With 17.5 million deaths worldwide every year, cardiovascular disease (CVD) is the leading cause of death in the world, with 80% occurring in low- and middle-income countries.(1) CVD, as many other non-communicable diseases (NCDs), has become an increasingly important global/public health priority, yet nearly 6 billion people worldwide remain without access to safe cardiac surgical care when needed. Public health interventions have included control and prevention through lifestyle changes, yet these measures have had only limited effect on cases with significant conditions and in reducing mortality due to the need for dramatic changes in the daily habits of large populations and cultures.(2)
Despite said global situation, disparities in accessing global cardiac surgical care remain widespread. In sub-Saharan Africa and Asia, there are only 1 cardiac center per 38 million and 25 million people, respectively.(3) In contrast, Europe and North America have 1 per 120,000 population, despite lower incidences of surgical CVD and its mortality.(4) A similar maldistribution is seen among cardiothoracic surgical workforce, with 27 and 28 cardiothoracic surgeons per 1 million people in North America and Western Europe, respectively. Africa has to rely on 1 cardiothoracic surgeons per 4 million population, therefore accounting for only 1% of the total global cardiothoracic surgical capacity.(5) As a result, and worsened by socioeconomic barriers, only 25% of the world’s population has ready access to cardiac surgical care.(6)
On a pediatric level, access to cardiac surgery is even worse. Developed countries are expected to need a cardiac center for every two million people, compared to one per one million people in developing countries. Nevertheless, several countries with up to 70 million population are yet to establish a pediatric cardiac surgical center. Accordingly, 15 million children globally die or suffer from disability every year due to treatable and/or preventable CVD.(7) This becomes an even bigger issue in regions such as sub-Saharan Africa, where 47% of the population is younger than 15 years old.
The global situation calls for urgent upscaling of cardiothoracic surgical workforce and inclusion of cardiac surgery in national surgical plans and global surgery discussions and interventions. In order to grant access to cardiac surgical care for the 4.5 billion people without, establishment of residency tracks and high-volume cardiac (training) centers is necessary, driven by inclusive policies and relevant funding, allowing for low-cost or no-cost care for all. Further mapping of the global state of access to cardiac surgery will prove vital to hold international and national leaders accountable for existing gaps in global cardiac surgical care and consequent health disparities.
References:
1. World Health Organization. Global status report on noncommunicable diseases 2010. Geneva; 2011.
2. Replogle RL. A Proposal for International Certification in Cardiothoracic Surgery. Asian Cardiovasc Thorac Ann. 2004;12(4).
3. Yankah C, Fynn-Thompson F, Antunes M, Edwin F, Yuko-Jowi C, Mendis S, et al. Cardiac surgery capacity in sub-Saharan Africa: Quo Vadis? Thorac Cardiovasc Surg. 2014;62(5):393–401.
4. Pezzella AT. Global aspects of cardiothoracic surgery with focus on developing countries. Asian Cardiovasc Thorac Ann. 2010;18(3):299–310.
5. Turina MI. European Association for Cardio-Thoracic Surgery: Carrying the torch. Eur J Cardio-thoracic Surg. 2002;22(6):857–63.
6. Hoffmann JI. The global burden of congenital heart disease. Cardiovasc J Afr. 2013;24(4):141–6.
7. Yacoub MH. Establishing pediatric cardiovascular services in the developing world: A wake-up call. Circulation. 2007;116(17):1876–8.
Global Cardiac Surgery 