Today marks the start of #WHA75!
This week, @WHO, Ministries of Health, civil society, & more will discuss #GlobalHealth priorities.
Missing on agenda? #GlobalSurgery & ๐ซ care.
Hence, I'll be sharing key points, papers, & developments in #GlobalCardiacSurgery in 75 tweets ๐
This week, @WHO, Ministries of Health, civil society, & more will discuss #GlobalHealth priorities.
Missing on agenda? #GlobalSurgery & ๐ซ care.
Hence, I'll be sharing key points, papers, & developments in #GlobalCardiacSurgery in 75 tweets ๐
(1/75) To start, what *is* #GlobalCardiacSurgery?
GCS extends far beyond OR, from community-based disease detection & efficient referral networks to timely care, long-term follow-up, robust supply chains & adequate financial risk protection. #WHA75
Read: academic.oup.com/ejcts/article/โฆ
GCS extends far beyond OR, from community-based disease detection & efficient referral networks to timely care, long-term follow-up, robust supply chains & adequate financial risk protection. #WHA75
Read: academic.oup.com/ejcts/article/โฆ
(2/75) Why does #GlobalCardiacSurgery matter?
โ ๏ธ Every year, 18 million people die from #CVD
๐ซ 500 million live with CVD; 100s of millions more to come.
๐ฅ Up to 1/3 will require #CTSurgery or interventional care in lifetime
Data @IHME_UW: healthdata.org/results/data-vโฆ
#WHA75
โ ๏ธ Every year, 18 million people die from #CVD
๐ซ 500 million live with CVD; 100s of millions more to come.
๐ฅ Up to 1/3 will require #CTSurgery or interventional care in lifetime
Data @IHME_UW: healthdata.org/results/data-vโฆ
#WHA75
(3/75) Why is #WHA75 not talking about #GlobalCardiacSurgery?
Many arguments often falsely raised to not (yet) address ๐ซ care โ๏ธ #GlobalHealth interventions.
Reality? #CVD care = indispensable part of strong #HealthSystems, #UHC, socioeconomic ๐ถ
Read: globalheartjournal.com/articles/abstrโฆ
Many arguments often falsely raised to not (yet) address ๐ซ care โ๏ธ #GlobalHealth interventions.
Reality? #CVD care = indispensable part of strong #HealthSystems, #UHC, socioeconomic ๐ถ
Read: globalheartjournal.com/articles/abstrโฆ
(4/75) Do policies tackle #GlobalCardiacSurgery?
Nationally, only 1 #NSOAP (Zambia) recognized #CTSurgery.
๐ thieme-connect.com/products/ejourโฆ
Internationally, @WHO @UN @WorldBank barely mention #CVD care & #GlobalSurgery, let alone ๐ซ surgical care.
๐ journals.sagepub.com/doi/abs/10.117โฆ
#WHA75
Nationally, only 1 #NSOAP (Zambia) recognized #CTSurgery.
๐ thieme-connect.com/products/ejourโฆ
Internationally, @WHO @UN @WorldBank barely mention #CVD care & #GlobalSurgery, let alone ๐ซ surgical care.
๐ journals.sagepub.com/doi/abs/10.117โฆ
#WHA75
(5/75) Why is #GlobalCardiacSurgery not prioritized?
Surgical healthcare & #RHD hindered by
๐ Insufficient data
๐ญ Misperceptions
๐ฃ๏ธ Fragmented advocacy
โ๏ธ Disagreement between stakeholders
Dr. @Yrshawar et al:
๐ thelancet.com/journals/langlโฆ
๐ ahajournals.org/doi/10.1161/JAโฆ
#WHA75
Surgical healthcare & #RHD hindered by
๐ Insufficient data
๐ญ Misperceptions
๐ฃ๏ธ Fragmented advocacy
โ๏ธ Disagreement between stakeholders
Dr. @Yrshawar et al:
๐ thelancet.com/journals/langlโฆ
๐ ahajournals.org/doi/10.1161/JAโฆ
#WHA75
(6/75) Why does prioritization of #GlobalCardiacSurgery matter?
๐ช #GlobalSurgery = <1% of #GlobalHealth financing
๐ thelancet.com/journals/langlโฆ
๐ฐ NCDs = 2% of GH financing
๐ healthdata.org/infographic/hiโฆ
๐ซ RHD = 1 of the most underfunded diseases
๐ academic.oup.com/trstmh/articleโฆ
#WHA75
๐ช #GlobalSurgery = <1% of #GlobalHealth financing
๐ thelancet.com/journals/langlโฆ
๐ฐ NCDs = 2% of GH financing
๐ healthdata.org/infographic/hiโฆ
๐ซ RHD = 1 of the most underfunded diseases
๐ academic.oup.com/trstmh/articleโฆ
#WHA75
(7/75) Implication of underfunding of #GlobalCardiacSurgery?
Lack of ๐ฐ = limited research capacity & interest (few grants):
๐ซ #RHD is nearly eradicated in HICs โฉ neglected in #GlobalHealth discourse.
๐ซ #CHD research is dominated by HICs โ๏ธ gaps in care in LMICs.
#WHA75
Lack of ๐ฐ = limited research capacity & interest (few grants):
๐ซ #RHD is nearly eradicated in HICs โฉ neglected in #GlobalHealth discourse.
๐ซ #CHD research is dominated by HICs โ๏ธ gaps in care in LMICs.
#WHA75
(8/75) Limited funding also means insufficient capacity.
High-income countries have 180 times (!) as many ๐ซ surgeons per million people as low-income countries.
๐ jtcvs.org/article/S0022-โฆ @AATSJournals
Numbers of other #HeartTeam members unknown but likely even fewer.
#WHA75
High-income countries have 180 times (!) as many ๐ซ surgeons per million people as low-income countries.
๐ jtcvs.org/article/S0022-โฆ @AATSJournals
Numbers of other #HeartTeam members unknown but likely even fewer.
#WHA75
(9/75) Resulting gap in #GlobalCardiacSurgery?
