The Current Landscape of Congenital Heart Surgery in Northern China: A Geographic and Population-Based Analysis

Abstract

Background: Congenital heart disease (CHD) is the leading birth defect in China, and many patients require congenital heart surgery (CHS) to achieve optimal outcomes. However, the current landscape and population accessibility to specialist resources for CHS in China are unclear.Methods: Care facilities performing CHS were identified from the 2018 white book of Chinese cardiovascular surgery and were categorized as full or limited facilities based on specialist capacity. Census-based population data and road data were obtained from administrative sources. Service area analysis of all facilities was performed to estimate geographic accessibility.Results: Of 93 facilities in 14 provinces and municipalities in northern China, only 30.1% had full specialist capacity. The shortage of pediatric cardiologists and mechanical circulatory support was the primary limiting factor. In 2018, 61.3% of facilities performed <200 CHS cases, and 31.6% of all CHS cases (N = 30,921) were performed in limited facilities with substantially lower volume than full-capacity facilities (median value: 85.0 vs. 368.0). Beijing had a disproportionately higher CHS volume (367 cases per million population) than other provinces. Of all children under 5 in northern China, only 12.9% live within 30 km (a typical half-day visit) of the service areas of all facilities. Compared to children from the eastern region (31.4%), 71.8% of children from the central region and 70.2% of children from the western region needed to travel >180 km (a typical overnight visit) to receive care in full-capacity facilities.Conclusions: Many facilities for CHS in northern China had limited specialist capacity, and many CHD patients received suboptimal surgical care. Policy measures should address the significant geographic disparities to receive high-quality surgical care among disadvantaged patients.

Inpatient costs of congenital heart surgery in China: results from the National Centre for Cardiovascular Diseases

“…An integrated approach to transferring the CHD patients to NCCD was previously reported, and impressive outcomes were obtained compared with the non-integrated approach but with a higher cost, 38 a common phenomenon in China. 8 In addition, the incidence rate has risen tremendously since the 1990s, 3 , 4 and the increased detection rate may be the major attributable factor. In contrast, the current prenatal diagnosis rate is still low compared with that in high-income countries.…”

“…7 Our group previously reported that specialist capacity is limited in northern China, and surgical treatment for CHD patients is suboptimal. 8 Approximately one-third of the CHD patients who cannot receive an adequate diagnosis and surgical treatment would die in the first year of life. 9 As a result, suboptimal surgical care may still be the main obstacle, and related costs are the main factors constituting the healthcare burden of these populations in China.…”

An interactive geographic information system to inform optimal locations for healthcare services

“…Whilst efforts have been made to describe the reach and capacity of current CHD services (both paediatric and adult), [ 45 – 47 ] little has been done to translate these findings into changes in healthcare services. This clinic planning tool allows for this to be determined in NSW, although scaling this to the whole of Australia would benefit future resource planning.…”

Two approaches for newborns with critical congenital heart disease: a comparative study

“…The proportion of neonatal surgery for CCHDs was 21.8% in the Society of Thoracic Surgeons Congenital Heart Surgery database and 19.5% in the European Association for Cardiothoracic Surgery database [11]. However, many facilities for congenital heart surgery in China have limited specialist capacity [12], resulting in delayed diagnosis, delayed life-saving medications, and suboptimal transport. Neonatal surgery accounted for 1.7% of all CHD patients in 2019 and 1.3% in 2020, according to the data from the Fuwai Hospital.…”