The role of patient education in heart failure management. Episode 62

Monika Rachtan
Hi, I would like to welcome you to another episode of the Po Pierwsze Pacjent (First Patient) programme. It turns out that in Poland, one million 200,000 people suffer from heart failure, and it is for these patients, but not only for them, as I think there is a cardio line for anyone who would like to talk about cardiological problems. Today, I will be talking to Professor Agnieszka Pawlak. A warm welcome to you. Professor.

Agnieszka Pawlak
A very warm welcome to you.

Monika Rachtan
Professor, I said that cardiology was created. It is such a place where patients can get information about their disease. But I would like to start by asking, how do you assess the knowledge of patients who have heart disease in general? When we get sick, do we know the answers to the kind of important questions that will determine later how this disease of ours will be modified.

Agnieszka Pawlak
Fortunately, more and more patients are aware that education is very important and knowledge of cardiac problems is important. But I have to say with great regret that the vast majority are patients who do not have this knowledge. And also I have the feeling that they do not strive too much to complete it in many places. Therefore, it seems to us that educating patients, but actually talking about medical problems in general in a broader context with patients, not just with patients, is justified. Because today we are a little bit of such a world, where we think that reading given medical information written by anyone, not verified by experts, is already a proof that it is reliable knowledge, and it is not so. So I think we need to educate ourselves, but we also need to look at where we get this information from and how this knowledge is passed on to us, and I think that this programme, the Po Pierwsze Pacjent (First Patient) meeting, with experts invited by the editor, is such a place for reliable information about health, let's say about health in general.

Monika Rachtan
This is why we decided to create this programme, not to use the language of influencers, not the face of a journalist to talk about health problems, but to invite experts who actually have the substantive knowledge and are in fact the only people authorised to pass on this medical knowledge to the public. Because we today on the internet, on Instagram tic tock, in many other places, are not even able to verify whether someone who claims to be a doctor actually is one. So here proven names, experts who sit in the biggest scientific societies in Poland. Thanks to this, we have a guarantee that this information is reliable and that this misinformation is not spreading as significantly as it is currently on the Internet.

Agnieszka Pawlak
So you already know that the information will be reliable today.

Monika Rachtan
Yes, that's right, that's right. Professor, and does the patient who is reading receive a discharge? He was diagnosed with heart failure, he was hospitalised. He receives a discharge from a doctor. Of course, he has the opportunity to talk to this doctor during discharge, but we know how it is. There's a lot of stress, the patient wants to go home, when he comes back and reads all these recommendations, is he able to understand them? What are your experiences?

Agnieszka Pawlak
I, for one, would like to thank you for inviting me. I should start with this, because the fact that I am here shows that we need to talk about cardiology patients and, in particular, about heart failure patients. We know that we have about one million 200 of them in Poland, and we know that these are patients who are at risk of a particularly poor prognosis. These are patients whose prognosis is often worse than that of oncology patients, but we do not want to compare this. And we also know how important it is for precisely this group of patients to be aware of their disease and its management. And it is precisely broadcasts such as this that are intended to broaden the general knowledge in society of both healthy people, who by their lifestyle can delay the onset of the disease or prevent it altogether. Let's say that heart failure is a disease that occurs in people who originally have, for example, hypertension. Who have diabetes, who have atrial fibrillation, who are overweight. See, these are the disease entities that we have around us and we all feel absolved that if I have such a disease entity, I will somehow cure it, but it is not somehow cured. Today our goal should be and we have these tools. And it is insanely important that we have such tools, that we should control them very well. I shouldn't be happy today that I have hypertension and I'm trying to control it, but I'm 150 over 95.

Monika Rachtan
So what does that mean? That it is me doing something wrong, that I am living the wrong way, that I am eating the wrong way? However, in such a situation, as you mentioned, should one actually go back to this doctor and work on modifying the therapy? Or perhaps also look at whether, for example, he is taking the medication prescribed by his doctor on a daily basis, or. Well.

