|
|
Heartline Magazine July - September 2004
Heart Disease Among Children - Cardiologist looks at incidence in Barbados
and the Caribbean
In Barbados, of the 4000 deliveries per year, approximately
30 infants are born with Congenital Heart Disease (CHD). Approximately 40% of
these need surgery or intervention.
This disclosure was made by cardiologist Dr. Richard
Ishmael, as he presented the Fifth Annual World Heart Day Public Lecture on
Sunday October 3, 2004 at the Cave Hill Campus of the University of the West
Indies. The lecture was organized by The Heart Foundation of Barbados.
Comparatively, the worldwide incidence of infants with
Congenital Heart Disease is 6 – 8%. In the English speaking Caribbean, out of a
total population of 5.32 million, about 600 infants are born each year with CHD
and approximately 250 – 300 of them require surgery.
Dr. Ishmael, who is Consultant Cardiologist and Director of
Cardiovascular Services at the Queen Elizabeth Hospital, treated the audience to
a highly informative discourse on “Children, Adolescents and Heart Disease.” He
not only provided well-documented examples of the nature and occurrence of the
illness, but also gave detailed explanations of the treatment. He said that
there are two classifications of Heart Disease: Congenital Heart Disease – those
who are born with it, and Acquired Heart Disease – those who develop it, noting
that the frequency of the former was greater.
“Generally,” said Dr. Ishmael, “heart disease is the leading
cause of death across the population in Barbados, and this fits in well with the
developed world. Almost 29% of all deaths in Barbados are from heart disease,
the contributing factors being lack of exercise, obesity, personality traits and
stress.” Cancer is next with 26%. He noted that approximately 80 adults have
open-heart surgery in Barbados.
Dr. Ishmael, who is also an associate lecturer in Cardiology
at the School of Clinical Medicine & Research, Cave Hill Campus of the
University of the West Indies, Barbados, lauded the organized pediatric cardiac
surgical programme which was started with Northshore University Hospital in New
York in 1982, and the subsequent development of an open heart programme at the
QEH in Barbados in 1994. Northshore University Hospital has the second largest
programme in New York State.
“This development has significantly improved the
cardiovascular treatment of Barbadian patients in the last 20 years or so, and
has actually fitted in well with the overall development of the island,” said
Dr. Ishmael. He continued, “The development of cardiac catherization in 1993,
followed by an open-heart programme in the QEH in 1994, has significantly raised
the standard of care at the QEH, especially of the care of the very sick with
the opening of a Pediatric ICU, funded by the Variety Club, and the improvement
of the care available in the medical and surgical ICUs. It has also contributed
to Barbados ranking high in terms of its position among developing countries, as
healthwise a country is assessed developmentally not only by its infant
mortality rate but its ability to care for its citizens. As cardiovascular
disease is the main cause of morbidity and mortality in this island, it was
excellent for us to have good heart care.”
To date, over 750 children from the Caribbean have been sent
to North Shore University Hospital for surgery. Of these, 141 were Barbadians.
The surgical mortality rate was 3%. This programme matured in 1994 with the
start of an open heart programme in Barbados with the help of North Shore.
Between 1994 and 2004, 81 infants have had open heart surgery, while 46 have had
closed heart surgery. The surgical mortality rate was 2%. Comparatively, there
have been 604 open heart surgeries on adults at the QEH, with a surgical
mortality rate of 3%. Infants with complex heart disease continue to be sent to
North Shore. Dr. Ishmael pointed out that it takes about US$10,000 to do open
heart surgery on a child. “While this may seem high,” he said, “it must be noted
that the normal cost for heart surgery in the U.S. is about US$40,000. The
traditional sources that are tapped for funding include government, the private
sector, charitable organizations, and Individuals. However, funding from these
sources is relatively small, and not enough to cover the costs of the overseas
programme.” A dedicated pediatric cardiac surgeon, in Dr. Ishmael’s opinion, is
needed at the QEH. This would take some of the workload off existing cardiac
surgeons who are mostly occupied with adult cases, and would also reduce the
need to send patients overseas.
“There has been significant economic benefit,” said Dr.
Ishmael, “from the cardiac surgical programme, both in terms of saving foreign
exchange when patients have their cardiac cath and surgery at the QEH rather
than overseas, and the earning of foreign exchange when patients from the region
have their cardiac investigations and surgery at the QEH. It is therefore
difficult to understand why the replacement for the cardiac catheterization
laboratory (critical to the diagnosis of heart disease prior to surgery) and the
increase in number of critical care beds (essential to the monitoring of
patients after cardiac cath and after heart surgery and heart attacks as well as
other critically ill patients) have not been put as a priority at the QEH.”
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
 |
|
