The Spectrum of Pediatric Cardiac Procedures and Their Outcomes: A six-month Report from the Largest Cardiac Facility in Sindh, Pakistan

Khokhar, Rajab A; Gowa, Murtaza Ali; Bangash, Sohail Khan; Tahir, Amber

doi:10.7759/cureus.5339

Cited by 16 publications

(17 citation statements)

References 14 publications

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“… 19 Pakistan is the second largest country (224 million) in south Asia but has only four facilities with a few specialists in CHD. 20 Nigeria, the most populous country in Africa (215 million), has only 13 centres performing congenital heart surgeries, with an annual volume of only 21 cases per centre. 21 The association between malnourishment and surgical mortality for CHD may also contribute to the limited progress in low-income settings.…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study

et al. 2022

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Background Congenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.Methods Cause-specific CHD mortality estimates were derived from the Global Burden of Disease 2019 study. We utilised an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0 to 4 to 65−69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period, and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care.Findings CHD is the leading cause of deaths from non-communicable diseases (NCDs) in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval 177,000−262,000). There were 129 countries with at least 50 deaths. India, China, Pakistan, and Nigeria had the highest mortality, accounting for 39.7% of deaths globally. Between 1990 and 2019, the net drift of CHD mortality ranged from −2.41% per year (95% confidence interval [CI] −2.55, −2.67) in high Socio-demographic Index (SDI) countries to −0.62% per year (95% CI: −0.82, −0.42) in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from paediatric to adult populations, except for an increasing trend of mortality in those aged 10−34 years in Mexico and Pakistan. During the past 30 years, favourable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = −4.0% [95% CI −4.8 to −3.1] per year) and the United States (−2.3% [−2.5 to −2.0]), and also in many middle-SDI countries like Brazil (−2.7% [−3.1 to 2.4]) and South Africa (−2.5% [−3.2 to −1.8]). However, 52 of 129 countries had either increasing trends (net drifts ≥0.0%) or stagnated reductions (≥−0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger

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Section: Discussionmentioning

confidence: 99%

Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study

et al. 2022

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“…National Institute of Cardiovascular Diseases (NICVD) in Karachi, the largest cardiac facility in Sindh, performed a slightly lower number (537) of procedures in 6 months. Previously this same hospital had reported 1,004 surgeries in two years (October 2013 to September 2015) [15]. This tertiary care hospital in Peshawar, a smaller city than Karachi, can account for fewer surgeries.…”

Section: Discussionmentioning

confidence: 96%

Effect of COVID-19 on the Cardiothoracic and Vascular Surgery Procedures Mix at a Tertiary Care Hospital

Ullah¹,

Hayat²,

Shakil³

et al. 2022

Cureus

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To assess the effect of the COVID-19 pandemic on the cardiothoracic and vascular surgery procedures volume at a tertiary care hospital. Materials & MethodsThis cross-sectional retrospective study was carried out at a tertiary care hospital's Cardiothoracic and Vascular Surgery department. All the four-year surgical procedures data were reviewed from August 2017 to August 2021. After extracting data from the hospital database software, a databank was generated in SPSS version 24.0. Average cases per month were calculated, and the data were stratified into three groups, Pre-COVID, COVID, and Post-COVID. Tables and charts were generated for the representation of data. ResultsThe total number of patients that underwent cardiovascular and thoracic procedures during the years 2017-2021 were 3,624, with male predominance (71.5%). Procedures were divided into Pre-COVID (68.5%), COVID (15.2%) and Post-COVID (16.3%) groups. Coronary Artery Bypass Grafting (CABG) was the most common procedure throughout the study duration (56.8%) and during the COVID-19 pandemic (29 procedures/month). Congenital Heart Surgeries (16.6%) and Valvular surgeries (11.5%) were next on the list. However, congenital heart surgeries were most affected during the pandemic (16 to 5 procedures/month). The average number of surgeries per month peaked at 2017 (135 procedures/month) and after that declined to its low of 46/month during the COVID-19 pandemic (The year 2020). ConclusionCardiothoracic and Vascular Surgeries have significantly decreased during the COVID-19 pandemic, especially the Coronary Artery Bypass (CABG) and Congenital Heart Surgeries. CABG procedures, however, remained the highest performed surgery even during the pandemic due to their emergent nature. Thoracic, vascular, and combined surgeries have stayed almost constant. The year 2020 (COVID-19 year) saw the lowest number of surgeries performed per month. An uprising trend in the number of surgical procedures is seen in the post-pandemic time (2021).

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“…Moreover, LMICs have a lower patient to physician ratios resulting in competing clinical demands, thus leaving inadequate time for quality research for the inundated physicians working in academic settings. For example, CHD prevalence in Pakistan is comparable to the United States, yet compared to the US there are < 5% pediatric cardiac care centers and < 1% of the pediatric cardiologists present in the country to manage overwhelming burden of disease ( 17 , 25 ). Similar trends are seen in many other LMICs i.e., 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries ( 26 ).…”

Section: Barriers To Evidence Generation In Lmicsmentioning

confidence: 99%

Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

et al. 2021

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Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

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The Spectrum of Pediatric Cardiac Procedures and Their Outcomes: A six-month Report from the Largest Cardiac Facility in Sindh, Pakistan

Cited by 16 publications

References 14 publications

Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study

Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study

Effect of COVID-19 on the Cardiothoracic and Vascular Surgery Procedures Mix at a Tertiary Care Hospital

Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change

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