Consensus recommendations for essential vascular care in low- and middle-income countries

Abstract

Introduction Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. Methods The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health, as well as with experience in LMIC healthcare. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. Results The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs (i.e. primary health centers, and first-level, referral, and tertiary hospitals). The recommendations include both essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. Conclusion The resources recommended have the potential to improve LMIC healthcare systems’ ability to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning pre- and inter-hospital transport system, and vascular training for both existing and future healthcare providers.

Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification

“…Furthermore, PAT only requires a vascular ultrasound machine that is typically present in most vascular laboratories worldwide, even among low- and middle-income countries. 9…”

Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group

“…Our findings that so many children with severe TBI are transported by private vehicle coupled with a low PH guideline adherence rate for those who were transported by ambulance are alarming given the urgent need of expedient vascular access and resuscitation treatments that these patients require. [17] While it is possible that critically injured children received better ambulance care than reported in this study, there are many children with severe TBI who are transported by private vehicle who do not have the opportunity to receive any early care. For more severely injured patients, the delay of a 5 hour transport time is well to develop EMS infrastructure, capacity building and PH educational strategies to provide high quality early pediatric TBI care are urgently needed.…”

Neutrophil Elastase-Derived Fibrin Degradation Products Indicate Presence of Abdominal Aortic Aneurysms and Correlate with Intraluminal Thrombus Volume

“…However, while global surgery has been the unrecognized field of global health, vascular surgery is the unrecognized field of global surgery. Vascular surgery is barely mentioned in the report by the Lancet commission and while prevalence of PAD is high and increasing, especially in LMICs, studies suggest that vascular procedures and amputations are performed infrequently and in some settings more often for trauma than for PAD (69,70).…”

“…These issues can be attacked from several different angles. In addition to crucial investments in surgical and anesthesiologic infrastructure and providers, increased capability of LMICs to diagnose and treat PAD would be required to meet future needs (69,70). With AAA specifically, improving the specificity and increasing the simplicity of diagnosis and surveillance algorithms, as well as the development of pharmaceutical agents to decrease the diameter growth rate and prevent rupture, would greatly lower the bar for adequate care in low-resource settings.…”

“…When the aneurysm reaches 50 mm in women and 55 mm in men, the patient is evaluated for EVAR or OAR, both of which are resource-demanding and associated with significant morbidity and mortality (299). The level of infrastructure, logistics and costs required to adequately follow present guidelines may prohibit treatment for many with a diagnosed or yet undiagnosed AAA (69,70). Further, even in a high-resource setting, some patients with small AAA will suffer from rupture despite being enrolled into surveillance (19,21,61,62).…”