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Rekhtman D, Bermudez F, Vervoort D, Kaze L, Patton-Bolman C, Swain J. A Global Systematic Review of Open Heart Valvular Surgery in Resource-Limited Settings. Ann Thorac Surg 2024; 117:652-660. [PMID: 37898373 DOI: 10.1016/j.athoracsur.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Many obstacles challenge the establishment and expansion of cardiac surgery in low- and middle-income countries, despite the unmet cardiac surgical needs. One challenge has been providing adequate follow-up care to monitor anticoagulation, manage morbidity, and prevent mortality. This systematic review describes outcomes after valvular cardiac surgery and focuses on strategies for prolonged follow-up care in resource-constrained settings. METHODS Studies published between 2012 and 2022 were collected from Embase and the Cochrane Library. Article inclusion criteria were adolescent and adult patients, open heart valvular surgery, and analysis of at least 1 postoperative outcome at least 30 days postoperatively. Studies that focused on pediatric patients, pregnant patients, transcatheter procedures, in-hospital outcomes, and nonvalvular surgical procedures were excluded. Descriptive statistics were assessed, and articles were summarized after abstract screening, full-text review, and data extraction. RESULTS Sixty-seven relevant publications were identified after screening. The most commonly studied regions were Asia (46%), Africa (36%), and Latin America (9%). Rheumatic heart disease was the most commonly studied valvular disease (70%). Reported outcomes included mortality, surgical reintervention, and thrombotic events. Follow-up duration ranged from 30 days to 144 months; 11 studies reported a follow-up length of 12 months. CONCLUSIONS Addressing the unmet cardiac care needs requires a multifaceted approach that leverages telemedicine technology, enhances medical infrastructure, and aligns advocacy efforts. Learning from the cost-effective establishment of cardiac surgery in low- and middle-income countries, we can apply past innovations to foster sustainable cardiac surgical capacity.
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Affiliation(s)
- David Rekhtman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Kaze
- Graduate School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom; Team Heart, Inc, Kigali, Rwanda
| | | | - JaBaris Swain
- Team Heart, Inc, Kigali, Rwanda; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Ilkjær C, Hoffmann T, Heiberg J, Hansen LS, Hjortdal VE. The effect of early follow-up after open cardiac surgery in a student clinic. SCAND CARDIOVASC J 2023; 57:2184861. [PMID: 36883910 DOI: 10.1080/14017431.2023.2184861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Objectives. Readmission rates following open cardiac surgery are high, affecting patients and the cost of care. This study aimed to investigate the effect of early additional follow-up after open cardiac surgery when 5th-year medical students conducted follow-ups under the supervision of physicians. The primary endpoint was unplanned cardiac-related readmissions within one year. The secondary outcomes were the detection of impending complications and health-related quality of life (HRQOL). Methods. Patients undergoing open cardiac surgery were prospectively included. For intervention, additional follow-up visits, including point-of-care ultrasound, were conducted by supervised 5th-year medical students on postoperative days 3, 14 and 25. Unplanned cardiac-related readmissions, including emergency department visits, were registered within the first year of surgery. Danish National Health Survey 2010 questionnaire was used for HRQOL. In standard follow-up, all patients were seen 4-6 weeks postoperative. Results. For data analysis, 100 of 124 patients in the intervention group and 319 of 335 patients in the control group were included. The 1-year unplanned readmission rates did not differ; 32% and 30% in the intervention and control groups, respectively (p = 0.71). After discharge, 1% of patients underwent pericardiocentesis. The additional follow-up initiated scheduled drainage, contrary to more unscheduled/acute drainages in the control group. Pleurocentesis was more common in the intervention group (17% (n = 17) vs 8% (n = 25), p = 0.01) and performed earlier. There was no difference between groups on HRQOL. Conclusion. Supervised student-led follow-up of newly cardiac-operated patients did not alter readmission rates or HRQOL but may detect complications earlier and initiate non-emergent treatment of complications.
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Affiliation(s)
- Christine Ilkjær
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben Hoffmann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johan Heiberg
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Laura Sommer Hansen
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Surgery, Aarhus University Hospital, Aarhus
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Abstract
PURPOSE OF REVIEW This review discusses current guidelines and evidence-based care for the preoperative optimization of patients who are undergoing coronary artery bypass grafting (CABG) and for enabling rapid discharge after surgery. RECENT FINDINGS Since the Enhanced Recovery After Cardiac Surgery Society (ERAS Cardiac) issued guidelines for perioperative care, in 2019, there has been a significant body of research that has added to and provided further guidance regarding preoperative optimization and accelerated recovery after CABG. SUMMARY A review of the current literature provides a framework for a pragmatic approach to preoperative optimization, utilizing the time from referral to surgery to mitigate multiple aspects of the patient condition, leading to improved patient outcomes and reduced length of stay and cost to the healthcare system.