Agnieszka Pawlak
I think this is also the place to start, yes? That is, before there is medication, I think two things are extremely important, especially today, and that is the issue of physical activity and stress reduction. Of course, it is very easy to say stress reduction, but it is important that we realise that we are under enormous stress and that we try to combat it. Why am I talking about this? Because please see, we are getting fantastic our clinical studies that show that we are achieving further reductions in deaths. Meanwhile, if we look at the outcome of society as a whole, there is no reduction in the number of deaths of our patients.

Monika Rachtan
More people are dying from cardiovascular disease, cardiovascular disease and heart failure is a disease.

Agnieszka Pawlak
Dominant, dominant. This begs the question, what is it that is happening that we are eradicating supposedly our risk factors, but still cannot manage it well? This seems to be the way civilisation is. New factors are emerging, new factors, that is. I think today it is reduced activity that is the dominant thing. And the other huge stress. This enormous stress is an unbelievable factor in that we hit worse, we sleep worse, we rest worse. All this affects our metabolism, we get fat. Today we also have a new syndrome, the cardio-renal metabolic syndrome. It's as if we're coming up with some terms for observing what's happening among the public, among us today. And it's not a coincidence that at the American congress that year, the presence of such a syndrome was just announced, because we see that these patients, because we want to treat them no longer a patient, just obesity, not only with the heart, not only with the kidneys, but we have to look at it very holistically. But we said about stress and we said about physical activity. I encourage you very much. It is not just a step. Every step is another dose of medicine.We talk about it a lot today, but in the adverts that are in front of the main news, you don't see the information that you need to move, you just see that there are painkillers or medicines for indigestion or something else. You might not have to use them and take them if you, for example, at least have some activity, that also reduces stress. And this is extremely important today.

Monika Rachtan
Well, Mrs. Professor, because I was recently wondering, I was watching a debate, which, incidentally, was organised by the Polish Press Agency, and it was about diabetes, and the statement was made there that diabetes is such a nice disease to have, because we have so many different medicines that we can provide the patient with excellent care. I disagreed a little bit with this statement, because I think that the fact that we have medicines for obesity, the fact that we have medicines for diabetes, this is, of course, very important. We are happy that there is a therapeutic arsenal that can be offered to patients, but, in fact, if 20-, 30- and 40-year-olds had thought about their lifestyle and tried to change something, in many cases, we would not have diabetes at all. Because it is not as if diabetes came out of thin air or because we now have such food. We can choose our own food, and it is up to us whether we develop diabetes and, later on, heart failure. Because a patient who has diabetes and who continues not to take care of his or her health, who only takes medication, can be changed, modified, etc., etc., etc., is still in that group. He is the one who is still in that risk group of developing further diseases.

Agnieszka Pawlak
We know very well, ladies and gentlemen, that a 5-10 kg reduction in weight sometimes results in the patient no longer being diagnosed with diabetes, because sugar levels are regulated, and we also know that our hypertension and blood pressure parameters fall and the patient does not need to be diagnosed with hypertension. We are, of course, still debating hypertension, diabetes. And maybe it doesn't resonate, but I would like it to resonate today, that simple parameters like just that. Because we sometimes think well I'm not obese enough, I'm not very obese, then I have that absolution. There are more obese people, but every excessive pound is carrying around this little storehouse of poison that just poisons us. And it has a holistic effect on us, holistically. So it's insanely important that we look at every excessive, excessive kilogram as a thing that we don't need, that worsens our prognosis. And on the other hand, if we're already overweight, what could be the result of this high stress? Overeating. We have different reactions of reduced activity. That's what we're going to realise here, and let's look at where we want to go. Because if we want to aim at being a patient who will be lying in cardiology wards in a while, will have heart failure and will suffer instead of enjoying life. Because I see many such patients. They say to me, Doctor, if I had known that I was going to have such shortness of breath, that I was going to feel so dramatically, why don't you take me back 20 years? I would function completely differently. I would look at it differently, but as I say to the patient please, today you still have a chance, that we can undo, that we can change things, but in twenty years it may be too late, Processes will have gone so far that we won't be able to undo some things. Perhaps medicine will go so far that we will be able to undo the processes of fibroids too. But for today, we can't do that. And it is worthwhile for us to take care of that. And it is worth fighting for all those factors that progress us to heart failure to be minimised. I see every day in my ward, what scares me is people who are really young 29-year-olds, 40-year-olds, 45-year-olds. And this is not, ladies and gentlemen, obesity. This is overweight. It's obesity that is huge.