~1.5 million ๐ซ operations each year, far below what is needed:
โค๏ธโ๐ฉน >90% w/ #CHD do not get care they need
โ <1 in 10 w/ #RHD receive needed surgery
๐ Even less for revasc., dissections, #HF, etc
thieme-connect.com/products/ejourโฆ
#WHA75
~1.5 million ๐ซ operations each year, far below what is needed:
โค๏ธโ๐ฉน >90% w/ #CHD do not get care they need
โ <1 in 10 w/ #RHD receive needed surgery
๐ Even less for revasc., dissections, #HF, etc
thieme-connect.com/products/ejourโฆ
#WHA75
(10/75) What is the need in #GlobalCardiacSurgery?
Unmet need highest in #LMICs; ๐ซ surgical need ๐ถ with socioeconomic development:
#RHD, #EMF, #Chagas, etc. โฉ #IHD, degenerative valvular disease, etc.
Note: #CHD remains!
๐ sciencedirect.com/science/articlโฆ
#WHA75
Unmet need highest in #LMICs; ๐ซ surgical need ๐ถ with socioeconomic development:
#RHD, #EMF, #Chagas, etc. โฉ #IHD, degenerative valvular disease, etc.
Note: #CHD remains!
๐ sciencedirect.com/science/articlโฆ
#WHA75
(11/75) What does all that scarcity mean for #GlobalCardiacSurgery?
SIX BILLION PEOPLE lack access to safe, timely, and affordable cardiac surgical care when needed. ๐ซ๐
๐ annalsthoracicsurgery.org/article/S0003-โฆ @annalsthorsurg
#WHA75
SIX BILLION PEOPLE lack access to safe, timely, and affordable cardiac surgical care when needed. ๐ซ๐
๐ annalsthoracicsurgery.org/article/S0003-โฆ @annalsthorsurg
#WHA75
(12/75) #GlobalCardiacSurgery is just too expensive.. Right?
Narayana Health ๐ฎ๐ณ performs ๐ซ operations at as little as US$1,500 per surgery.
๐ป๐ณ ~US$2,000-3,000
๐ฌ๐ญ๐ณ๐ฌ ~US$5,000-8,000
BUT w/o financial risk protection, costs still insurmountable.
acc.org/latest-in-cardโฆ
#WHA75
Narayana Health ๐ฎ๐ณ performs ๐ซ operations at as little as US$1,500 per surgery.
๐ป๐ณ ~US$2,000-3,000
๐ฌ๐ญ๐ณ๐ฌ ~US$5,000-8,000
BUT w/o financial risk protection, costs still insurmountable.
acc.org/latest-in-cardโฆ
#WHA75
(13/75) Does it make $ sense to invest in #GlobalCardiacSurgery?
Pediatric ๐ซ surgery = โฌ๏ธ cost-effective ($171/DALY averted) in LMICs ๐ jamanetwork.com/journals/jamanโฆ
Even more so than several other (already cost-effective) #GlobalHealth priorities ๐ link.springer.com/article/10.100โฆ
#WHA75
Pediatric ๐ซ surgery = โฌ๏ธ cost-effective ($171/DALY averted) in LMICs ๐ jamanetwork.com/journals/jamanโฆ
Even more so than several other (already cost-effective) #GlobalHealth priorities ๐ link.springer.com/article/10.100โฆ
#WHA75
(14/75) Does it make socioeconomic sense to invest in #GlobalCardiacSurgery?
Expanding integrated secondary and tertiary prevention & care for #RHD in the African Union may result in a net benefit of US$2.8 BILLION through 2030.
๐ thelancet.com/journals/langlโฆ
#WHA75
Expanding integrated secondary and tertiary prevention & care for #RHD in the African Union may result in a net benefit of US$2.8 BILLION through 2030.
๐ thelancet.com/journals/langlโฆ
#WHA75
(15/75) REMEMBER: #GlobalCardiacSurgery = #HealthSystems, not another operative silo.
Similarly, #CTSurgery is not about the surgeon, but about #HeartTeams.
๐ซ surgical care is not about clinicians, but patients, families, and communities.
Partnerships are key.
#WHA75
Similarly, #CTSurgery is not about the surgeon, but about #HeartTeams.
๐ซ surgical care is not about clinicians, but patients, families, and communities.
Partnerships are key.
#WHA75
(16/75) #GlobalCardiacSurgery is no longer only about disparities.
In recent decades, ๐ซ surgeons initiated ๐ partnerships.
In recent years, #GlobalSurgery momentum โฉ discussions within #CTSurgery.
In recent months, societal commitment ๐ attention for the field.
#WHA75
In recent decades, ๐ซ surgeons initiated ๐ partnerships.
In recent years, #GlobalSurgery momentum โฉ discussions within #CTSurgery.
In recent months, societal commitment ๐ attention for the field.
#WHA75
(17/75) Do examples of #GlobalCardiacSurgery prioritization exist?
In ๐ฌ๐ญ, ๐ซ surgeon & government leadership shifted financing from #CTSurgery abroad to local program:
๐ฐ Lower costs
๐ช Strengthened #HealthSystem
๐ฅ Treatment closer to home
๐ sciencedirect.com/science/articlโฆ
#WHA75
In ๐ฌ๐ญ, ๐ซ surgeon & government leadership shifted financing from #CTSurgery abroad to local program:
๐ฐ Lower costs
๐ช Strengthened #HealthSystem
๐ฅ Treatment closer to home
๐ sciencedirect.com/science/articlโฆ
#WHA75
(18/75) Are there other #GlobalCardiacSurgery success stories?
In Nepal, Dr. @KoiralaBhagawan pioneered the "Poor Patients Relief" program, a microinsurance program by the government to finance ๐ซ surgery for children, the elderly, & the poor.
๐ asj.amegroups.com/article/view/5โฆ
#WHA75
In Nepal, Dr. @KoiralaBhagawan pioneered the "Poor Patients Relief" program, a microinsurance program by the government to finance ๐ซ surgery for children, the elderly, & the poor.
