 3000 per 2000 per 3000 per 2000 per angiography year year year year 2016 25.2 16.1 14 21 -18 -11 2018 26.1 16.6 14 21 -18 -11 2024 28.6 18.3 16 23 -16 -9 2029 30.6 19.8 17 25 -15 -7
Source: compiled by DAiS based on data from the NFZ database and the demographic forecast of the Central Statistical Office
22Details are included in the attachment at the end of the document. 23 In these circumstances, coronary angiography and PCI during one operation are regarded as two procedures.
149 The performed analysis (based on the demographic changes only, ceteris paribus) indicates that the demand for procedures performed in haemodynamic laboratories will increase in Mazowieckie Voivodeship from 41.4 thousand in 2016 to 50.4 thousand in 2029 (+21.6%).
Considering the above, the demand for haemodynamic tables will systematically increase. However, when comparing the current resources (17 tables in the region according to the available data) to the desired resources, it should be stated that there is no urgent need for increasing the number of haemodynamic tables in the projected period.
3.4 Adult Cardiac Surgery Forecast
The prognosis of healthcare needs in the field of adult cardiac surgery is based on changes taking place in the demographic structure of the Polish population. Considering two main factors, i.e. decreasing population numbers and simultaneous ageing of the population, one should expect an increasing demand for cardiac surgery for acquired heart defects. Until 2020, the situation is expected to be stable, whereas after 2020 there will be a noticeable sharp rise resulting from a substantial increase in a number of people above 75 years of age (see Table 27
Table 27: Projected number of cardiosurgical procedures (2016—2029)
Year 2016 2020 2025 2029
Projected number of surgeries 24,405 24,314 24,881 25,622
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
The prognosis for 2016 predicts over 24.4 thousand cardiosurgical operations of acquired heart defects in Poland. The highest number of patients will be from Mazowieckie, Dolnośląskie, Wielkopolskie and Małopolskie voivodeships (see Figure 116). Residents of the following voivodeships will require the least cardiac surgeries: Lubuskie, Opolskie, Podlaskie and Świętokrzyskie.
150 Figure 116: Projected number of patients requiring cardiosurgical procedures per voivodeship (2016)
Projected number of surgeries
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
In 2029, the total number of acquired defects requiring cardiosurgical operations in Poland will exceed 25.6 thousand. As in 2016, the highest number of patients will be from voivodeships with the highest population size, i.e. Mazowieckie, Dolnośląskie, Wielkopolskie and Małopolskie (see Figure 117). Residents of the following voivodeships will require the least cardiac surgeries: Lubuskie, Opolskie, Podlaskie and Świętokrzyskie.
Figure 117: Projected number of patients requiring cardiosurgical procedures per voivodeship (2029)
Projected number of surgeries
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
151 Taking into account the varied age population structure in individual voivodeships, it can be stated that in voivodeships with age structure changing faster the number of procedures required to be performed also will be changing dynamically. The largest increase in the number of required cardiosurgical operations between 2016 and 2029 will be observed in Pomorskie, Mazowieckie, Wielkopolskie, Małopolskie, as well as Zachodniopomorskie and Lubuskie voivodeships. Interestingly, within this period in Opolskie Voivodeship, the number of patients will drop (see Figure 118).
Figure 118: Projected number of surgeries in years 2016-2029 by voivodeships
Projected change
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office In 2014, the highest number of surgeries per 1 operating theatre was performed in Swissmed Vascular in Gdańsk - 569 operations per an operating theatre. It can be assumed that this could be the maximum number of cardiac surgeries performed in each operating theatre in Poland. This means that adult cardiac surgery centres have a potential to fulfil the needs on a national scale (see Figure 119 and Table 28). As can be seen, assuming the maximum of 569 surgeries per each operating theatre in Poland, the potential will be used in about 2/3, which means that even with a significant increase in the incidence rate there still will be some resources left to exploit.