Monika Rachtan
Professor, and I'll ask maybe this will be quite an unpopular question and if you don't even want to answer it, no problem. But we do talk a lot about weight reduction today, although with cardiovascular disease it seems to me that this is one of the most important topics to talk about. We today have such a great lightness in the use of different obesity treatments. Whether it is medication or bariatric surgery. Again, these are tools that are needed, but I myself observe people around me who have benefited from such treatment, who have undergone surgery, who have taken such tablets, and the moment they stop taking them, nothing changes. They just keep on coming, the yoyo effect, the 20 kilos they have managed to lose. They lose. Those 20 kilos come back to them again. And what's more, another 20 are added, because there is some strange effect that I cannot define. I haven't found information on why this happens, but it seems to me that these tools are probably too easy to access, because if the procedures are not followed, because with the pill medication it is said that the patient should first try for 6 months as recommended to change their eating habits and only then, if this is successful, can they stop the pill treatment and they should maintain these healthy eating habits. How does your professor look at this?

Agnieszka Pawlak
Well, this is just proof of our enormous conformism. We want everything to be easy, simple and pleasant, and we know that the most beautiful things are usually born in some hardship, however. We also need to remember that even if we take pills to slim us down, they only work on individual receptors and they may achieve some effects by blocking a pathway, but they don't really heal us holistically from this toxic effect of fat tissue, which affects the whole body and today we don't want to go to the trouble of practising walking, reducing. I even used to talk more about diet with patients wondering. Mediterranean diet such a diet different. Today I have gone down to a very simple level. Today I believe that the most important thing is for the patient to judge for himself the quantity of a given meal, the quantity seen, but so critically. He himself was an observer of his day and saw where he was snacking. Because it's actually our snacking. It is somewhere putting on a smaller portion, but adding three times. And on the other hand, it's the lack of that activity. That the whole philosophy of how we operate is a question with this civilisation that we have of too much calorie intake and not enough physical activity. And I think it will be a lot simpler if we stop putting together some diets that are a huge challenge and we know that they just can't work for us throughout our lives. We live for a period of time under stress that we want to lose weight. We watch and we don't even think so holistically about ourselves that we are treating ourselves with our reduction, our body weight. In fact, a lot of goodness We just look at that weight with trepidation, whether it's dropping or not dropping and we're under enormous stress. If it's dropping too slowly for us and we're making such dramatic sacrifices, it shouldn't be like that.

Monika Rachtan
In fact, the focus is on how we feel, on our own wellbeing.

Agnieszka Pawlak
It's supposed to be a process that goes slowly but very consciously, because also these fluctuations in weight. See what the editor said about first losing weight and then suddenly gaining weight. They are even more dangerous for us. So it is important that we simply consider how much I can afford today. When it comes to cutting down on food, maybe it's not worth throwing in today that I'll stop eating at all and lose 10 kilos? It's just that I always say to my patients please review and start with what will be easiest for you to reduce. So, if you look at yourself honestly for these 2 or 3 days and you realise that you have sweets and biscuits all over the place, which you simply snack on as you pass by, why not impose some kind of rigour of not eating lunches, dinners or breakfasts? Just maybe it is worth reducing these snacking, these places that stand and tempt us.

Monika Rachtan
And when such a patient responds that these are her little pleasures?

