Cape Town Declaration on Access to Cardiac Surgery in the Developing World

On August, 3rd 2018, the “Cape Town Declaration on Access to Cardiac Surgery in the Developing World” was published in the Journal of Thoracic and Cardiovascular Surgery, amongst other journals, in order to raise awareness of the increasing global burden of rheumatic heart disease (RHD).


In 2006, the Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa was released, calling for attention for the prevention and treatment of RHD around the world. Today, RHD remains an important condition, with 34 million being affected by RHD worldwide (equalling the prevalence of HIV), the majority of which lives in low- and middle-income countries (LMICs).

Nevertheless, preventive efforts, although important, have been unsuccessful in eliminating RHD. Furthermore, open-heart surgery (OHS) remains the only treatment for RHD, yet is largely inaccessible for the majority of the world’s population. In endemic regions, the need for OHS runs up to 300 surgeries per 1 million population. Nevertheless, only 22 cardiac centers exist for the nearly 1 billion people living in sub-Saharan Africa, with further limited access in high-prevalence countries as India, Pakistan, China, and Indonesia.

The Declaration acknowledges the need for building local capacity to address the burden of RHD in a sustainable manner, rather than short-term solutions as “fly-in fly-out” humanitarian missions. Long-term partnerships with local collaboration and training ought to create a more cost-effective, effective, and sustainable framework, allowing autonomous local services to be created with government buy-in. However, to do so, coordination of efforts by all stakeholders will prove vital in the long run.

To urge all relevant entities within the international cardiac surgery, industry, and government sectors to commit to develop and implement an effective strategy to address the scourge of rheumatic heart disease in the developing world through increased access to lifesaving cardiac surgery.

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