๐ asj.amegroups.com/article/view/5โฆ
#WHA75
(19/75) Any other notable #GlobalCardiacSurgery examples in #LMICs?
The Salam Centre in Sudan ๐ธ๐ฉ
๐ frontiersin.org/articles/10.33โฆ
The Shisong Center in Cameroon ๐จ๐ฒ
๐ frontiersin.org/articles/10.33โฆ
The Maputo Heart Institute in Mozambique ๐ฒ๐ฟ
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
+dozens more! #WHA75
The Salam Centre in Sudan ๐ธ๐ฉ
๐ frontiersin.org/articles/10.33โฆ
The Shisong Center in Cameroon ๐จ๐ฒ
๐ frontiersin.org/articles/10.33โฆ
The Maputo Heart Institute in Mozambique ๐ฒ๐ฟ
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
+dozens more! #WHA75
(20/75) Can #GlobalCardiacSurgery be scaled?
Narayana Health in India performs one of the *highest* number of ๐ซ operations per year at the *lowest* cost anywhere in the world.
Their operative outcomes are *highly* favorable.
๐ link.springer.com/chapter/10.100โฆ
#WHA75
Narayana Health in India performs one of the *highest* number of ๐ซ operations per year at the *lowest* cost anywhere in the world.
Their operative outcomes are *highly* favorable.
๐ link.springer.com/chapter/10.100โฆ
#WHA75
(21/75) What are #GlobalCardiacSurgery NGOs doing?
๐ซ 86 NGOs: 56 pediatric, 5 adult, 25 both
๐ช Median volume: 82 cardiac operations per year
๐ Active in 96 LMICs
๐ฅ Care delivery, capacity building, supplies, & more
๐ semthorcardiovascsurg.com/article/S1043-โฆ
#WHA75
๐ซ 86 NGOs: 56 pediatric, 5 adult, 25 both
๐ช Median volume: 82 cardiac operations per year
๐ Active in 96 LMICs
๐ฅ Care delivery, capacity building, supplies, & more
๐ semthorcardiovascsurg.com/article/S1043-โฆ
#WHA75
(22/75) How do #GlobalCardiacSurgery NGOs influence policy?
@CHeartLink is a leading voice in #CHD & #GlobalSurgery advocacy in Brazil, China, India, Malaysia, Vietnam, & on the ๐ stage.
The Invisible Child: childrensheartlink.org/the-invisible-โฆ
@TheLancet: thelancet.com/journals/lanceโฆ
#WHA75
@CHeartLink is a leading voice in #CHD & #GlobalSurgery advocacy in Brazil, China, India, Malaysia, Vietnam, & on the ๐ stage.
The Invisible Child: childrensheartlink.org/the-invisible-โฆ
@TheLancet: thelancet.com/journals/lanceโฆ
#WHA75
(23/75) How do organizations โฌ๏ธ #GlobalCardiacSurgery capacity-building?
@heartuni_org = #OpenAccess e-learning on #CHD & pediatric #CVD:
๐ Training curriculum
๐ฝ๏ธ Conference/Grand Round recordings
๐ heartuniversity.org @JustinTretterMD
๐ cambridge.org/core/journals/โฆ
#WHA75
@heartuni_org = #OpenAccess e-learning on #CHD & pediatric #CVD:
๐ Training curriculum
๐ฝ๏ธ Conference/Grand Round recordings
๐ heartuniversity.org @JustinTretterMD
๐ cambridge.org/core/journals/โฆ
#WHA75
(24/75) How are patients & families engaged in #GlobalCardiacSurgery discourse?
@globalarchorg = ๐ alliance of patient-family organizations, providing voice at the ๐ซ of cardiovascular discourse.
#DeclarationOfRights for People with #CHD & #RHD: secure.lglforms.com/form_engine/s/โฆ
#WHA75
@globalarchorg = ๐ alliance of patient-family organizations, providing voice at the ๐ซ of cardiovascular discourse.
#DeclarationOfRights for People with #CHD & #RHD: secure.lglforms.com/form_engine/s/โฆ
#WHA75
(25/75) How are policymakers engaged in #GlobalSurgery & ๐ซ medicine?
@surgfoundation provides innovative platform for entire ecosystem to โฌ๏ธ global surgical interventions.
@worldheartfed unites #CVD voices ๐ to tackle the leading cause of death.
#WHA75 #GlobalCardiacSurgery
@surgfoundation provides innovative platform for entire ecosystem to โฌ๏ธ global surgical interventions.
@worldheartfed unites #CVD voices ๐ to tackle the leading cause of death.
#WHA75 #GlobalCardiacSurgery
(26/75) How is the next generation of #GlobalCardiacSurgery engaged?
@GlobalCardiac is a global network of trainees interested in #CTSurgery, #GlobalSurgery, & #HealthEquity:
๐ข Advocacy & webinars
๐ Research & conference presentations
๐ Social & mentorship networks
#WHA75
@GlobalCardiac is a global network of trainees interested in #CTSurgery, #GlobalSurgery, & #HealthEquity:
๐ข Advocacy & webinars
๐ Research & conference presentations
๐ Social & mentorship networks
#WHA75
(27/75) How is industry engaged in #GlobalSurgery?
@JNJGlobalHealth has been a strong and vocal supporter of #Surgery4All: jnj.com/global-public-โฆ
@EdwardsLifesci supports #GlobalCardiacSurgery through @CTSurgeryFdn Every Heartbeat Matters Award: thoracicsurgeryfoundation.org/awards/edwards/
#WHA75
@JNJGlobalHealth has been a strong and vocal supporter of #Surgery4All: jnj.com/global-public-โฆ
@EdwardsLifesci supports #GlobalCardiacSurgery through @CTSurgeryFdn Every Heartbeat Matters Award: thoracicsurgeryfoundation.org/awards/edwards/
#WHA75
(28/75) How are societies engaged in #GlobalCardiacSurgery?