Agnieszka Pawlak
I can honestly say, as we're already talking about the cardiovascular aspects and they see what's going on and we start talking about that very thing, seriously. There's no discussion that you have to have a radical diet now because you need to lose weight. It's just trying to show how important it is to take care of yourself and where we want to go with this whole thing. It makes me happy to say that a lot of patients say well yes, I don't need to do a revolution in my life. I can change something that costs me the least amount of money today and if it's fixed for me. And I know that we have systems for perpetuating certain behaviours not at all. A long 30 days, 21 days to enter 1 then another year will come and that's when it's time for the next step.

Monika Rachtan
It is a bit of an encouragement. I have succeeded in something, I have had success, so I can dare to reach for more. And it's not that significant in our everyday life, we may not even notice it. I think it is, but I also think that the person of the cardiologist creates a bit of fear in the patient. Because when a GP tells us that we should reduce our body weight, it is. Doctor, and you should also reduce your body weight. Often doctors say that patients respond in this way, or simply this information falls into one ear and out the other, and unfortunately there are no results. On the other hand, the moment one visits the cardiologist's office, it means that something is already happening. It means that there is already this shortness of breath, it means that I am already feeling unwell. It means there's some prospect of it possibly ending in a heart attack. And the moment I sit down in front of the cardiologist, it gets serious. I think that's the power.

Agnieszka Pawlak
I think it could do that. But if it was the case that before the cardiologist, before the thought of just being a cardiologist was meeting and I would have another one. Another complication then there would be a lot of thin people in our society, and unfortunately that is not the case. And unfortunately it is also the case that a penny of cardiology patients are still obese despite their many experiences.

Monika Rachtan
This is a significant problem, as it makes their prognosis even worse.

Agnieszka Pawlak
It makes their prognosis worse, But I think it's also just that kind of horror that they would have to change, revolutionise everything here. And it seems to me that they don't. We just have to approach it with calmness, with a sense of just treating ourselves responsibly like that. Good. I deserve that. And that it's not some kind of punishment, it's just this tiny gift that I'm giving myself.

Monika Rachtan
Let's go back to heart failure and the cardioline, because this is a new tool of the Polish Cardiac Society, in fact the heart failure association, which has been launched for patients. What is the cardioline?

Agnieszka Pawlak
CardioLinia is our shortened name, which I think sounds very good and is catchy, but it refers to the idea that we called the Heart Failure Patient Education and Support Centre, because it is mainly dedicated to this patient population. And where did it come from? Here at the beginning we talked about the fact that we have such a large patient group. We also know that this group of patients very often ends up in hospital. What's more, this is a group of patients, We also said at very high risk of death.

Monika Rachtan
That is, these patients are very often hospitalised again after diagnosis as a result of some complication.

Agnieszka Pawlak
And that is what you said very well about some complications. This most common complication, which results in the patient ending up in hospital again, is unfortunately conductivity.

Monika Rachtan
What is it about?

Agnieszka Pawlak
What is conduction and how important it is, and how simple it is, that with such an incapable heart, fluid is retained in our body and we reduce this fluid by administering diuretics, But of course in some patients this fluid is accumulated faster and in some slower. And the whole art of the heart failure patient is that he will be able to observe this. And please see it is nothing so difficult that we observe that my legs are swelling. I observe that I have shortness of breath or that my abdominal girth is increasing. These are the kinds of things that will then affect that I have shorter breath, I get more tired, but I have to observe it. And as I observe it, I should know what I should do next. Sometimes still, to finish this moment of evaluation, we support, to show it somehow numerically, or to have such evidence for ourselves, that is the patient also for himself with the fact that we, for example, take daily measurements, weight measurements. Because in the beginning, as this fluid accumulates, we may not fully see it.