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Affiliation(s)
| | - Rozen M Alex
- University of Ottawa Heart Institute, Division of Cardiac Rehabilitation and Prevention
- The Ottawa Hospital, Department of Psychology, Ottawa, Ontario, Canada
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Mols RE, Borregaard B, Løgstrup BB, Rasmussen TB, Thrysoee L, Thorup CB, Christensen AV, Ekholm O, Rasmussen AA, Eiskjær H, Risør BW, Berg SK. Patient-reported outcome is associated with health care costs in patients with ischaemic heart disease and arrhythmia. Eur J Cardiovasc Nurs 2023; 22:23-32. [PMID: 35543021 DOI: 10.1093/eurjcn/zvac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 01/14/2023]
Abstract
AIMS Systematic use of patient-reported outcomes (PROs) have the potential to improve quality of care and reduce costs of health care services. We aimed to describe whether PROs in patients diagnosed with heart disease are directly associated with health care costs. METHODS AND RESULTS A national cross-sectional survey including PROs at discharge from a heart centre with 1-year follow-up using data from national registers. We included patients with either ischaemic heart disease (IHD), arrhythmia, heart failure (HF), or valvular heart disease (VHD). The Hospital Anxiety and Depression Scale, the heart-specific quality of life, the EuroQol five-dimensional questionnaire, and the Edmonton Symptom Assessment Scale were used. The economic analysis was based on direct costs including primary, secondary health care, and medical treatment. Patient-reported outcomes were available from 13 463 eligible patients out of 25.241 [IHD (n = 7179), arrhythmia (n = 4322), HF (n = 987), or VHD (n = 975)]. Mean annual total direct costs in all patients were €23 228 (patients with IHD: €19 479, patients with arrhythmia: €21 076, patients with HF: €34 747, patients with VDH: €48 677). Hospitalizations contributed overall to the highest part of direct costs. For patients discharged with IHD or arrhythmia, symptoms of anxiety or depression, worst heart-specific quality of life or health status, and the highest symptom burden were associated with increased economic expenditure. We found no associations in patients with HF or VHD. CONCLUSION Patient-reported outcomes at discharge from a heart centre were associated with direct health care costs in patients with IHD and arrhythmia. REGISTRATION ClinicalTrials.gov: NCT01926145.
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Affiliation(s)
- Rikke E Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.,University of Southern, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark
| | - Brian B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Trine B Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1017 Copenhagen K, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.,University of Southern, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark
| | - Charlotte B Thorup
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Anne V Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Anne A Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Bettina W Risør
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Social and Health Services, DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
| | - Selina K Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
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Borregaard B, Sibilitz KL, Weiss MG, Ekholm O, Lykking EK, Nielsen SN, Riber LP, Dahl JS, Moller JE. Occurrence and predictors of pericardial effusion requiring invasive treatment following heart valve surgery. Open Heart 2022; 9:openhrt-2021-001880. [PMID: 35064056 PMCID: PMC8785202 DOI: 10.1136/openhrt-2021-001880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/04/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To describe the occurrence of significant pericardial effusion, and to investigate characteristics associated with pericardial effusion within three months following heart valve surgery. METHODS A retrospective, observational cohort study including adult patients undergoing heart valve surgery at Odense University Hospital from August 2013 to November 2017. Data were gathered from The Western Denmark Heart Registry and electronic patient records.Cox proportional hazard models were used to investigate the associations between characteristics associated with significant pericardial effusion during index admission and within 3 months. Results are presented as HR with 95% CI. RESULTS In total, 1460 patients were included (70% men, median age 71 years (IQR 63-76)) and of those, n=230 patients (16%) developed significant pericardial effusion.EuroScore II was significantly associated with an increased risk of pericardial effusion during index admission and associated with a lower risk following discharge (index admission HR 1.05, 95% CI 1.02 to 1.08, after discharge HR 0.80, 95% CI 0.69 to 0.92). Increasing age (HR 0.97, 95% CI 0.95 to 0.98 per year) and concomitant coronary artery bypass grafting versus isolated valve surgery (HR 0.58, 95% CI 0.35 to 0.97) were significantly associated with a reduced risk of pericardial effusions in both periods. Being a man (HR 2.30, 95% CI 1.32 to 4.01) and aortic valve disease versus mitral valve disease (HR 2.16, 95% CI 1.20 to 3.90) were significantly associated with an increased risk after discharge. CONCLUSION Significant pericardial effusions requiring drainage were present in 16% of cases following heart valve surgery, and different clinical characteristics were associated with the development of effusion.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark .,Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Marc Gjern Weiss
- Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Emilie Karense Lykking
- Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stine Nørris Nielsen
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Peter Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jordi Sanchez Dahl
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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