The #CSIA by @worldheartfed @AATSHQ @STS_CTsurgery @EACTS #ASCVTS resembles societal commitment to expanding #RHD surgical care capacity and delivery in Mozambique, Rwanda, & beyond.
๐ world-heart-federation.org/cardiac-surgerโฆ
#WHA75
The #CSIA by @worldheartfed @AATSHQ @STS_CTsurgery @EACTS #ASCVTS resembles societal commitment to expanding #RHD surgical care capacity and delivery in Mozambique, Rwanda, & beyond.
๐ world-heart-federation.org/cardiac-surgerโฆ
#WHA75
(29/75) How are ๐ซ surgeons themselves engaged in #GlobalCardiacSurgery?
The cardiac surgeon-advocate commits to:
๐ Health policy
๐ Local & global disparities
๐ซ Community engagement
๐ก (Un)conscious bias education
๐ sciencedirect.com/science/articlโฆ
#WHA75
The cardiac surgeon-advocate commits to:
๐ Health policy
๐ Local & global disparities
๐ซ Community engagement
๐ก (Un)conscious bias education
๐ sciencedirect.com/science/articlโฆ
#WHA75
(30/75) Much happened in #GlobalCardiacSurgery in recent years!
In 2015, #DCP3 @WorldBank had dedicated #GlobalSurgery volume:
๐ซ #CHD = 66% of preventable deaths of common surgical conditions
๐ฅ #CTSurgery could prevent 58% of said mortality
๐ dcp-3.org/surgery
#WHA75
In 2015, #DCP3 @WorldBank had dedicated #GlobalSurgery volume:
๐ซ #CHD = 66% of preventable deaths of common surgical conditions
๐ฅ #CTSurgery could prevent 58% of said mortality
๐ dcp-3.org/surgery
#WHA75
(31/75) Have there been political #GlobalCardiacSurgery commitments?
In 2018, the WHA71.14 Resolution โRheumatic fever and rheumatic heart diseaseโ was passed at #WHA71, an important political statement to tackle #RHD worldwide ๐ซ๐.
๐ apps.who.int/gb/ebwha/pdf_fโฆ
#WHA75
In 2018, the WHA71.14 Resolution โRheumatic fever and rheumatic heart diseaseโ was passed at #WHA71, an important political statement to tackle #RHD worldwide ๐ซ๐.
๐ apps.who.int/gb/ebwha/pdf_fโฆ
#WHA75
(32/75) Have there been multidisciplinary #GlobalCardiacSurgery commitments?
In 2020, @NCDIpoverty Commission reframed discussion surrounding #NCDs & injuries as part of #UHC for the poorest billion, including many neglected #CVD (e.g., #RHD).
๐ thelancet.com/commissions/NCโฆ
#WHA75
In 2020, @NCDIpoverty Commission reframed discussion surrounding #NCDs & injuries as part of #UHC for the poorest billion, including many neglected #CVD (e.g., #RHD).
๐ thelancet.com/commissions/NCโฆ
#WHA75
(33/75) What #GlobalCardiacSurgery resources have become available?
Dr. @jacqueskpodonu released his textbook "Global Cardiac Surgery Capacity Development in #LMICs," compiling chapters from #GlobalSurgery leaders from across disciplines & ๐.
๐ link.springer.com/book/10.1007/9โฆ
#WHA75
Dr. @jacqueskpodonu released his textbook "Global Cardiac Surgery Capacity Development in #LMICs," compiling chapters from #GlobalSurgery leaders from across disciplines & ๐.
๐ link.springer.com/book/10.1007/9โฆ
#WHA75
(34/75) What #GlobalCardiacSurgery efforts have societies made?
Pre-2021: one #GlobalSurgery session at #CTSurgery conference (#AATS2019).
October โ21 โ May โ22: ALL major ๐ซ surgery conferences had GCS sessions (#EACTS2021, #CCC2021, #STS2022, #AATCVS2022, #AATS2022).
#WHA75
Pre-2021: one #GlobalSurgery session at #CTSurgery conference (#AATS2019).
October โ21 โ May โ22: ALL major ๐ซ surgery conferences had GCS sessions (#EACTS2021, #CCC2021, #STS2022, #AATCVS2022, #AATS2022).
#WHA75
(35/75) What academic #GlobalCardiacSurgery efforts have been made?
Although #OpenAccess publishing remains ๐ฐ (scielo.br/j/rbccv/a/hNtPโฆ), @ctsnetorg's new #CTSNetGlobal platform promotes free & dedicated #GlobalSurgery in #CTSurgery publishing.
๐ ctsnet.org/article/ctsnetโฆ
#WHA75
Although #OpenAccess publishing remains ๐ฐ (scielo.br/j/rbccv/a/hNtPโฆ), @ctsnetorg's new #CTSNetGlobal platform promotes free & dedicated #GlobalSurgery in #CTSurgery publishing.
๐ ctsnet.org/article/ctsnetโฆ
#WHA75
(36/75) What #GlobalCardiacSurgery ๐ efforts have arisen?
In Nov 2021, @nih_nhlbi hosted 3-day public workshop on prevention & care for #RHD with experts from across ๐.
๐ @NIH commitment to eradicating RHD:
โน๏ธ nhlbi.nih.gov/events/2021/erโฆ
๐ฝ๏ธ vimeo.com/651148197
#WHA75
In Nov 2021, @nih_nhlbi hosted 3-day public workshop on prevention & care for #RHD with experts from across ๐.
๐ @NIH commitment to eradicating RHD:
โน๏ธ nhlbi.nih.gov/events/2021/erโฆ
๐ฝ๏ธ vimeo.com/651148197
#WHA75
(37/75) What governmental #GlobalCardiacSurgery leadership has paved the way for a better future?