Agnieszka Pawlak
So this weight is very important. In the same condition, that is with or without pyjamas. A heart failure patient should weigh themselves in the morning and know that this weight should be stable. If it suddenly increases by 2 3 kilos in 2 3 days, it means that something is happening to our body in our failure and we should be vigilant. Even more so, observe these changes, are we not getting swollen, is our breathing getting shorter? Is my abdominal circumference not increasing? Because then I know what to do. And the patient has this tool with him, because the heart failure patient usually has a diuretic and he should not be afraid to increase the dose of the diet medication. The patient can do, and even should do. These are the European guidelines that the patient may not have to modify other medications, but the diuretic treatment is his defence and it is his tool that is assigned to him and he has the possibility of such an increase. That is, he gives himself an ethical drug and observes that it subsides, he increases the dose. Please see this is very simple, isn't it? And it's a wonder that we don't do it. Because if we don't give ourselves an increased dose of medication, sooner or later the patient will end up in hospital after all. Because for some people it takes two weeks, for some people it takes two months for their legs not to fit into their shoes, because more often than not that is the intervention factor. Such an alarming one and the patient ends up in hospital. But in a situation where we take this simple medication. Whether it's furosemide or whether it's torasemide then we can delay our hospitalisation. Meaning we can prevent it and give ourselves time in a situation where we are not getting better? In some way completely radical, it doesn't go away completely. Give ourselves time to get to a cardiologist, to an internist, to a primary care physician.

Monika Rachtan
Because this is where any doctor can help us intervene. Not necessarily the cardiology hospital where we previously lay, where we previously received treatment, or the internal medicine department.

Agnieszka Pawlak
What's more. What's more, we today have coordinated care for heart failure in the county. Accordingly, the primary care physician has the option to send for an ECHO test for the assessment of NT-proBNP, a marker such as this, which is indicative of myocardial damage. He or she also has the option to make a referral for a holter. All of this is huge. Hard work. Professor Mastalerz-Migas, who is very active in this aspect, well it's our heart failure patients who benefit. And I think that's another thing, so that we just benefit from it.

Monika Rachtan
And is a patient who actually notices this increased amount of water in his body and is supposed to modify his treatment supposed to increase these diuretics? Then by how much should he increase them? If, let's assume he takes one tablet, he should take one and a half. How should this be done?

Agnieszka Pawlak
Patients usually know how this dehydration worked for them. Did it require in a situation where there was a hospital patient on diuretic treatment, a very increased dose? But undoubtedly adding one tablet in a situation where we saw that we were increasing that weight and we had swelling. Adding one tablet and observing if it reduces our symptoms of swelling with that extra tablet. It's for that kind of verification and if they don't subside, they still persist, they're increasing, then maybe you need to add another one, or maybe you need to go to your primary care physician, your cardiologist or your internist to determine exactly that. But the idea is that we put the brakes on a certain process of such a dynamic build-up, and this keeps us out of hospital. We create such a safe time for ourselves to be able to intervene. And this is also very important to be able to assess ourselves. The first time it will be a very uncomfortable situation that it is me suddenly managing myself, But today we are setting ourselves up for patio centricity. Guest Today the patient is not a tool managed by the doctor. Today the patient must be able to manage himself and his illness. We want our patients to be educated. we want our patients to know how to act. These are not secret knowledge. Yes, of course we our aspect of patient support and treatment is much broader than diuretic treatment and we have many options, both pharmacological and non-pharmacological, so we are certainly needed by these patients. But that ability to manage just such an element as a diuretic is fundamental. If it turns out, for example, that such an added tablet to one already in use reduces these symptoms dramatically, then perhaps we only need to increase by half a tablet in the next period and we will have no more increase. It is also worth looking at why this happened to me.

Monika Rachtan
And what could be the reason?

