Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization

Abstract

BackgroundCongenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively; among patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan.MethodsA prevalence based cost of illness study design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children ≤ 5 years of age from June 2006 to June 2009. A total of 120 patients were enrolled after obtaining an informed consent and the data was collected using a pre-tested questionnaire.ResultsThe mean age at the time of surgery in group A (1-12 mo age) was 6.08 ± 2.80 months and in group B (1-5 yrs) was 37.10 ± 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outpatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures.ConclusionThis study concluded that significant expenditure is incurred by people with CHD; with the implication that resources could be saved by earlier detection and awareness campaigns.

Pattern and frequency of pediatric congenital heart disease at the Cardiac Research Institute of Kabul Medical University, Afghanistan

“…We found that among our CHD subjects, 20% had cyanotic heart disease and 80% had acyanotic heart disease, similar to results reported in both local and international studies. [2][3][4][5][6][7][8][9][10][11][12] The ASD and VSD were the most common lesions in our study subjects. Of our CHD subjects, we noted that 103/235 (43.8%) had ASD, which was similar to results from previous studies in neighboring Pakistan, 32.1% at the Punjab Institute of Cardiology (PIC), Lahore, 39.9% at the National Institute of Cardiology Karachi, and 38.16% at the Siddique Sadiq Memorial Trust Hospital, Gujranwala.…”

“…1 Congenital heart disease is a high contributor to the overall burden of pediatric cardiovascular diseases. 2 In developing countries like Afghanistan with very limited health facilities and poor access to the health centers, having a child with cardiovascular defects often results in social and economic problems that affect the entire family. 2 In the Western world, the incidence of CHD was reported to be 8/1,000 live births.…”

“…2 In developing countries like Afghanistan with very limited health facilities and poor access to the health centers, having a child with cardiovascular defects often results in social and economic problems that affect the entire family. 2 In the Western world, the incidence of CHD was reported to be 8/1,000 live births. 1,2 In Afghanistan, it has been difficult to obtain an accurate figure of the incidence of congenital heart disease.…”

“…2 In the Western world, the incidence of CHD was reported to be 8/1,000 live births. 1,2 In Afghanistan, it has been difficult to obtain an accurate figure of the incidence of congenital heart disease. In Pakistan, a study reported a CHD prevalence of up to 6/1,000 live births.…”

Circulating microRNAs as potential biomarkers for diagnosis of congenital heart defects

“…[1][2][3][4] Hence, early diagnosis of fetal CHD is of great signifi cance for timely postnatal surgical intervention or termination of pregnancy. [5,6] Accordingly, novel biomarkers for the improvement of efficiency and accuracy in the diagnosis of fetal CHD are needed in combination with conventional fetal echocardiography. [7,8] In the new era of non-invasive prenatal tests, potential biomarkers such as microRNAs, [9,10] proteins, [11] and the merging fetal cells [12] in maternal circulation that will cause minimum risk to fetus are easily accepted.…”