In Malaysia, the government has recognized the importance of ๐ซ surgical care for children with #CHD. @DGHisham
๐
#WHA75 @bzheleva @CHeartLink
In Malaysia, the government has recognized the importance of ๐ซ surgical care for children with #CHD. @DGHisham
๐
https://twitter.com/bzheleva/status/1486370028760952837?t=iLuQe50s9pp4RJfAKpiAZw&s=19
#WHA75 @bzheleva @CHeartLink
(38/75) What #GlobalCardiacSurgery models have been successfully replicated elsewhere?
Narayana Health started Health City Cayman Islands to โฌ๏ธ #CTSurgery and other complex care for Caribbean & at โฌ๏ธ๐ฐ for US.
๐ hbr.org/2018/06/is-thiโฆ
๐ hbs.edu/faculty/Pages/โฆ
#WHA75
Narayana Health started Health City Cayman Islands to โฌ๏ธ #CTSurgery and other complex care for Caribbean & at โฌ๏ธ๐ฐ for US.
๐ hbr.org/2018/06/is-thiโฆ
๐ hbs.edu/faculty/Pages/โฆ
#WHA75
(39/75) What data-oriented #GlobalCardiacSurgery initiatives are โฌ๏ธ #CTSurgery outcomes across settings?
@IQICforCHD convenes >70 ๐ซ programs in >25 countries (mostly #LMICs) to track #CHD surgery outcomes in a standardized fashion.
๐ iqic.chboston.org
#WHA75
@IQICforCHD convenes >70 ๐ซ programs in >25 countries (mostly #LMICs) to track #CHD surgery outcomes in a standardized fashion.
๐ iqic.chboston.org
#WHA75
(40/75) What training opportunities exist in #GlobalCardiacSurgery?
#CTSurgery training programs limited in #LMICs.
Differing licensing processes in HICs ๐ international training.
But, several countries leave many ๐ซ surgery spots unfilled.
๐ jtcvs.org/article/S0022-โฆ
#WHA75
#CTSurgery training programs limited in #LMICs.
Differing licensing processes in HICs ๐ international training.
But, several countries leave many ๐ซ surgery spots unfilled.
๐ jtcvs.org/article/S0022-โฆ
#WHA75
(41/75) What training opportunities may arise for #GlobalCardiacSurgery?
No int'l accreditation/standardization โก๏ธ ๐ซ#GlobalSurgery residency?
๐ Different & changing disease burdens
๐ Shared learning
๐ฅ #HealthSystems understanding
๐ ctsnet.org/article/opportโฆ
#WHA75
No int'l accreditation/standardization โก๏ธ ๐ซ#GlobalSurgery residency?
๐ Different & changing disease burdens
๐ Shared learning
๐ฅ #HealthSystems understanding
๐ ctsnet.org/article/opportโฆ
#WHA75
(42/75) What educational tools may support #GlobalCardiacSurgery?
Simulation training & #VR = underutilized in #CTSurgery beyond high-income country settings.
But, opportunities to โฌ๏ธ๐ฐ (e.g., e-learning; VR: cardboard headset + smartphone).
๐ onlinelibrary.wiley.com/doi/abs/10.111โฆ
#WHA75
Simulation training & #VR = underutilized in #CTSurgery beyond high-income country settings.
But, opportunities to โฌ๏ธ๐ฐ (e.g., e-learning; VR: cardboard headset + smartphone).
๐ onlinelibrary.wiley.com/doi/abs/10.111โฆ
#WHA75
(43/74) How can #GlobalCardiacSurgery capacity-building ๐ถ further?
Early in pandemic: virtual conferences = elevating voices previously left unheard & โฌ๏ธ access to learning, research, networking.
Now: many back to in-person only.
โฉ Hybrid?
๐ jtcvs.org/article/S0022-โฆ
#WHA75
Early in pandemic: virtual conferences = elevating voices previously left unheard & โฌ๏ธ access to learning, research, networking.
Now: many back to in-person only.
โฉ Hybrid?
๐ jtcvs.org/article/S0022-โฆ
#WHA75
(44/75) How can #GlobalCardiacSurgery training be expanded?
Human factors ~ patient outcomes โฉ up to 60% of surgery-related adverse events.
Non-technical skills (#NOTSS) = under-leveraged in #CTSurgery, yet โ across settings.
๐ jtd.amegroups.com/article/view/3โฆ
#WHA75
Human factors ~ patient outcomes โฉ up to 60% of surgery-related adverse events.
Non-technical skills (#NOTSS) = under-leveraged in #CTSurgery, yet โ across settings.
๐ jtd.amegroups.com/article/view/3โฆ
#WHA75
(45/75) How can #GlobalCardiacSurgery care delivery be further improved?
Quality improvement #QI initiatives (e.g., @ERASCardiac) โฉ optimize perioperative outcomes.
Essential: #HeartTeam collaboration throughout #CTSurgery care continuum.
๐ jamanetwork.com/journals/jamasโฆ
#WHA75
Quality improvement #QI initiatives (e.g., @ERASCardiac) โฉ optimize perioperative outcomes.
Essential: #HeartTeam collaboration throughout #CTSurgery care continuum.
๐ jamanetwork.com/journals/jamasโฆ
#WHA75
(46/75) How may #GlobalCardiacSurgery outcomes further improve?
The @WHO Surgical Safety Checklist & #CTSurgery-specific checklists ~ โฌ๏ธ operative mortality.
๐ฝ๏ธ lifebox.org/thechecklistefโฆ @SaferSurgery
๐ sciencedirect.com/science/articlโฆ
#WHA75
The @WHO Surgical Safety Checklist & #CTSurgery-specific checklists ~ โฌ๏ธ operative mortality.
๐ฝ๏ธ lifebox.org/thechecklistefโฆ @SaferSurgery
๐ sciencedirect.com/science/articlโฆ
#WHA75
(47/75) How can #GlobalCardiacSurgery care delivery be optimized across settings?
Randomized controlled trials (RCTs) are cornerstone of evidence-based medicine.
Cardiovascular RCTs remain limited in #LMICs, especially for #CTSurgery โฉ opportunity for ๐ collaboration.