152 Figure 119: Projected number of patients requiring cardiosurgical procedures per 1 operating
theatre (2015-2029)
Number of patients (in thousands) (in of patients Number
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
Table 28: Projected number of cardiac surgeries and unexploited potential in thousands (2016- 2029)
Year 2016 2020 2025 2029
Projected number of surgeries 24.4 24.4 24.9 25.6
Unexploited max. potential 14.3 14.4 13.8 13 Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
Assuming the maximum number of cardiac surgeries per an operating theatre, only Lubuskie and Świętokrzyskie Voivodeships in 2016 would lack appropriate facilities to perform the projected number of cardiac surgeries. However, the neighbouring voivodeships, Dolnośląskie and Zachodniopomorskie, and Śląskie, Małopolskie and Mazowieckie, respectively, have highly unexploited potential and the surgeries could be performed there.
153 Figure 120: Projected number of patients requiring cardiosurgical procedures per 1 operating theatre in selected voivodeships (2016)
Projected number
of surgeries
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
The same is expected to be the case in 2029. With the same assumption on the maximum number of surgeries performable in one operating theatre, three voivodeships will exceed the limit: the aforementioned Lubuskie and Świętokrzyskie, as well as Wielkopolskie. It should be kept in mind, however, that they border with voivodeships with a still low utilisation rate in terms of operation theatres, hence patients may use the potential of other centres.
Figure 121: Projected number of patients requiring cardiosurgical procedures per 1 operating theatre in selected voivodeships (2029)
Projected number
of surgeries
Source: compiled based on data from “Kardiochirurgia Polska 2014” report and data provided by the Central Statistical Office
The phenomenon of patients migration can be observed in Figure 122 which shows the geographic distribution of cardiac surgeries in Poland in 2014. The highest number of cardiac surgeries is performed
154 in voivodeship which have a large number of operating theatres; however, their potential is not exploited to the full.
Figure 122: Geographic distribution of cardiac surgeries in Poland (2014)
Source: “Kardiochirurgia Polska 2014” report authored byB. Maruszewski, Z. Tobota, consulted by M. Zembala (www.krok.org.pl).
There are six centres of adult cardiac surgery in Mazowieckie Voivodeship. Projections of healthcare needs for Mazovian population show a high demand for cardiac surgeries. Nevertheless, there are enough operation theatres and there is no need to establish new cardiac surgery centres in this region. It is observed that the immense potential of existing facilities in not harnessed.
3.5 Paediatric Cardiology and Cardiac Surgery Forecast
Demographic analysis is based on data from the world literature on the prevalence of congenital heart defects in live newborns. It is assumed that congenital heart defects occur with the prevalence of 5-10 per 1,000 live births. Figure 123 shows the projected number of births of children with congenital heart defects, wherein the lower edge of the marked area is a forecast with the assumed congenital heart defects occurrence of 5 per 1,000 live births, and the upper edge with 10 per 1,000.
155
Figure 123: Projected births of children with congenital heart defects
defects Projected births of children with congenital congenital with children of births Projected
Source: compiled based on data provided by the NFZ
Figure 125: Projected births of children with congenital heart defects per voivodeship (2016)Most publications and analyses assume the prevalence of 7-8 per 1,000 births. Therefore, the cardiac surgery forecast includes the projected number of live births in the following years in individual voivodeships, as well as the occurrence of congenital heart defects of 8 per one thousand live births.
Projected births of children with congenital heart defects in the years 2016 and 2029 as per voivodeship were presented in Figure 124. The same information is presented in a form of geographic distribution in Figures 125 and 126.
Figure 124: Projected births of children with congenital heart defects per voivodeship
Year 2016
Year 2029 Number of cases Number
Source: compiled based on data provided by the NFZ
156 Figure 125: Projected births of children with congenital heart defects per voivodeship (2016)
Projected births of children with congenital heart defects
Source: compiled based on data provided by the NFZ
Figure 126: Projected births of children with congenital heart defects per voivodeship (2029)
Projected births of children with congenital heart defects
Source: compiled based on data provided by the NFZ
The number of births in general will systematically drop in all regions; therefore, the number of births of children with congenital heart defects will also drop. It can be observed that the drop is relatively even in all voivodeships. It is forecast that in the analysed Mazowieckie Voivodeship, 423 children with congenital heart defects will be born in 2016, and 356 in 2029.
In the literature, it is usually assumed that the percentage of newborns with congenital heart defects requiring surgery in the first days after birth (duct dependent congenital heart disease and some others) is around 20%. Based on this assumption, the numbers of surgeries in newborns with congenital heart defects for 2016 and 2029 were forecast. Forecast results are presented in Figure 127 and 128.
