Management of patients with pulmonary hypertension in the military state conditions: realities and problems

Abstract

Any military actions on the territory of any country can significantly influence on the quality of medical care. Especially, it could reflect on patients with rare diseases requiring expensive treatment. In this article there were analyzed the work of the specialized pulmonary hypertension (PH) center during the period of Russia’s military invasion in Ukraine and presented the results of the outpatient survey due to problems with patient access to medical care and medicine provision in the period from 24-Feb-2022 to 01-Jul-2024 (war period).
We selected patients with a diagnosis of PH carried out for the periods: since 01-Jan-2018 until 30-Apr-2020 (pre-war and pre-COVID-19 period) and since 22-Feb-2022 until 01-Jul-2024 (war period): n=328 and n=394 respectively. The selection was made from the electronic hospital database and the electronic registry of patients that have been conducted in the department since 2014. With the help of the Google Form system, a questionnaire was created and sent through modern devices of communication (Viber, Facebook) to fill out online to patients who are registered (applied for outpatient or inpatient care) in the department or are subscribers to the social network accounts of the Ukrainian Association of Patients with Pulmonary hypertension and/or the Lviv City Charitable Foundation «Sisters of Dalili». We got 220 responses. 
It was established that martial law status in the country did not significantly affect the management of patients with different forms of PH in the specialized center. The number of treated patients and performed right heart catheterization procedures increased by 20 and 22 % respectively during the «war period», compared to the «pre-war» period. 65 % of PH patients who came abroad due to the war used the help of the specialized department for direct referral to PH centers in Poland for further treatment, including surgical one. 41,7 % of respondents changed their place of residence during the war, but only 17,9 % had interruptions in taking of drugs for the PH treatment. Along with the usual sources of free medicines (humanitarian aid from charitable organizations, the government’s free medicines program), one in five patients «shared out» medicines with other patients. In 45 % of the patients who visited foreign PH centers, the therapy previously prescribed in Ukraine was changed to more effective or safer drugs that are not registered in Ukraine.