Adult and Paediatric Cardiac Intervention in Timor-Leste: Disease Burden, Demographics and Clinical Outcomes

Paratz, E.; Mock, Nicki; Cochrane, Andrew; Harper, Richard W.; Larobina, Marco; Wilson, William; Appelbe, Alan; Eggleton, S.; Kushwaha, Virag; Almeida, Inez T. da Silva; Monteiro, André; Bayley, Noel

doi:10.1016/j.hlc.2019.10.008

Cited by 2 publications

(5 citation statements)

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“…At the onset of the pandemic, there was high concern among ETHF staff that our patient base would be at uniquely high risk given their pre‐existing cardiac pathology. Additionally, delays in their progression to interventions could increase mortality even if they did not contract COVID‐19: the typical Timorese patient with cardiac disease warranting intervention experienced a median wait time of 5 months pre‐pandemic 2 …”

Section: Discussionmentioning

confidence: 99%

“…The major frustration consistently reported by clinicians involved in the telehealth clinics is the lack of definitive intervention for young patients with symptomatic severe cardiac disease amenable to cardiac intervention or surgery. The experience of talking to young patients without capacity to arrange emergent cardiac intervention is asymmetric with the usual ETHF clinic experience, where over 100 cardiac procedures and surgeries have previously been arranged for patients in Australia 2 . With the ongoing closure of international borders and requirement for quarantine in both countries, it is not possible to bring patients to Australia.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, delays in their progression to interventions could increase mortality even if they did not contract COVID-19: the typical Timorese patient with cardiac disease warranting intervention experienced a median wait time of 5 months pre-pandemic. 2 To date, there have been areas of success. Timor-Leste has managed their COVID-19 protection very effectively with only 10 000 cases as of August 2021.…”

Section: Success and Shortfall In A Time Of Major Disruptionmentioning

confidence: 99%

“…The experience of talking to young patients without capacity to arrange emergent cardiac intervention is asymmetric with the usual ETHF clinic experience, where over 100 cardiac procedures and surgeries have previously been arranged for patients in Australia. 2 With the ongoing closure of international borders and requirement for quarantine in both countries, it is not possible to bring patients to Australia.…”

Section: Is a Telehealth Clinic Useful If Intervention Is Not Possible?mentioning

confidence: 99%

“…The East Timor Hearts Fund (ETHF) is a non‐governmental organisation operating from Australia to assist the cardiac needs of Timor‐Leste. It was created in 2010, and its cardiologists have reviewed more than 2000 patients, 1 with almost 100 cardiac procedures performed 2 . As Timor‐Leste is a low middle income country (LMIC) without in‐country capacity for cardiac interventional procedures or surgery, ETHF plays an important role in the country's health infrastructure.…”

Section: Introductionmentioning

confidence: 99%

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Telemedicine to Timor‐Leste: implementing an international cardiac telehealth service during population dislocation, floods and COVID‐19

Paratz

Mock²,

Marques³

et al. 2022

Internal Medicine Journal

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Background The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor‐Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID‐19 pandemic, development of collaborative telehealth services was required. Methods Scoping discussions identified major challenges (structural, patient‐related and medical system‐related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face‐to‐face clinic in February 2019. Post‐clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic,there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili‐based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6‐minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post‐clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion Our pilot telehealth clinics indicate that capacity‐building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor‐Leste have a significant burden of disease amenable to intervention. This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Success and Shortfall In A Time Of Major Disruptionmentioning

confidence: 99%

Section: Is a Telehealth Clinic Useful If Intervention Is Not Possible?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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