157 Figure 127: Projected number of surgeries in newborns with congenital heart defects requiring surgery per voivodeship (2016)
Projected number of neonatal surgeries
Source: compiled based on data provided by the NFZ
Figure 128: Projected number of surgeries in newborns with congenital heart defects requiring surgery per voivodeship (2029)
Projected number of neonatal surgeries
Source: compiled based on data provided by the NFZ
As the literature-based method for forecasting the number of surgeries on newborns with congenital heart defects takes into account an even number of children requiring a surgery, the analysis of these numbers also shows a downward trend. It is forecast that in the analysed Mazowieckie Voivodeship, 85 newborns with congenital heart defects will require a cardiac surgery in 2016, and 71 in 2029.
While predicting the future healthcare situation in terms of congenital heart defects treatment, it should be emphasised that it is against the global standards to plan on multiplying paediatric cardiac surgery centres. Better treatment results are invariably linked to a higher number of services, including surgery procedures, provided by one centre. Although the services of congenital heart defect surgeries in
158 newborns are sufficiently secured, no effort should be spared to increase the number of reoperations and to shorten their waiting lists. This requires an increased activity of the centres which perform few operations, i.e. fewer than 250, and perform a limited scope of necessary surgeries, selecting only patients with simple heart defects. The only regions in Poland which may be considered for establishing a new centre with the highest referral level in paediatric cardiac surgery include two voivodeships: Lubelskie and Podkarpackie. This is justified by the need to perform more than 300 operations of congenital heart defects annually in this area, including over 60 urgent surgeries in newborns with duct- dependent congenital heart diseases in the first days of life.
The Polish field of cardiac surgery, including paediatric part, for many years has gathered full data on the course and results of cardiac surgery treatment. Modern statistical methods allowed to define the current standards for obtained results. The tool of the Polish National Registry of Cardiac Surgery Procedures and an annual report entitled “Kardiochirurgia Polska” helps to assess and control the obtained results as it measures both early mortality and morbidity, and compares them to international scales of death and complication rates. This information is provided to all of the responsible for cardiac surgery treatment, the payer, and healthcare institutions (MZ, NFZ).
As has already been mentioned when discussing the current state, in Mazowieckie Voivodeship, the needs of children with CHD are fulfilled at the highest level by the cardiac surgery centre in IP CZD. This applies also to a significant number of children from neighbouring regions and the entire country. There is a gross disproportion in both the number and the type of performed procedures, especially in neonates, between IP CZD and Independent Public Paediatric Clinical Hospital. At this very moment (2015), the said centre is being moved to a new place with modern infrastructure which ought be utilised to a much greater extent.
