Abstract
Background:Low- and-middle-income-countries (LMICs) currently bear 80% of the world’s cardiovascular disease (CVD) mortality burden. The same countries are underequipped to handle the disease burden due to critical shortage of resources. Functional cardiac catheterization laboratories (cath labs) are central in the diagnosis and management of CVDs. Yet, most LMICs, including Uganda, fall remarkably below the minimum recommended standards of cath lab:population ratio due to a host of factors including the start-up and recurring costs.Objectives:To review the performance, challenges and solutions employed, lessons learned, and projections for the future for a single cath lab that has been serving the Ugandan population of 40 million people in the past eight years.Methods:A retrospective review of the Uganda Heart Institute cath lab clinical database from 15 February 2012 to 31 December 2019 was performed.Results:In the initial two years, this cath lab was dependent on skills transfer camps by visiting expert teams, but currently, Ugandan resident specialists independently operate this lab. 3,542 adult and pediatric procedures were conducted in 8 years, including coronary angiograms and percutaneous coronary interventions, device implantations, valvuloplasties, and cardiac defect closures, among others. There was a consistent expansion of the spectrum of procedures conducted in this cath lab each year. The initial lack of technical expertise and sourcing for equipment, as well as the continual need for sundries present(ed) major roadblocks. Government support and leveraging existing multi-level collaborations has provided a platform for several solutions. Sustainability of cath lab services remains a significant challenge especially in relation to the high cost of sundries and other consumables amidst a limited budget.Conclusion:A practical example of how centers in LMIC can set up and sustain a public cardiac catheterization laboratory is presented. Government support, research, and training collaborations, if present, become invaluable leverage opportunities.
Highlights
Low- and-middle-income-countries (LMICs) currently bear 80% of the world’s cardiovascular disease (CVD) mortality burden
That figure is about 30%, with 80% of the burden occurring in low- and middle-income countries (LMIC) [1,2,3,4,5]
The objective of this study is to review the eight-year journey of running a single cardiac catheterization laboratory in Uganda, while paying particular attention to the procedures performed, the lessons learned, the challenges surmounted, and the projections for the future
Summary
Low- and-middle-income-countries (LMICs) currently bear 80% of the world’s cardiovascular disease (CVD) mortality burden. LMIC, including Uganda, are underequipped to handle this burden in the setting of limited diagnostic and therapeutic equipment, limited availability of highly specialized personnel, constrained national budgets, and multiple competing national priorities, among other significant limitations [3]. These challenges partially explain the high premature mortality and morbidity in LMICs in relation to cardiovascular diseases [5]. Rheumatic heart disease (RHD) is still the leading cause of cardiovascular mortality and morbidity among young adults in developing countries, including Uganda [7]. Rheumatic mitral valve stenosis, which is very poorly tolerated ( during pregnancy) and other conditions that exert stress on an individual’s hemodynamics, can often be treated in the cath lab
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