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Byiringiro S, Nyirimanzi N, Mucumbitsi J, Kamanzi ER, Swain J. Cardiac Surgery: Increasing Access in Low- and Middle-Income Countries. Curr Cardiol Rep 2020; 22:37. [PMID: 32430786 DOI: 10.1007/s11886-020-01290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW Low- and middle-income countries (LMICs) have long-battled communicable diseases, and now, a rise in non-communicable diseases (NCD) is conferring tremendous burden in these areas. Cardiovascular disease (CVD) remains the number one cause of death among NCDs across the globe. The current review provides insight regarding this disease burden and highlights challenges as well as strategies for establishing functional cardiac surgery centers and sustainable access to comprehensive cardiovascular care within LMICs. RECENT FINDINGS Without effective prevention and treatment strategies, estimates suggest that deaths from CVDs will reach 24 million by the year 2030. Surgery exists as a limited option for selected patients with advanced cardiac disease in LMICs in comparison with its availability in developed countries. Multi-lateral or public-private initiatives, government investment, philanthropic efforts, innovative financing systems to strengthen Universal Health Coverage, and expansion of training options through centers of excellence appear to be the way forward to broadening the availability of cardiovascular services, inclusive of surgery, to LMICs.
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Affiliation(s)
- Samuel Byiringiro
- School of Nursing, The Johns Hopkins University, 525 North Wolfe St., Baltimore, MD, USA.
| | | | | | | | - JaBaris Swain
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Jiang W, Teng J, Xu J, Shen B, Wang Y, Fang Y, Zou Z, Jin J, Zhuang Y, Liu L, Luo Z, Wang C, Ding X. Dynamic Predictive Scores for Cardiac Surgery-Associated Acute Kidney Injury. J Am Heart Assoc 2016; 5:JAHA.116.003754. [PMID: 27491837 PMCID: PMC5015294 DOI: 10.1161/jaha.116.003754] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Cardiac surgery–associated acute kidney injury (CSA‐AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA‐AKI from preoperative to early postoperative periods is needed. Methods and Results A total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA‐AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA‐AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA‐AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer–Lemeshow goodness‐of‐fit tests revealed a good agreement of expected and observed CSA‐AKI rates. Conclusions The first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA‐AKI was validated in cardiac surgery patients.
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Affiliation(s)
- Wuhua Jiang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China
| | - Jie Teng
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China Shanghai Kidney and Blood Purification Laboratory, Shanghai, China
| | - Jiarui Xu
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China
| | - Yimei Wang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China
| | - Yi Fang
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China Shanghai Kidney and Blood Purification Laboratory, Shanghai, China
| | - Zhouping Zou
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China
| | - Jifu Jin
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China
| | - Yamin Zhuang
- Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Liu
- Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Shanghai Kidney and Dialysis Institute, Shanghai, China Shanghai Kidney and Blood Purification Laboratory, Shanghai, China
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Joshi R, Jan S, Wu Y, MacMahon S. Global inequalities in access to cardiovascular health care: our greatest challenge. J Am Coll Cardiol 2009; 52:1817-1825. [PMID: 19038678 DOI: 10.1016/j.jacc.2008.08.049] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/31/2008] [Accepted: 08/05/2008] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease (CVD) was the leading cause of death globally in 2005, responsible for 17.5 million deaths, more than 80% of which occurred in low- and middle-income countries (LMIC). In these regions, CVD occurs at a much younger age than in high-income countries, thereby contributing disproportionately to lost potential years of healthy life as well as lost economic productivity. Many effective interventions for CVD prevention and management are now affordable for all but the very poorest countries, but large treatment gaps still exist because of poor prescribing practices, limited availability of medicines, and lack of appropriately skilled health care providers. Despite the increasing awareness of the growing epidemic of CVD in LMIC, this public health priority has received little attention from those who determine the international health agenda. Although the burden of CVD is already enormous in developing countries, there exists a window of opportunity to prevent the epidemic reaching its full potential magnitude. This requires the rapid deployment of strategies already proven to be effective in high-income countries. Such strategies need to be tailored for LMIC for them to be affordable, effective, and accessible to disadvantaged groups and the burgeoning middle classes. Ideally, the control of CVD in these countries would involve a dual approach in which evidence-based clinical strategies for CVD prevention and treatment are complemented by evidence-based population level strategies. We propose that upgrading primary health care services is a central requirement for the control of the CVD epidemics facing the developing world.
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Affiliation(s)
- Rohina Joshi
- The George Institute for International Health, Faculty of Medicine, University of Sydney, Sydney, Australia.
| | - Stephen Jan
- The George Institute for International Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Yangfeng Wu
- The George Institute China, Department of Epidemiology, School of Public Health, Peking University, Peking, China
| | - Stephen MacMahon
- The George Institute for International Health, Faculty of Medicine, University of Sydney, Sydney, Australia
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