Table 29: Number of tables in haemodynamic and electrophysiological laboratories in Poland (2013)
in haemo
NFZ Voivodeship Hospital City/town Branch
tables in haemo laboratories in(used haemo laboratories)* tables in haemo laboratories separate electrophysiological laboratory separate pacemaker implantation laboratory,ICD, CRT implantations performed laboratories ablations in haemo laboratories DOLNOŚLĄSKI Jan Mikulicz - Radecki University Teaching Hospital in Wrocław Wrocław 2 2 1 DOLNOŚLĄSKI REGIONAL SPECIALIST HOSPITAL IN WROCŁAW WROCŁAW 1 1 1 1 DOLNOŚLĄSKI 4 Military Clinical Hospital with Specialist Outpatient Clinic Wrocław 2 2 1 1 Independent Public Healthcare Centre in Wrocław DOLNOŚLĄSKI Complex of Healthcare Facilities in Kłodzko Kłodzko 1 1 1 1 DOLNOŚLĄSKI Tadeusz Marciniak Lower Silesian Specialist Hospital - Emergency Wrocław 2 2 1 1 Medical Centre DOLNOŚLĄSKI Kotlina Jelenionórska Regional Hospital Centre Jelenia Góra 1 1 DOLNOŚLĄSKI "Miedziowe Centrum Zdrowia" S.A. hospital in Lubin Lubin 2 2 1 1 DOLNOŚLĄSKI ALFRED SOKOŁOWSKI SPECIALIST HOSPITAL WAŁBRZYCH 1 1
159
in haemo
NFZ Voivodeship Hospital City/town Branch
tables in haemo laboratories in(used haemo laboratories)* tables in haemo laboratories separate electrophysiological laboratory separate pacemaker implantation laboratory,ICD, CRT implantations performed laboratories ablations in haemo laboratories DOLNOŚLĄSKI General Independent Public Healthcare Complex in Zgorzelec Zgorzelec 1 1 DOLNOŚLĄSKI Regional Specialist Hospital in Legnica Legnica 1 1 1 DOLNOŚLĄSKI American Heart of Poland, Centre of Cardiology and Angiology of Polanica-Zdrój 1 1 1 1 Sudety KUJAWSKO- Antoni Jurasz University Hospital No. 1 in Bydgoszcz Bydgoszcz 2 2 1 POMORSKI KUJAWSKO- Jan Biziel University Hospital No. 2 in Bydgoszcz Bydgoszcz 2 2 1 POMORSKI KUJAWSKO- 10 Military Clinical Hospital with Specialist Outpatient Clinic Bydgoszcz 2 2 1 POMORSKI Independent Public Healthcare Centre in Bydgoszcz KUJAWSKO- Ludwik Błażek General Hospital in Inowrocław Inowrocław 1 1 1 POMORSKI KUJAWSKO- Emil Warmiński Memorial Municipal Hospital Bydgoszcz 1 1 1 POMORSKI KUJAWSKO- Jerzy Popiełuszko Regional Specialist Hospital in Włocławek Włocławek 1 1 1 POMORSKI KUJAWSKO- Ludwik Rydygier Regional Polyclinic Hospital in Toruń Toruń 1 1 1 POMORSKI KUJAWSKO- Władysław Biegański Regional Specialist Hospital Grudziądz 2 2 1 POMORSKI KUJAWSKO- Nicolaus Copernicus Specialist Municipal Hospital Toruń 1 1 1 POMORSKI KUJAWSKO- ESKULAP Hospital, Centre for Heart and Vascular Disease Osielsko 1 1 POMORSKI Treatment KUJAWSKO- CARDINOX SPÓŁKA Z OGRANICZONĄ ODPOWIEDZIALNOŚCIĄ TUCHOLA 1 1 1 POMORSKI LUBELSKI Independent Public Clinical Hospital No. 4 in Lublin Lublin 2 2 1 1 LUBELSKI JOHN PAUL II INDEPENDENT PUBLIC PROVINCIAL HOSPITAL ZAMOŚĆ 2 2 1 1 LUBELSKI Regional Specialist Hospital in Biała Podlaska Biała Podlaska 1 1 1 1 LUBELSKI Cardinal Stefan Wyszyński Regional Specialist Hospital Independent Lublin 1 1 1 1 Public Healthcare Centre LUBELSKI