The Namibian Children's Heart Project: a South-South partnership to provide cardiac care
The Namibian Children's Heart Project: a South-South partnership to provide cardiac care
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DOI：
10.1017/s1047951118002172
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发表时间：
2019-02-01
影响因子：
1
通讯作者：
Zuhlke, Liesl J.
中科院分区：
文献类型：
--
作者：
Shidhika, Fenny F.;Hugo-Hamman, Christopher T.;Zuhlke, Liesl J.
引言：先天性和后天性心脏病在发展中国家非常普遍，尽管专业护理有限。纳米比亚于2009年建立了儿科心脏病服务，但人力资源和基础设施严重不足。因此，患者被转诊到南非进行心脏介入治疗。目的：描述转诊患者的诊断、临床特征、干预措施、术后发病率和死亡率以及随访情况。研究方法：人口统计学，诊断，干预措施，术中和术后发病率和死亡率，以及纵向随访数据的所有患者提到南非，进行了记录和分析。结果：总队列包括193例患者，其中179例（93%）患有CHD，7%患有后天性心脏病。大多数患者（78.8%）在转移前旅行超过400公里至温得和克。有28例经皮介入治疗。分别在27例和129例患者中进行了姑息性和确定性手术。156例患者中，80例（51.3%）发生术后并发症，其中15例（9.6%）为手术直接并发症。手术死亡率为8/156（5.1%，95%置信区间2.2-9.8），30天死亡率为3.2%。ICU住院时间延长与死亡风险增加5%相关，风险比1.05，95%置信区间1.02-1.08，p = 0.001。151例（78%）患者完成了超过7年的随访。结论：尽管在邻国寻求介入治疗的患者的心脏计划面临挑战，以及与晚期表现相关的多个病变和复杂性的不良特征，但我们报告了良好的手术和介入结局。我们的目标仍然是在纳米比亚发展全面的可持续心脏服务。
Introduction: Congenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa. Objectives: To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care. Methods: Demographics, diagnoses, interventions, intra- and post-operative morbidity and mortality, as well as longitudinal follow-up data of all patients referred to South Africa, were recorded and analysed. Results: The total cohort constituted 193 patients of which 179 (93%) had CHD and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek before transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients, respectively. Out of 156 patients, 80 (51.3%) had post-operative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 2.2-9.8), with a 30-day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death with hazard ratio 1.05, 95% confidence interval 1.02-1.08, p = 0.001. Follow-up was complete in 151 (78%) patients for more than 7 years. Conclusions: Despite the challenges associated with a cardiac programme for referring patients seeking intervention in a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia.