The Cape Town Declaration on Access to Cardiac Surgery in the Developing World

Peter Zilla,R Morton Bolman,Magdi H Yacoub,Friedhelm Beyersdorf,Karen Sliwa,Liesl Zühlke,Robert S.D Higgins,Bongani Mayosi,Alain Carpentier,David Williams

doi:10.1016/j.athoracsur.2018.05.020

Abstract

Twelve years after cardiologists and cardiac surgeons from all over the world issued the ‘Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa’, calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and RHD, and to periodically review progress made and challenges that remain, RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world population live. Globally equal in prevalence to human immunodeficiency virus infection, RHD affects 33 million people worldwide. Prevention efforts have been important but have failed to eradicate the disease. At the present time, the only effective treatment for symptomatic RHD is open heart surgery, yet that life-saving cardiac surgery is woefully absent in many endemic regions. In this declaration, we propose a framework structure to create a co-ordinated and transparent international alliance to address this inequality.

Highlights

Mission: to urge all relevant entities within the international cardiac surgery, industry and government sectors to commit to develop and implement an effective strategy to address the scourge of rheumatic heart disease in the developing world through increased access to life-saving cardiac surgery
Twelve years after cardiologists and cardiac surgeons from all over the world issued the Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa, calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and rheumatic heart disease, and to periodically review progress made and challenges that remain,[1] RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world’s population live
In endemic regions of low-income countries, the need for cardiac surgery is estimated at 300 operations per one million population (Global Unmet Needs in Cardiac Surgery, unpublished work by Zilla and colleagues), yet, the nearly one billion people living in sub-Saharan Africa between the Maghreb and South Africa have access to only 22 cardiac centres.[6]

Summary

Introduction

Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Peter Zilla, MD, PhD, peter.zilla@uct.ac.za Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Karen Sliwa, MD, PhD

Results

Conclusion