INDEPENDENT PUBLIC HEALTHCARE CENTRE OF THE LUBLIN 1 1 MINISTRY OF INTERNAL AFFAIRS IN LUBLIN LUBELSKI Independent Public Healthcare Centre in Puławy Puławy 1 1 LUBELSKI Non-Public Invasive Cardiology Centre “Ikardia” Nałęczów Nałęczów 1 1 1 LUBELSKI 1 Military Clinical Hospital with Specialist Outpatient Clinic Lublin 1 1 Independent Public Healthcare Centre in Lublin LUBELSKI Cardiology Centre Chełm - Inpatient Healthcare Chełm 1 1 1 LUBUSKI General Hospital in Nowa Sól Nowa Sól 2 2 1 1 LUBUSKI WieIospecjalistyczny Szpital Wojewódzki w Gorzowie Wlkp. Spółka z Gorzów 1 1 1 1 ograniczoną odpowiedzialnością Wielkopolski LUBUSKI Provincial Hospital Karol Marcinkowski Independent Public Zielona Góra 1 1 1 1 1 Healthcare Centre in Zielona Góra LUBUSKI 105 Military Hospital and Clinic Independent Public Healthcare Żary 1 1 Centre ŁÓDZKI Independent Public Healthcare Centre Military Memorial Medical Łódź 5 5 2 1 Academy – Central Veterans' Hospital ŁÓDZKI NICOLAUS COPERNICUS PROVINCIAL SPECIALIST HOSPITAL Łódź 1 1 1 IN ŁÓDŹ ŁÓDZKI WŁADYSŁAW BIEGAŃSKI REGIONAL SPECIALIST HOSPITAL IN Łódź 3 3 1 1 ŁÓDŹ ŁÓDZKI Nicolaus Copernicus Independent Provincial Hospital in Piotrków Piotrków 1 1 Trybunalski Trybunalski ŁÓDZKI General Hospital Jagiellońska Radomsko 1 1 1 ŁÓDZKI AHP, 12th Department of Cardiology in Bełchatów Bełchatów 1 1 1 ŁÓDZKI Cardiology Centre of Zgierz MED-PRO - Inpatient and 24h Hospital Zgierz 2 2 2 Healthcare
160
in haemo
NFZ Voivodeship Hospital City/town Branch
tables in haemo laboratories in(used haemo laboratories)* tables in haemo laboratories separate electrophysiological laboratory separate pacemaker implantation laboratory,ICD, CRT implantations performed laboratories ablations in haemo laboratories ŁÓDZKI Allenort Cardiology Centre Kutno 1 1 ŁÓDZKI Non-Public Invasive Cardiology and Angiology Centre of Łęczyca Łęczyca 1 1 1 ŁÓDZKI Independent Public Healthcare Centre of the Ministry of Internal Łódź 2 2 2 Affairs in Łódź - HOSPITAL ŁÓDZKI Allenort Cardiology Centre Tomaszów 2 2 1 Mazowiecki ŁÓDZKI Non-Public Invasive Cardiology and Angiology Centre Sieradz 1 1 1 MAŁOPOLSKI John Paul II Specialist Hospital in Kraków – Hospital Wards Kraków- 4 4 1 1 Krowodrza MAŁOPOLSKI INDEPENDENT PUBLIC HEALTHCARE CENTRE UNIVERSITY Kraków 3 3 1 HOSPITAL IN KRAKÓW MAŁOPOLSKI E. SZCZEKLIK SPECIALIST HOSPITAL IN TARNÓW TARNÓW 1 1 1 MAŁOPOLSKI TYTUS CHAŁUBIŃSKI COUNTY HOSPITAL IN ZAKOPANE ZAKOPANE 1 1 1 MAŁOPOLSKI University Children's Hospital in Kraków Kraków 2 2 1 1 MAŁOPOLSKI Saint Luke's Provincial Hospital in Tarnów Independent Public TARNÓW 1 1 1 Healthcare Centre - Inpatient treatment MAŁOPOLSKI County Hospital in Chrzanów Chrzanów 1 1 1 MAŁOPOLSKI INVASIVE CARDIOLOGY, ELECTROTHERAPY AND ANGIOLOGY KRAKÓW 2 2 1 1 CENTRE OF KRAKÓW MAŁOPOLSKI Invasive Cardiology, Electrotherapy and Angiology Centre in Nowy Nowy Sącz 1 1 1 1 Sącz MAŁOPOLSKI Invasive Cardiology, Electrotherapy and Angiology Centre in Nowy Nowy Targ 1 1 1 Targ MAŁOPOLSKI Invasive Cardiology, Electrotherapy and Angiology Centre in Oświęcim 1 1 1 Oświęcim MAŁOPOLSKI Cardiovascular Centre of Lesser Poland, AHP - Chrzanów Chrzanów 1 1 1 MAZOWIECKI Cardinal