Agnieszka Pawlak
The reason may be that the patient is not fully aware, although our patients are very educated, that we usually set this diuretic treatment for a certain volume of fluids that the patient takes And we say that the minimum volume of fluids that a person should drink is between one and a half and two litres, because all the metabolites are then in our body these toxic ones are able to excrete in the urine. And so we recommend this to our patients. If a patient forgets or is not aware of this and suddenly drinks three, and sometimes the patient says five litres, it may happen that these drugs are not given in this sufficient dose to maintain this dehydration effect. Well, there is also sometimes the issue of, for example, various family gatherings or other issues of taking some alcohol, sleepless nights, excessive amounts of the appearance of rhythm disturbances, because, for example, we were somewhere in hot rooms, we sweated, it is a question of where, where the sun operates and we can have electrolyte disturbances. Rhythm disturbances occur and eventually symptoms of exacerbation of heart failure appear. So that's also important for us to watch. Everything is for us, for our patients as well, but some things, like all of us, not just heart failure patients, some things just don't serve us. We are. Everyone is an individual, right? And that's something to pay attention to. And also there are such warm days ahead of us. We had very hot days on Sunday, which for normal, healthy people were also difficult to bear, even more so for patients, so maybe it's not a good idea to go out to some beach then, to be completely exposed, exposed to the sun. Maybe then it is a good idea to go into rooms that are a bit shaded or air-conditioned, because the issue is vasodilation, expansion of pressure drops. You take a lot of medication.

Monika Rachtan
Even for the healthy on these hot days, it feels very uncomfortable, especially cardiac patients. I think that here, however, staying cool, in a cool place, because not in the cold is extremely important. A cardiac patient who suffers from heart failure. I hope he listens to us today and modifies this dose of medication for himself. Should he, after such a modification, contact his attending physician and inform him of this situation, or can he just stay on these medications and take them anyway, because he sees the effects, that everything is already fine.

Agnieszka Pawlak
Probably the first time a patient modifies it, they will probably have that anxiety about whether they've definitely done everything right and it's worth it to minimise our anxieties in life. So it's worth it if there's any uncertainty around that, let's ask the experts and the doctors, let's establish whether our actions are good, but I think he'll know perfectly well the next time. It's like we have, for example, when we have something that hurts, we know that we're supposed to take a painkiller, or that we're supposed to use some techniques that could relieve us of that pain? And that I think is such a simple activity that the patient will have that sense of being able to manage that. It's not some difficult thing. I don't want, it's not for patients to misunderstand me either, that I'm trivialising the issue because I've graduated, because I've seen a lot of patients, because I'm in contact every day. But the reality is that the patient with failure he lives and also has contact with it every day. And I understand that, that these things may come up in the beginning, but the sooner we understand that our own ability to manage something will give us more comfort in life. Because please see if something happens, even somewhere on holiday, when we go away and we know what to do about it, it's completely calmer to go through that holiday than with the thought like, my legs are going to swell up and what am I going to do now? Where am I going to find a doctor? Or will that doctor know what to do about it? In terms of my illness.

Monika Rachtan
I think many patients have this fear, especially cardiac patients. And also I wouldn't want to say here that all cardiology patients are elderly people, but heart failure patients are often elderly people who are all the more likely to have a certain fear, anxiety about the disease. Going back to the cardioline, you said it is an education centre for heart failure patients, but actually the cardioline is also a certain tool. It is simply a line, or a helpline, that a patient can call to get information related to your disease. Who provides this information to the patient?

Agnieszka Pawlak
These are, ladies and gentlemen, very professionally trained lady nurses, because at one time there was an education programme and it is on the website of the Polish Cardiac Society. Certification in heart failure for lady nurses. And we can boast in Poland of having 1,400 of you certified or certified ladies nurses in heart failure. It is not at all that easy. I, for one, would like to thank all of these ladies very much for their time, their willingness to educate themselves, to expand their horizons and their knowledge of heart failure and ultimately their professional ability to serve heart failure patients. Because this course is, first of all, time-consuming. There we have many educational hours. Each of the lessons there to do is punctuated at an unknown time with questions, so you can't let go and go do something else. At the end of each lesson there are questions that have to be answered. Therefore, based on what we have listened to. Well, and finally after a lot of these lessons there is a full exam that you have to pass. So it's not the kind of certification that someone fires up the first lesson and then comes to switch off the computer when the last one is over and has a certificate just it's very, very thorough and we're happy with that. But for you on this cardiology. We have made an effort that these are ladies who are so certified. We still did such a preparatory course, where we repeated and refreshed all these things, but also taught or trained in the techniques of proper communication, so that such communication is effective. It's insanely important that we know how to communicate in a way that we can understand. So that the knowledge we want to pass on is understandable to the patient, so that the patient can take it in properly, use it.