#WHA75
Randomized controlled trials (RCTs) are cornerstone of evidence-based medicine.
Cardiovascular RCTs remain limited in #LMICs, especially for #CTSurgery โฉ opportunity for ๐ collaboration.
#WHA75
(48/75) How can #GlobalCardiacSurgery care delivery be optimized?
๐ซ research in LMICs limited & must be scaled:
โถ๏ธ HICs: 8.1% of #CVD DALYs โ๏ธ 81.1% of research
โ ๏ธ Low-income/lower-middle-income countries: 59.5% of DALYs โ๏ธ 2.8% of research
๐ globalheartjournal.com/articles/10.53โฆ
#WHA75
๐ซ research in LMICs limited & must be scaled:
โถ๏ธ HICs: 8.1% of #CVD DALYs โ๏ธ 81.1% of research
โ ๏ธ Low-income/lower-middle-income countries: 59.5% of DALYs โ๏ธ 2.8% of research
๐ globalheartjournal.com/articles/10.53โฆ
#WHA75
(49/75) Why should #GlobalCardiacSurgery research be โฌ๏ธ?
๐ซ guidelines cannot be generalized across populations.
๐ Different settings, systems, resources, etc = different care needs/outcomes.
โ ๏ธ Country income group & inequality ~ mortality
๐ hal.univ-lorraine.fr/hal-02516015/dโฆ
#WHA75
๐ซ guidelines cannot be generalized across populations.
๐ Different settings, systems, resources, etc = different care needs/outcomes.
โ ๏ธ Country income group & inequality ~ mortality
๐ hal.univ-lorraine.fr/hal-02516015/dโฆ
#WHA75
(50/75) What should be done to facilitate #GlobalCardiacSurgery research scaling?
#OpenAccess publishing = increased dissemination, citations, etc.
But:
๐ต Median ๐ซ APCs = US$3,000
โ Discounts & waivers limited
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
๐ ghspjournal.org/content/9/4/733
#WHA75
#OpenAccess publishing = increased dissemination, citations, etc.
But:
๐ต Median ๐ซ APCs = US$3,000
โ Discounts & waivers limited
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
๐ ghspjournal.org/content/9/4/733
#WHA75
(51/75) How can #GlobalCardiacSurgery ๐ be facilitated further?
#CTSurgery journals: female (10.5%) & LMIC (5.2%) underrepresentation on editorial boards.
๐ semthorcardiovascsurg.com/article/S1043-โฆ
LMIC editorial board representation ~ LMIC publications.
๐ jamanetwork.com/journals/jamanโฆ
#WHA75
#CTSurgery journals: female (10.5%) & LMIC (5.2%) underrepresentation on editorial boards.
๐ semthorcardiovascsurg.com/article/S1043-โฆ
LMIC editorial board representation ~ LMIC publications.
๐ jamanetwork.com/journals/jamanโฆ
#WHA75
(52/75) How can #GlobalCardiacSurgery interventions be financed beyond traditional ๐ฐ?
Innovative financing instruments (e.g., social impact bonds) may be explored following โ ๏ธโ ๏ธ examples:
๐ #NCDs: gh.bmj.com/content/6/3/e0โฆ
๐ #GlobalSurgery: gh.bmj.com/content/5/6/e0โฆ
#WHA75
Innovative financing instruments (e.g., social impact bonds) may be explored following โ ๏ธโ ๏ธ examples:
๐ #NCDs: gh.bmj.com/content/6/3/e0โฆ
๐ #GlobalSurgery: gh.bmj.com/content/5/6/e0โฆ
#WHA75
(53/75) How can #GlobalCardiacSurgery interventions be facilitated?
Public-private partnerships (#PPP) have been leveraged across #GlobalHealth and ๐ซ medicine, and may be strategically pursued to ๐ถ global #CTSurgery capacity.
๐ hsph.harvard.edu/health-systemsโฆ
#WHA75
Public-private partnerships (#PPP) have been leveraged across #GlobalHealth and ๐ซ medicine, and may be strategically pursued to ๐ถ global #CTSurgery capacity.
๐ hsph.harvard.edu/health-systemsโฆ
#WHA75
(54/75) How can patient outcomes be prioritized within #GlobalCardiacSurgery?
Value-based healthcare (#VBHC) models = โฌ๏ธ patient outcomes whilst โฌ๏ธ resource utilization.
โ ๏ธ VBHC is feasible across settings.
๐ catalyst.nejm.org/doi/abs/10.105โฆ
#WHA75
Value-based healthcare (#VBHC) models = โฌ๏ธ patient outcomes whilst โฌ๏ธ resource utilization.
โ ๏ธ VBHC is feasible across settings.
๐ catalyst.nejm.org/doi/abs/10.105โฆ
#WHA75
(55/75) How can resource utilization be optimized in #GlobalCardiacSurgery?
Underused costing methods, such as time-driven activity-based costing (#TDABC), may:
โ ๏ธ Improve costing
๐ Highlight inefficiencies
๐ Promote M&E for $ + quality
๐ annalsthoracicsurgery.org/article/S0003-โฆ
#WHA75
Underused costing methods, such as time-driven activity-based costing (#TDABC), may:
โ ๏ธ Improve costing
๐ Highlight inefficiencies
๐ Promote M&E for $ + quality
๐ annalsthoracicsurgery.org/article/S0003-โฆ
#WHA75
(56/75) How may #GlobalCardiacSurgery efficiency be maximized from the start?
Regionalization of complex health services, such as #CTSurgery:
๐ค Pools resources
๐ฅ Increases volume
๐ฐ Reduces healthcare costs
โ Improves outcomes
๐ journals.lww.com/co-cardiology/โฆ
#WHA75
Regionalization of complex health services, such as #CTSurgery:
๐ค Pools resources
๐ฅ Increases volume
๐ฐ Reduces healthcare costs
โ Improves outcomes
๐ journals.lww.com/co-cardiology/โฆ
#WHA75
(57/75) How can #GlobalCardiacSurgery fit into national health plans?