Wyszyński Institute of Cardiology Warsaw 4 4 1 MAZOWIECKI Public Paediatric Central Clinical Hospital in Warsaw Warsaw 2 2 1 MAZOWIECKI Central Clinical Hospital of the Ministry of the Interior and Warsaw 2 2 1 Administration in Warsaw MAZOWIECKI Infant Jesus Clinical Hospital Warsaw 1 1 MAZOWIECKI Central Clinical Hospital of the Ministry of Defence Warsaw 44 2 2 1 MAZOWIECKI SZPITAL GROCHOWSKI IM. DR MED. RAFAŁA MASZTAKA Warsaw 2 2 1 SPÓŁKA Z OGRANICZONĄ ODPOWIEDZIALNOŚCIĄ MAZOWIECKI Regional Polyclinical Hospital in Płock Płock 1 1 1 MAZOWIECKI Mazowiecki Szpital Specjalistyczny Spółka z Ograniczoną Radom 1 1 1 Odpowiedzialnością MAZOWIECKI Bródno Clinical Centre Warsaw 1 1 1 MAZOWIECKI Regional Specialist Hospital in Ciechanów Ciechanów 1 1 MAZOWIECKI Specialist Hospital in Siedlce Siedlce 2 2 1 MAZOWIECKI Jozef Psarski Mazovia Specialist Hospital in Ostrołęka – Inpatient Ostrołęka 1 1 1 and 24h Hospital Healthcare MAZOWIECKI Jerzy Popiełuszko Bielański Hospital – Independent Public Warsaw 1 1 1 Healthcare Centre MAZOWIECKI Tytus Chałubiński Specialist Hospital in Radom - Inpatient Radom 2 2 1 Healthcare MAZOWIECKI Anna Gostyńska Wola Hospital Independent Public Healthcare Warsaw 1 1 1 Centre MAZOWIECKI John Paul II Independent Public Specialist Western Hospital Grodzisk 1 1 1 Mazowiecki MAZOWIECKI Międzylesie Specialist Hospital in Warsaw Warsaw 1 1 1 MAZOWIECKI MAGODENT Non-Public Healthcare Centre Warsaw 1 1 1 MAZOWIECKI Independent Public Healthcare Centre in Siedlce Siedlce 0 1 1 MAZOWIECKI Cardiology Centre - Hospital Józefów 2 2 1 MAZOWIECKI Fryderyk Chopin European Health Centre Otwock 1 1 1
161
in haemo
NFZ Voivodeship Hospital City/town Branch
tables in haemo laboratories in(used haemo laboratories)* tables in haemo laboratories separate electrophysiological laboratory separate pacemaker implantation laboratory,ICD, CRT implantations performed laboratories ablations in haemo laboratories MAZOWIECKI Medicover Hospital Warsaw 1 1 1 MAZOWIECKI Allenort Cardiology Centre Warsaw 1 1 1 MAZOWIECKI SENSOR CLINIQ HOSPITAL Warsaw 0 1 1 OPOLSKI Independent Public Healthcare Centre Regional Medical Centre in Opole 2 3 1 1 1 Opole - Hospital OPOLSKI Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy 0 1 Głuchołazy OPOLSKI American Heart of Poland, Cardiovascular Centre of Nysa Nysa 1 2 1 1 OPOLSKI American Heart of Poland, 4th Department of Invasive Cardiology, Kędzierzyn- 1 2 1 1 1 Electrostimulation and Angiology - Kędzierzyn Koźle Koźle OPOLSKI Kluczbork 1 OPOLSKI Provincial Hospital in Opole Opole 0 1 PODKARPACKI Jadwiga Królowa Provincial Hospital No. 2 in Rzeszów Rzeszów 2 2 1 1 1 1 PODKARPACKI INDEPENDENT PUBLIC COMPLEX OF HEALTHCARE FACILITIES Stalowa Wola 1 1 1 1 SPECIALIST COUNTY HOSPITAL PODKARPACKI ST. PADRE PIO PROVINCIAL HOSPITAL IN PRZEMYŚL PRZEMYŚL 2 2 1 1 PODKARPACKI Independent Public Healthcare Centre of the Ministry of Internal Rzeszów 1 1 Affairs in Rzeszów PODKARPACKI Saint Joseph’s Heart Centre Rzeszów 1 1 1 1 PODKARPACKI Cardiovascular Interventions Centre of Podkarpacie in Sanok Sanok 1 1 1 1 PODKARPACKI Invasive Cardiology, Electrotherapy and Angiology Centre in Krosno Krosno 1 1 1 PODKARPACKI