Monika Rachtan
So that it is not art for art's sake. What questions can patients call with? With heart failure? Well, is it just the patients or also their relatives? Can anyone call the cardiolines at all?

Agnieszka Pawlak
That is, any of us can call cardio. Others in aspect. Above all, we would like to see heart failure, but the cardiothoracic clinic has been set up not only for patients, but also for their families. We know what you said, that it is a question of there being older people. For them, sometimes it is this communication through some telephone links that is more difficult. It is more difficult to register. Consequently. Anyway, in many, many of these cases of elderly patients, it is indeed very beautifully cared for by the families and they want to have this full information. And now how does it work? You can go to the website cardiolinia.pl and there you will find the nurses who are presented. You can choose a nurse who works at the cardiotherapy clinic and they have a monthly schedule. You can choose the time when you would like to listen to such education, have it, ask questions. And then the patient is registered. We call back and this education is scheduled for 30 minutes. Then we try to finish it and we try to make sure that whatever questions the patient has come to us with. And they can vary. So that in each of these meetings we discuss just this monitoring of heart failure symptoms, management options, that is, dose modification, so that the patient every patient hears that. Because we hope that if that's the most common cause of hospitalisation, if we can do that, then we will reduce hospitalisation,

Monika Rachtan
In that first year after diagnosis very many patients end up on the ward these figures. I now frankly admit that I can't remember what the percentage was, but I think it was probably around 50%.

Agnieszka Pawlak
50% hits again. That is the first thing. The second thing, which is unfortunately infamous for us. We are still the highest ranked country among OECD countries, that is 34 countries in Europe and others, where this hospitalisation for heart failure is the highest. Unfortunately, this number has not fallen in recent times, but has increased even more, so this gap is widening.

Monika Rachtan
So this education is very important, very essential. I would also add that, from the information I have read on the website, you can also read it for yourself, but I think it is quite important that such a call is actually made at an arranged time, that it is the nurse who calls you and not the caller who calls you. So you have to remember to give a good number to yourself or to someone close to you and that the lady nurse is also calling from a restricted number so that you are not afraid and that you answer, because I know that older people, for example, are afraid to answer restricted numbers, so here you are calling from a restricted number. And I guess another important thing is that this is not a one-off advice, that you can probably make several appointments.

Agnieszka Pawlak
You can make several appointments. On this page, you will find other information relating precisely to lifestyle, symptoms of heart failure and the most frequently asked questions by patients. We have already provided the answers there so you can find them and read them for yourself, but we have also included, which I think is very important, this kind of information about how this visit will go and what we would ask for. So we usually also ask that the patient is prepared for the visit. If they've been hospitalised, that they have a card, a discharge card with them or a history of their past or their illness. Because it will be easier for us to talk, more precise, and the time will be better used.

Monika Rachtan
It is very important that the patient is prepared. I would add that there are also such beautiful guides to heart failure on the website, which you can use. These are very good materials, because they were prepared by the Polish Cardiac Society, so we can be sure that they are reliable.

Agnieszka Pawlak
And, of course, the companies that prepared it. Here we have these educational programmes by Novartis and we thank them for the opportunity to make them available and they are brilliantly done, so the patient can just use this for their own good.

Monika Rachtan
Dear Sirs Heart failure is a disease that needs to be managed and in some situations the patient can do this too. We warmly invite you to do so. If you are in doubt, please use the cardio line www.Cardiolinia.pl. There you can register for an appointment with a lady, a telephone, a nurse, to get all the information you need. Thank you very much for your attention. My guest, but above all your guest, was Professor Agnieszka Pawlak. Thank you very much, Professor.

Agnieszka Pawlak
Thank you very much. It was a great pleasure for me. Thank you very much.

Monika Rachtan
Thank you very much. This was the programme First Patient. My name is Monika Rachtan and I invite you to subscribe to my channel. See you there!