#NSOAPs = policy plans to โฌ๏ธ access to surgical healthcare.
#CTSurgery not well incorporated into NSOAPs to date โฉ get seat at the table & strengthen entire #HealthSystem.
๐ thieme-connect.com/products/ejourโฆ
#WHA75
#NSOAPs = policy plans to โฌ๏ธ access to surgical healthcare.
#CTSurgery not well incorporated into NSOAPs to date โฉ get seat at the table & strengthen entire #HealthSystem.
๐ thieme-connect.com/products/ejourโฆ
#WHA75
(58/75) How can #GlobalCardiacSurgery accessibility for patients be ๐ถ?
On the road to #UHC & #NSOAPs, healthcare packages must gradually expand to address most pressing healthcare needs with biggest risks of catastrophic health expenditure.
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
#WHA75
On the road to #UHC & #NSOAPs, healthcare packages must gradually expand to address most pressing healthcare needs with biggest risks of catastrophic health expenditure.
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
#WHA75
(59/75) How can #GlobalCardiacSurgery resources be ๐ถ?
Long, fragmented supply chains hinder availability of surgical equipment & materials (e.g., ๐ซ valves), & often โฌ๏ธ๐ฐ.
Shorter, local, transparent supply chains can โฌ๏ธ costs & stock-outs.
๐ americanjournalofsurgery.com/article/S0002-โฆ
#WHA75
Long, fragmented supply chains hinder availability of surgical equipment & materials (e.g., ๐ซ valves), & often โฌ๏ธ๐ฐ.
Shorter, local, transparent supply chains can โฌ๏ธ costs & stock-outs.
๐ americanjournalofsurgery.com/article/S0002-โฆ
#WHA75
(60/75) Collaboration is ๐, in #GlobalCardiacSurgery and beyond.
๐ซ surgical care spans entire care continuum, from community to hospital & back.
#GlobalSurgery = cross-cutting #HealthSystem intervention, much more than what happens in OR.
๐ bulletin.facs.org/2017/07/latin-โฆ
#WHA75
๐ซ surgical care spans entire care continuum, from community to hospital & back.
#GlobalSurgery = cross-cutting #HealthSystem intervention, much more than what happens in OR.
๐ bulletin.facs.org/2017/07/latin-โฆ
#WHA75
(61/75) How can #GlobalCardiacSurgery become more collaborative?
There is no #SafeSurgery without #SafeAnesthesia, and #CTSurgery is no exception.
๐ Anesthesia workforce = limited globally; ๐ซ anesthesia even fewer.
๐ wfsahq.org/resources/workโฆ @wfsaorg
#WHA75
There is no #SafeSurgery without #SafeAnesthesia, and #CTSurgery is no exception.
๐ Anesthesia workforce = limited globally; ๐ซ anesthesia even fewer.
๐ wfsahq.org/resources/workโฆ @wfsaorg
#WHA75
(62/75) How can #GlobalCardiacSurgery learn from & grow together w/ other specialties?
Neuro-/cardiovascular & #VascSurg greatly share capacity (e.g., imaging, interventions, critical care) & barriers/opportunities.
๐ link.springer.com/chapter/10.100โฆ
๐ heartasia.bmj.com/content/heartaโฆ
#WHA75
Neuro-/cardiovascular & #VascSurg greatly share capacity (e.g., imaging, interventions, critical care) & barriers/opportunities.
๐ link.springer.com/chapter/10.100โฆ
๐ heartasia.bmj.com/content/heartaโฆ
#WHA75
(63/75) How can #GlobalCardiacSurgery benefit from regional collab?
Small Island States (1% ๐ population): Limited ๐ซ surgery โ๏ธ Burden of #RHD etc. โฌ๏ธ
Regional ๐ค (e.g., Asia-Pacific NSOAPs) โฉ #CTSurgery growth?
๐ annalsthoracicsurgery.org/article/S0003-โฆ
๐ gh.bmj.com/content/2/4/e0โฆ
#WHA75
Small Island States (1% ๐ population): Limited ๐ซ surgery โ๏ธ Burden of #RHD etc. โฌ๏ธ
Regional ๐ค (e.g., Asia-Pacific NSOAPs) โฉ #CTSurgery growth?
๐ annalsthoracicsurgery.org/article/S0003-โฆ
๐ gh.bmj.com/content/2/4/e0โฆ
#WHA75
(64/75) Why should #GlobalCardiacSurgery โฌ๏ธ shared learning & co-development in #GlobalSurgery interventions?
Reciprocity โก๏ธ Improve health outcomes everywhere
#CTSurgery examples: #OPCAB, Del Nido cardioplegia, low-cost CT, etc.
๐ jamanetwork.com/journals/jamasโฆ @bc_alkire
#WHA75
Reciprocity โก๏ธ Improve health outcomes everywhere
#CTSurgery examples: #OPCAB, Del Nido cardioplegia, low-cost CT, etc.
๐ jamanetwork.com/journals/jamasโฆ @bc_alkire
#WHA75
(65/75) In which ways should #GlobalCardiacSurgery innovate prior to surgery?
Community-based screening & detection of #CVD remains limited in LMICs + remote โก๏ธ opportunity for handheld echo, task-sharing, and more?
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
๐ sciencedirect.com/science/articlโฆ
#WHA75
Community-based screening & detection of #CVD remains limited in LMICs + remote โก๏ธ opportunity for handheld echo, task-sharing, and more?
๐ ncbi.nlm.nih.gov/pmc/articles/Pโฆ
๐ sciencedirect.com/science/articlโฆ
#WHA75
(66/75) How do diagnostics fit into #GlobalCardiacSurgery?
Diagnostics = essential part of #HealthSystem.
๐ thelancet.com/journals/lanceโฆ
Min. overall needs:
๐ท 20 radiography units per million population
๐ฅ 1 CT scanner per 10 radiography units
๐ link.springer.com/chapter/10.100โฆ
#WHA75
Diagnostics = essential part of #HealthSystem.