American Heart of Poland, 5th Department of Invasive Cardiology Mielec 1 1 and Angiology - Mielec PODLASKI “PROCARDIA” Non-Public Healthcare Centre Augustów 1 1 1 1 PODLASKI Medical University of Bialystok Clinical Hospital Białystok 2 2 1 PODLASKI Jędrzej Śniadecki Independent Public Healthcare Centre Regional Białystok 1 1 1 1 Polyclinical Hospital in Białystok PODLASKI Cardinal Stefan Wyszyński Regional Hospital Łomża 1 1 1 1 PODLASKI Independent Public Healthcare Centre of the Ministry of Internal Białystok 1 1 1 1 Affairs in Białystok POMORSKI University Clinical Centre Gdańsk 3 3 1 1 POMORSKI Regional Specialist Hospital in Słupsk Słupsk 1 1 1 POMORSKI Saint Vincent’s Hospital in Gdynia Gdynia 1 1 1 POMORSKI SAINT ADALBERT’S GENERAL HOSPITAL GDAŃSK 1 1 1 1 POMORSKI Swissmed Vascular Hospital Gdańsk 1 1 difficulties in obtaining data POMORSKI Jan Karol Łukowicz Specialist Hospital in Chojnice Chojnice 1 1 1 POMORSKI Szpital Specjalistyczny w Kościerzynie spółka z ograniczoną Kościerzyna 2 2 1 odpowiedzialnością POMORSKI American Heart of Poland, Centre of Cardiology and Angiology in Sztum 1 1 1 Sztum POMORSKI Pomorskie Centra Kardiologiczne Non-Public Healthcare Centre - Starogard 1 1 Starogard Gdański Gdański POMORSKI Pomorskie Centra Kardiologiczne Non-Public Healthcare Centre - Wejherowo 1 1 Wejherowo POMORSKI Non-Public Healthcare Centre "Clinica Sopot" Sopot 1 1 1 1 ŚLĄSKI Independent Public Clinical Hospital No. 7 of the Silesian Medical Katowice 3 3 1 1 1 University in Katowice Prof. Leszek Giec Upper-Silesian Medical Centre ŚLĄSKI Silesian Center for Heart Diseases Zabrze 6 6 1 1 ŚLĄSKI Specialist Hospital in Zabrze Zabrze 1 1 1 ŚLĄSKI Regional Specialist Hospital No. 4 in Bytom Bytom 1 1 1 ŚLĄSKI American Heart of Poland, 3rd Department of Invasive Cardiology, Dąbrowa 1 1 1 Angiology and Electrocardiology Górnicza ŚLĄSKI American Heart of Poland, 2nd Department of Cardiology Bielsko-Biała 1 1 1
162
in haemo
NFZ Voivodeship Hospital City/town Branch
tables in haemo laboratories in(used haemo laboratories)* tables in haemo laboratories separate electrophysiological laboratory separate pacemaker implantation laboratory,ICD, CRT implantations performed laboratories ablations in haemo laboratories ŚLĄSKI Independent Public Healthcare Centre Provincial Specialist Hospital Rybnik 1 1 1 No. 3 in Rybnik ŚLĄSKI Non-Public Hospital Polonia Świata Healthcare Centre of Polska Gliwice 1 1 1 1 1 Grupa Medyczna ŚLĄSKI Saint Barbara’s Regional Specialist Hospital No. 5 in Sosnowiec Sosnowiec 1 1 1 1 ŚLĄSKI American Heart of Poland, 10th Department of Cardiology, Tychy 1 1 1 1 1 Electrophysiology and Electrostimulation ŚLĄSKI Tomasz Ludyga EuroMedic MEDICAL CENTER Hospital Katowice 1 1 1 1 ŚLĄSKI Blessed Virgin Mary’s Voivodeship Specialist Hospital in Częstochowa 1 1 1 1 Częstochowa ŚLĄSKI Non-Public Healthcare Centre MEDICAL CENTRE OF RACIBÓRZ Racibórz 1 1 1 ŚLĄSKI American Heart of Poland, 1st Department of Cardiology and Ustroń 1 1 1 Angiology ŚLĄSKI Non-Public Hospital Polonia Świata Healthcare Centre of Polska Gliwice 1 1 1 Grupa Medyczna ŚLĄSKI Non-Public Hospital Polonia Świata Healthcare Centre of Polska Gliwice 1 1 1 