Situación real de las cardiopatías congénitas en dos hospitales públicos del estado de Jalisco

Abstract

Introducción: Las cardiopatías congénitas representan un problema de salud pública a nivel mundial. Objetivo: Conocer la cantidad de pacientes cardiópatas atendidos en dos hospitales públicos del estado de Jalisco, así como la mortalidad y los recursos con que cuentan los hospitales participantes para la atención de estos pacientes en el período del 2015 al 2018. Se solicitó la información a la Plataforma Nacional de Transparencia y además se revisaron las bases de datos de los servicios de cardiología pediátrica y cirugía cardiovascular pediátrica de los hospitales participantes. Resultados: El hospital de segundo nivel cuenta con los recursos humanos, pero no con el material para atender a estos pacientes, por lo que no es posible ofrecer ningún tipo de tratamiento paliativo o correctivo (sólo se cierran algunos conductos arteriosos en la etapa neonatal). Se valoró a un total de 624 pacientes, de los cuales el 92.2% correspondió a cardiopatías no críticas; la mortalidad global fue del 12% pero en las cardiopatías críticas fue del 79.5%. El hospital de tercer nivel cuenta con recursos humanos y material para atender a estos pacientes; en el período de estudio se realizaron 289 operaciones y la mortalidad global fue del 20.4%. Conclusión: Las cardiopatías congénitas en el estado de Jalisco son una causa importante de mortalidad, con una incidencia elevada y una capacidad de resolución sumamente limitada, ya que los servicios de salud de Jalisco para la atención de estos pacientes son insuficientes e inadecuados. Es esencial fortalecer el sistema de salud para atender a estos pacientes.

Inequity of congenital heart disease care in the public hospitals of Mexico. The false right to health

“…CHD surgical treatment also consumes considerable resources, infrastructure and complex equipment, in addition to certified professionals. It is obviously highly expensive 6 . This lack of funding it is the main barrier.…”

“…Health is a basic human right. All children born with CHD deserve to receive treatment and have access to interventions able of saving their lives and these rights should not be reserved for those born in specific areas of the country 6 .…”

“…CHDs represent the most common form of severe birth defects. In general, of 130 million births/year around the world, more than 1 million are estimated to occur with any CHD, which constitutes a global public health problem 6 . The incidence of severe CHD is nearly 2.5-3/1,000 births.…”

“…In Mexico, the real prevalence of CHD is unknown; however, available information is based on 2015 mortality rates. CHDs correspond to the second cause of mortality in children younger than 1 year and, in the age range of 1-14 years, CHDs went from the third to the second cause, displacing childhood cancer 6,7 . According to Calderón et al 7 regionalization proposal, around 25 cardiac surgery centers were required in Mexico in 2010, but there are only ten medical-surgical centers specialized in the care of these patients, of which eight are in Mexico City, one in Monterrey and another in Guadalajara; the latter belongs to the Mexican Institute of Social Security, and thus it only serves insured population.…”

“…This means that a multidisciplinary team, both medical and in terms of resources, is required for comprehensive care of these patients and, although regional hospitals have excellent human resources and multidisciplinary teams are put together, in many cases there are no material resources to implement treatments in a timely manner and with quality; this is why the figures between health institutes and state hospitals markedly diverge. At the regional level, there are hospitals whose surgical mortality is 20% in heart diseases with a risk adjustment for congenital heart surgery score of 1-3, and others where, by not having the material resources to offer any type of treatment, record mortality rates for critical heart diseases of up to 80% 6 ; furthermore, given that the material resources for its care are not available, CHD mortality is not modified in the states, and neither is it possible offering the minimum required coverage to the population that requires it; consequently, pediatric cardiology services centralization continues and this gives rise to the elevated number of patients on waiting list at health institutions.…”