๐ thelancet.com/journals/lanceโฆ
Min. overall needs:
๐ท 20 radiography units per million population
๐ฅ 1 CT scanner per 10 radiography units
๐ link.springer.com/chapter/10.100โฆ
#WHA75
(67/75) How does critical care availability fit into #GlobalCardiacSurgery?
Critical care capacity = rate-limiting & life-saving in #CTSurgery.
๐ 96+ countries: <5.0 ICU beds per 100,000 population.
Pandemic = ICU capacity innovation?
๐ sciencedirect.com/science/articlโฆ
#WHA75
Critical care capacity = rate-limiting & life-saving in #CTSurgery.
๐ 96+ countries: <5.0 ICU beds per 100,000 population.
Pandemic = ICU capacity innovation?
๐ sciencedirect.com/science/articlโฆ
#WHA75
(68/75) In which ways can & should #GlobalCardiacSurgery innovate after surgery?
๐ซ rehabilitation + follow-up often โฌ๏ธ & fragmented in variable-resource contexts & remote settings.
โก๏ธ Opportunity for innovative models, telemedicine, & more.
๐ sciencedirect.com/science/articlโฆ
#WHA75
๐ซ rehabilitation + follow-up often โฌ๏ธ & fragmented in variable-resource contexts & remote settings.
โก๏ธ Opportunity for innovative models, telemedicine, & more.
๐ sciencedirect.com/science/articlโฆ
#WHA75
(69/75) What gaps in knowledge persist in #GlobalCardiacSurgery?
๐ท Select gaps & *many* more.
โ ๏ธ Role of/need for clinical epidemiology, health economics, qualitative research, geospatial analysis, anthropology, political science, and more.
๐ ctsnet.org/article/movingโฆ
#WHA75
๐ท Select gaps & *many* more.
โ ๏ธ Role of/need for clinical epidemiology, health economics, qualitative research, geospatial analysis, anthropology, political science, and more.
๐ ctsnet.org/article/movingโฆ
#WHA75
(70/75) What is unknown re: #GlobalCardiacSurgery workforce?
๐ฅ How many/where are cardiologists, ๐ซ nurses, intensivists, perfusionists, technicians ๐?
๐ How many training programs exist for all members of #HeartTeam?
โ๏ธ How far is #CTSurgery from #GenderEquity ๐?
#WHA75
๐ฅ How many/where are cardiologists, ๐ซ nurses, intensivists, perfusionists, technicians ๐?
๐ How many training programs exist for all members of #HeartTeam?
โ๏ธ How far is #CTSurgery from #GenderEquity ๐?
#WHA75
(71/75) What is unknown re: #GlobalCardiacSurgery care delivery?
๐ฅ Outcomes in variable-resource contexts
๐ซ Treatment for neglected #CVD (e.g., #EMF)
โ๏ธ Optimal treatment considering patient context (e.g., mitral valve surgery for #RHD)
๐ journals.lww.com/co-cardiology/โฆ
#WHA75
๐ฅ Outcomes in variable-resource contexts
๐ซ Treatment for neglected #CVD (e.g., #EMF)
โ๏ธ Optimal treatment considering patient context (e.g., mitral valve surgery for #RHD)
๐ journals.lww.com/co-cardiology/โฆ
#WHA75
(72/75) What is unknown re: #GlobalCardiacSurgery financing?
๐ฐ Healthcare $ across system
โ๏ธ Cost-effectiveness across settings
๐ Financial burdens on patients
๐ซ Countriesโ #CTSurgery spending
๐ Innovative financing instruments' impact
๐ link.springer.com/chapter/10.100โฆ
#WHA75
๐ฐ Healthcare $ across system
โ๏ธ Cost-effectiveness across settings
๐ Financial burdens on patients
๐ซ Countriesโ #CTSurgery spending
๐ Innovative financing instruments' impact
๐ link.springer.com/chapter/10.100โฆ
#WHA75
(73/75) What are growing gaps in #GlobalCardiacSurgery?
๐ถ Increasing access to #CTSurgery โก๏ธ (lifelong?) follow-up needs into the last mile.
โ Increased survival โก๏ธ growing ๐ซ care needs.
๐ #ACHD care capacity limited worldwide.
๐ internationaljournalofcardiology.com/article/S0167-โฆ
#WHA75
๐ถ Increasing access to #CTSurgery โก๏ธ (lifelong?) follow-up needs into the last mile.
โ Increased survival โก๏ธ growing ๐ซ care needs.
๐ #ACHD care capacity limited worldwide.
๐ internationaljournalofcardiology.com/article/S0167-โฆ
#WHA75
(74/75) What can never be forgotten in #GlobalCardiacSurgery?
Global = local.
Disparities exist in EVERY country, even with #UHC:
โถ๏ธ Geography
โถ๏ธ Sex & gender
โถ๏ธ Race, ethnicity, Indigeneity, immigration
โถ๏ธ Socioeconomic status
And more.
๐ onlinecjc.ca/article/S0828-โฆ
#WHA75
Global = local.
Disparities exist in EVERY country, even with #UHC:
โถ๏ธ Geography
โถ๏ธ Sex & gender
โถ๏ธ Race, ethnicity, Indigeneity, immigration
โถ๏ธ Socioeconomic status
And more.
๐ onlinecjc.ca/article/S0828-โฆ
#WHA75
(75/75) There is still much to do in #GlobalCardiacSurgery.
It's a privilege to contribute to this growing field w/ support of mentors ๐.
I'm inspired by the #FutureOfTheOR, like @GlobalCardiac & @InciSioNGlobal.
I'm hopeful for a better future.
Action is now needed.
#WHA75
It's a privilege to contribute to this growing field w/ support of mentors ๐.
I'm inspired by the #FutureOfTheOR, like @GlobalCardiac & @InciSioNGlobal.
I'm hopeful for a better future.
Action is now needed.
#WHA75
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