Grupa Medyczna ŚLĄSKI American Heart of Poland, 15th Department of Cardiology in Myszków 1 1 Myszków ŚWIĘTOKRZYSKI Regional Polyclinical Hospital in Kielce Kielce 2 2 1 1 ŚWIĘTOKRZYSKI Holy Spirit Specialist Hospital in Sandomierz Sandomierz 1 1 ŚWIĘTOKRZYSKI Saint Luke's Specialist Hospital Końskie 1 1 ŚWIĘTOKRZYSKI County Public Healthcare Centre STARACHOWIC 1 1 1 1 E ŚWIĘTOKRZYSKI American Heart of Poland, Wadiusza Kiesz Centre of Cardiology and Starachowice 1 1 1 Angiology ŚWIĘTOKRZYSKI Invasive Cardiology, Electrotherapy and Angiology Centre in Pińczów 1 1 1 1 Pińczów ŚWIĘTOKRZYSKI Invasive Cardiology, Electrotherapy and Angiology Centre in Ostrowiec 1 1 1 1 Ostrowiec Świętokrzyski Świętokrzyski WARMIŃSKO- REGIONAL SPECIALIST HOSPITAL IN OLSZTYN Olsztyn 2 2 1 1 MAZURSKI WARMIŃSKO- REGIONLA POLYCLINICAL HOSPITAL IN ELBLĄG Elbląg 2 2 1 1 MAZURSKI WARMIŃSKO- Allenort Cardiology Centre Ełk 2 2 1 MAZURSKI WARMIŃSKO- Allenort Cardiology Centre Iława 1 1 MAZURSKI WARMIŃSKO- Pomorskie Centra Kardiologiczne Non-Public Healthcare Centre - Mrągowo 1 1 MAZURSKI Mrągowo WIELKOPOLSKI REHABILITATION-CARDIOLOGY HOSPITAL IN KOWANÓWKO Oborniki 1 1 1 Kowanówko WIELKOPOLSKI Karol Marcinkowski University Hospital of Lord’s Transfiguration in Poznań-Stare 2 2 1 1 Poznań Miasto WIELKOPOLSKI Provincial Hospital in Poznań Poznań 1 2 1 WIELKOPOLSKI J. Struś City Hospital Poznań 2 2 1 1 WIELKOPOLSKI Non-Public Healthcare Centre "Szpital w Puszczykowie im. prof. Puszczykowo 1 1 1 Stefana Tytusa Dąbrowskiego” - Hospital wards WIELKOPOLSKI Ludwik Perzyna Regional Polyclinical Hospital in Kalisz - Inpatient Kalisz 2 2 1 1 Healthcare WIELKOPOLSKI STANISŁAW STASZIC SPECIALIST HOSPITAL IN PIŁA Piła 1 1 1 WIELKOPOLSKI Regional Polyclinical Hospital in Konin Konin 1 1 1 WIELKOPOLSKI "Pleszewskie Centrum Medyczne w Pleszewie" Spółka z Pleszew 1 1 1 ograniczoną odpowiedzialnością WIELKOPOLSKI Heliodor Święcicki Clinical Hospital at the Karol Marcinkowski Poznań 1 2 1 1 Medical University in Poznań
163
in haemo
NFZ Voivodeship Hospital City/town Branch
tables in haemo laboratories in(used haemo laboratories)* tables in haemo laboratories separate electrophysiological laboratory separate pacemaker implantation laboratory,ICD, CRT implantations performed laboratories ablations in haemo laboratories WIELKOPOLSKI Complex of Healthcare Facilities in Ostrów Wielkopolski Ostrów 1 1 1 Wielkopolski WIELKOPOLSKI Centrum Medyczne HCP - Inpatient treatment Poznań-Wilda 1 1 1 1 WIELKOPOLSKI Complex of Healthcare Facilities in Gniezno Gniezno 1 1 1 WIELKOPOLSKI Non-Public Invasive Cardiology Centre Leszno 1 1 1 1 ZACHODNIOPOMO Independent Public Regional Polyclinical Hospital Szczecin 1 1 1 1 RSKI ZACHODNIOPOMO Independent Public Clinical Hospital No. 2 of Pomeranian Medical Szczecin 2 2 1 1 RSKI University in Szczecin ZACHODNIOPOMO Nicolaus Copernicus Regional Hospital in Koszalin Koszalin 1 1 1 1 RSKI ZACHODNIOPOMO CARDIOVASCULAR CENTRE DRAWSKO 1 1 RSKI POMORSKIE ZACHODNIOPOMO Allenort Cardiology Centre Szczecinek 1 1 1 RSKI
Source: data provided by prof. dr hab. n. med. Jarosław Kaźmierczak, National Consultant, adjusted by the data provided by regional councils
164