Global Unmet Needs in Cardiac Surgery

Abstract

More than 6 billion people live outside industrialized countries and have insufficient access to cardiac surgery. Given the recently confirmed high prevailing mortality for rheumatic heart disease in many of these countries together with increasing numbers of patients needing interventions for lifestyle diseases due to an accelerating epidemiological transition, a significant need for cardiac surgery could be assumed. Yet, need estimates were largely based on extrapolated screening studies while true service levels remained unknown. A multi-author effort representing 16 high-, middle-, and low-income countries was undertaken to narrow the need assessment for cardiac surgery including rheumatic and lifestyle cardiac diseases as well as congenital heart disease on the basis of existing data deduction. Actual levels of cardiac surgery were determined in each of these countries on the basis of questionnaires, national databases, or annual reports of national societies. Need estimates range from 200 operations per million in low-income countries that are nonendemic for rheumatic heart disease to >1,000 operations per million in high-income countries representing the end of the epidemiological transition. Actually provided levels of cardiac surgery range from 0.5 per million in the assessed low- and lower-middle income countries (average 107 ± 113 per million; representing a population of 1.6 billion) to 500 in the upper-middle-income countries (average 270 ± 163 per million representing a population of 1.9 billion). By combining need estimates with the assessment of de facto provided levels of cardiac surgery, it emerged that a significant degree of underdelivery of often lifesaving open heart surgery does not only prevail in low-income countries but is also disturbingly high in middle-income countries.

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Affiliated Institutions

• Harefield Hospital GB
• Milpark Hospital ZA
• National University of Singapore SG
• Iran University of Medical Sciences IR
• Narayana Health IN
• University of Ilorin NG
• Wake Forest University US
• All India Institute of Medical Sciences IN
• Fu Wai Hospital CN
• Eduardo Mondlane University MZ
• Hospital of the University of Pennsylvania US
• Chinese Academy of Sciences CN
• National University Hospital SG
• Hospital Clínic de Barcelona ES
• Sefako Makgatho Health Sciences University ZA
• University of Cape Town ZA
• Shaheed Rajaei Cardiovascular Medical and Research Center IR
• University of Constantine 3
• Hospital de Messejana BR
• Imperial College London GB
• University of Freiburg DE
• University Frères Mentouri Constantine 1 DZ
• Johns Hopkins University US
• Universitat de Barcelona ES
• Chinese Academy of Medical Sciences & Peking Union Medical College CN
• University of Vermont US

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