1. Transforming Bulgarian Acute Coronary Syndrome Strategy in 2 years Bulgarian Cardiac Institute Slaveyko Djambazov, MD Chief Executive Officer E: s.djambazov.hq@comleague.com Sinaia, September, 2009

3. Regional Variations in CV Mortality S.Djambazov, P.Widimsky et al. (pending World Cardiology Congress, China 2010) 1,42% 1,17% 0,94% 0,96% 0,90% 0,95% The relative risk of cardiovascular death is 27% higher in regions without tertiary cardiac care facilities when compared with regions having those

4. Trends in Cardiovascular Mortality source: NHIF 2007 *assumptions based on Czech registry Result: Extremely high absolute in-hospital ACS mortality – app. 15% source: NHIF, MoH, NSI 2007 168 TL/1mln 132 pPCI/1mln 700 STEMI/1mln* 3250 ACS/1mln*

7. UniCardio Clinic Pleven First STEMI pt The rest of Brno team followed that policy and it became main focus of the Bulgarian Cardiac Institute

8. Ferrari Widimsky Mauri Pezzano Grigorov Pleven Veliko Tarnovo BCI works closely with ESC

9. Procedures-Pleven-Oct 07-June 09 2008 2009 VT JM open Extension

10. Improvement of primary and secondary transportation – compensating the insufficient state system Fleet of 18 own ambulances for primary and secondary transportation Equipment for transportation of patients in cardiogenic shock, IABP, ventilation

11. BCI ambulances strategic positioning: 24/7 Coverage of app.80% of the territory and 65% of the population Next step: real-time ECG transfer via GSM network from ALL hospitals to BCI ambulances and BCI centers

13. Overall capacity of BCI 5 500 1 121 PCIs 1 300 296 pPCIs 45 14 Cardiologists 5 (36) 1 (4) International teams 23 3 Trainees in interventional cardiology 32 8 CCU beds 178 adj. 56 Cardiac hospital beds 21 000 6 377 Invasive procedures 140 000 60 000 Patients examned est. 2009 2008

14. Procedures-BCI-Oct `07-May `09 2008 2009 VT JM VN For that period more than 550(!) lectures were delivered across the country – own private budget

16. Further Expansion in place

17. International Cooperation

19. Overcoming difficulties Till 09.2007- STEMI- 585 1st year of work- STEMI- 764 ACS in-hospital mortality rate reduction in Pleven for 1 year- 30% Unrivalled network capacity and ACS treatment organization Source: T . Vekov , M . Grigorov , O.Hlinomaz, L.Groch, J.Sitar, M.Rezek, S . Djambazov , B.Kuzmanov, V.Hristov, Journal of Biomedical and Clinical Research , volume 1, number 1; Any secrets? call centres BCI gets same reimbursement as state hospitals

20. Stent for life Percentage of STEMI patients not treated by reperfusion (neither p-PCI, nor thrombolysis). Mean in-hospital mortality of all STEMI patients (including those not treated by reperfusion) in countries with p-PCI dominance and thrombolysis dominance Source: P.Widimsky et al; Reperfusion therapy for ST-elevation acute myocardial infarction in Europe (not published data)

23. Healthcare is never immune to saturation Our goal is to achieve 400 pPCI per 1 mln in 3 years Is BCI for profit organization? Thank you! and also to all my colleagues and friends from Czech Republic and BCI family of hospitals