Cardiovascular diseases require not only timely diagnosis and effective treatment, but also constant care, which begins with the recognition of the risk and continues throughout all stages of the disease. The need for better prevention, coordination between medical specialists and support for patients was the leading topic of the patient session within the framework of the XIX National Congress of Cardiology, held in Sofia. The session was attended by representatives of the Association of Patients Active in Healthcare (APAZ), the Bulgarian Society of Cardiology, leading cardiologists and specialists engaged in the psychosocial aspects of chronic diseases.
„For APAZ, prevention should not be limited to information campaigns and one-time examinations. "It should be a constant and organized care, in which the patient knows what the risks are for his health, when and where to be examined and who is responsible for his follow-up," emphasized the deputy chairman of APAZ Nikolay Nedyalkov. The organization insists that institutions ensure earlier detection of cardiovascular risk, equal access to prevention and better coordination between specialists, especially for people with chronic diseases. Among the specific proposals of APAZ are changes to Regulation No. 9 and the National Framework Agreement, which would ensure better follow-up of patients with heart failure after discharge from hospital, including access to control examinations, tests and timely adaptation of therapy. On these issues, the organization works together with the Society of Cardiologists in Bulgaria. APAZ also insists that chronic kidney disease be included in the National Prevention Program 2026-2030, in order to improve early detection of risk and coordination between cardiologists, nephrologists and other specialists. In parallel with the institutional proposals, the organization develops patient education initiatives on high cholesterol, familial hypercholesterolemia, physical activity and healthy eating. The goal is for patients to receive timely help and a clear follow-up plan, instead of seeking a solution only after complications occur.
The need for better follow-up and treatment of patients with heart failure outside the hospital was among the main topics in the discussion with the participation of Prof. Dr. Ivan Gruev from the Bulgarian Cardiological Society, Assoc. Prof. Dr. Antonia Kisheva from UMHAL “St. Marina“ – Varna and Prof. Dr. Vasil Traykov from Acibadem City Clinic UMHAL Tokuda. The cardiologists discussed the proposal for the introduction of a specialized outpatient procedure that would ensure timely examinations, tests and adaptation of therapy, without the need for patients to be admitted to the hospital with each deterioration of their condition. Practical experience with outpatient treatment was also presented, in which suitable patients receive intravenous diuretics under medical supervision and are discharged home, with follow-up visits if necessary in the following days. Such a model could limit some of the avoidable hospitalizations and reduce the burden on both patients and their families, as well as on the health system. Participants raised the issue of insufficient access to control examinations, limitations in outpatient care and the need for better exchange of medical information, including through electronic health records. The general message of the discussion was that the treatment of heart failure should not become a series of hospitalizations, but a continuous and coordinated care that allows for timely intervention and a better quality of life for patients.
The absence of symptoms does not mean the absence of risk. This was one of the main messages in the presentation by Prof. Arman Postajian, dedicated to early prevention, arterial hypertension and high cholesterol. Prof. Postajian presented data from an international study published in the New England Journal of Medicine, according to which five main risk factors - high blood pressure, cholesterol disorders, diabetes, smoking and increased body mass index - explain approximately 57% of new cardiovascular diseases in women and 53% in men in the studied populations over a ten-year period. The specialist drew attention to the correct measurement of blood pressure and the importance of home monitoring. He emphasized that smartwatches can signal a possible problem, but do not replace measurement with a validated cuff device. Another important emphasis was high LDL cholesterol, in which the risk accumulates over the years, even when a person has no complaints. Patients with familial hypercholesterolemia and a hereditary predisposition to early cardiovascular diseases require special attention. The main message of the presentation was that prevention should begin before symptoms appear, with regular monitoring of basic health indicators, individual risk assessment and timely treatment.
Why do patients not always follow medical recommendations, even when they understand the risks to their health? The presentation by Alexander Milanov, a clinical social worker at the Center for Clinical Psychology, Psycho-Oncology and Psychosomatics at Acibadem City Clinic, Tokuda University Hospital, was dedicated to this question. Milanov presented the psychological mechanisms that influence the acceptance of the diagnosis, adherence to treatment and changes in daily habits. Referring to various models, he explained how personal perceptions of the disease, fear of medications and a sense of control over one's own health can determine the patient's behavior. Irregular medication intake and postponing necessary changes are not always a sign of irresponsibility. Behind them are often fear, internal hesitation, previous unsuccessful attempts or difficulties in everyday life. Therefore, effective support requires understanding individual needs, not just giving medical instructions. Special attention was paid to the trust between the doctor and the patient, as well as the role of the family. According to Milanov, the patient should feel free to share his doubts and difficulties in treatment, without fear of accusation. Financial constraints, access to medical care and complex therapeutic regimens can also hinder adherence to therapy. “We do not fight the disease, we learn to adapt to it“ – with this message, Milanov emphasized that successful treatment requires not only medical solutions, but also psychological and social support that helps a person live fully with their chronic disease.
The patient session of the XIX National Congress of Cardiology united the medical, psychological and patient perspectives on the need for earlier prevention, better monitoring and support in chronic diseases. APAZ will continue to work with the medical community and institutions for specific changes that will improve access to prevention, outpatient treatment and coordinated care. The main message is that a good healthcare system not only treats complications, but also prevents them and supports the patient throughout the entire course of the disease.