Prof. Anna Tomaszuk: "We don't treat research results - we treat living people"

- This is over 30%, or even well over 30% of all deaths - reminds Prof. Anna Tomaszuk from the Clinic of Cardiology, Lipidology and Internal Medicine with the Department of Intensive Cardiac Supervision at the Medical University of Białystok.

Prof. Anna Tomaszuk: That's a very pertinent question, and the answer is simple: cardiovascular disease remains the most dangerous adversary in Polish medicine – both in terms of deaths, morbidity, and daily clinical practice. One in three Poles dies from heart disease. That's over 30%, even well over 30%, of all deaths in Poland. This percentage is very high.

If we added up deaths caused by cancer, chronic obstructive pulmonary disease, and diabetes, only then would this number balance out deaths resulting from heart disease. This shows that heart disease is indeed the most common cause of death in Poland and a serious health problem.

AT: The literature and observations from everyday clinical practice indicate that we still have insufficient levels of heart disease prevention. A good example is the LDL cholesterol level in Poles – as many as 70–80% of patients have poorly controlled LDL cholesterol levels. This means we are not achieving target values.

A similar situation applies to blood pressure – only one in four patients has well-controlled hypertension. It is estimated that prevention and education, both at the primary care and specialist levels, are still insufficient.

In hospitals, however, we are seeing a significant increase in hospitalizations due to heart failure. We also cannot forget the effects of long COVID, the health debt the pandemic has left in cardiology. At that time, neither patients nor patients paid adequate attention to diseases other than COVID-19. This continues to have consequences.

AT: Of course. Above all, it's about better patient education, improved adherence to medical recommendations, and support for patients in changing their lifestyles. There are also specific preventive programs, such as Prevention 40+ and the National Cardiovascular Disease Program for 2022–2032, which offer hope that the situation can change for the better.

AT: I think that the primary change has been the presentation of heart attacks and their treatment. Today, we have faster diagnosis and very rapid intervention – access to coronary angiography and widely used coronary angioplasty. This undoubtedly translates into better patient prognoses. There's no doubt about that now.

We, as doctors, are better able to detect heart attacks, including those with atypical patterns, because we simply know and have more skills than we did a decade or two ago. We also have more effective, more individualized pharmacological treatment because we have access to precise, effective medications.

I am thinking of drugs such as ticagrelor, prasugrel, high-intensity statins, flozins or GLP-1 analogues in patients after a heart attack with heart failure or diabetes.

The patient himself has also changed. We're increasingly seeing older people with multiple health conditions—hypertension, diabetes, obesity, and chronic kidney disease. Unfortunately, we're also seeing a negative trend: more and more heart attacks among younger people. This is usually related to high stress levels, metabolic syndrome, and a sedentary lifestyle.

On the other hand, it must be admitted that patients – citizens of our country – are now better educated and more aware of the symptoms of a heart attack. They seek help more quickly than they did 15 years ago. Overall awareness and response times have significantly improved.

Patients themselves have also changed in terms of their expectations. Today, heart attack patients expect to return to work and normal life very quickly. They are increasingly reluctant to accept their illness; they want to regain full mobility as quickly as possible. They also often need psychological support, which, unfortunately, is still lacking in our healthcare system. We now see many people experiencing depression and anxiety after a heart attack.

The modern patient is more aware and better educated, but also has greater demands and expectations regarding treatment and the healing process.

AT: That's an interesting question. I think that for me, as a physician, this work has profound meaning because we don't treat test results—we treat living people with their health histories. We see not only the patient but often their family as well. We have people in front of us who discuss things, ask questions, have doubts and fears, but also great hopes—that they will regain their health, that they will live long. A simple, humane, empathetic approach protects us physicians from burnout and from falling into a routine.

Modern medicine, based on procedures and extensive diagnostic imaging, can indeed be dehumanizing, but patients still need relationships, understanding, and empathy. A doctor provides them with a sense of security. Sometimes a good, honest, and open conversation can be incredibly helpful in treatment.

I'd like to emphasize that it's not just the doctor who plays an important role here. We have the privilege of working in teams – with nurses, technicians, and medical assistants. This gives us a sense of stability and provides patients with comprehensive care.

Cardiology as a field offers immense satisfaction. We have a real impact on people's health and lives. It's certainly a great responsibility and burden, but also a source of immense satisfaction. We're not just there to provide technical information—what to do, where to go, what tests to perform. We also provide support, authority, filtering what patients have read online, which often raises doubts and fears. Patients entrust us with their health and lives.

That's why I believe that only close collaboration with the patient and their family can lead to success. We've long since moved away from a paternalistic approach to patients. Today, the patient is the center of attention, and all decisions are made together. People want to receive reliable information and understand what's happening with their health. And in such an honest, collaborative doctor-patient relationship, doctors can also find satisfaction in their work.