The Cape Town Declaration on access to cardiac surgery in the developing world

THE CAPE TOWN DECLARATION The Cape Town Declaration on access to cardiac surgery in the developing world This article is copublished in The Annals of Thoracic Surgery, Asian Cardiovascular and Thoracic Annals, Cardiovascular Journal of Africa, Chinese Circulation Journal, European Journal of Cardio-Thoracic Surgery, The Journal of Thoracic and Cardiovascular Surgery, Polish Journal of Thoracic and Cardiovascular Surgery, South African Heart Journal and South African Medical Journal. THE MISSION Peter Zilla*, R. Morton Bolman#, Magdi H. Yacoub†, Friedhelm Beyersdorf ‡, Karen Sliwa◊, Liesl Zühlke§, Robert S.D. HigginsΔ, Bongani Mayosi+, Alain Carpentier∫ and David Williams∞ * 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 lifesaving cardiac surgery. SAHeart 2018;15:190-194 Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa # Division of Cardiothoracic Surgery, University of Vermont, Burlington, Vermont, United States of America † ‡ Chain of Hope, Chelsea, London, United Kingdom Department of Cardiovascular Surgery, Universitäts-Herzzentrum © 2018 by STS, AATS, Clinics Cardive Publishing (Pty) Ltd., EACTS, National Center of Cardiovascular Disease, Polish Society of Cardiothoracic Surgeons, SAGE Publications Ltd., SA Heart, and SAMJ. Freiburg – Bad Krotzingen, Freiburg, Germany ◊ Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa § Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa over the world issued the “Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Department of Surgery, Johns Hopkins Medicine, Baltimore, Africa,” calling on the world community to address the Maryland, United States of America prevention and treatment of rheumatic heart disease (RHD) Faculty of Health Sciences, University of Cape Town, Cape Town, through improving living conditions, to develop pilot pro- South Africa grammes at selected sites for control of rheumatic fever and Δ + Twelve years after cardiologists and cardiac surgeons from all ∫ Hǒpital Europeen Georges Pompidou, Paris, France ∞ Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America 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 Address for correspondence: than 80% of the world population live. Globally equal in Dr Peter Zilla prevalence to human immunodeficiency virus infection, RHD University of Cape Town/Groote Schuur Hospital affects 33 million people worldwide.(2) Chris Barnard Division of Cardiothoracic Surgery Chris Barnard Building 3rd Floor 3 Anzio Road Observatory 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 Cape Town life-saving cardiac surgery is woefully absent in many endemic 7925 regions. In this declaration, we propose a framework structure South Africa to create a coordinated and transparent international alliance to address this inequality. Email: Elimination of RHD and relief from its debilitating consequences can only occur through interdisciplinary effort, as outlined in the Cairo Accord.(3) Previous initiatives have focused on primary 190 Volume 15 Number 3 2018 and secondary prevention of RHD.(4) Their declarations have AIM 1 been recognised by the Heads of State of African Union To establish an international working group (coalition) of countries and by the World Health Organisation. This recog- individuals from cardiac surgery societies and representatives nition has been important in developing recommendations by from industry, cardiology, and government to evaluate and the World Health Organisation Executive Board to the 2018 endorse the development of cardiac care in low- to middle- World Health Assembly to enlist global commitment to RHD. income countries. Progress in prevention of RHD has been slow during the past 15 years,(5) and thus, surgery will likely remain an integral part of RHD treatment for several generations. Lack of access to cardiac surgery services and the cost of valve replacement render this disease fatal for millions of patients. In endemic regions of low-income countries, the need for cardiac surgery It is proposed that the international coalition will have 2 representatives from each of the major cardiac surgery societies (The Society of Thoracic Surgeons, American Association for Thoracic Surgery, European Association for Cardio-Thoracic Surgery, The Asian Society for Cardiovascular and Thoracic Surgery), and ideally, 2 additional committed members. There will be at least 1 representative from industry and at least 1 is estimated at 300 operations per 1 million population, yet, appointee to represent cardiology/the World Heart Federa- the nearly 1 billion people living in Sub-Saharan Africa between tion. The responsibilities of the Coalition will include establish- the Maghreb and South Africa have access to only 22 cardiac ing criteria for centers for clinical care and training as well as centers.(7) Although there is 1 cardiac center per 120 000 selecting and endorsing the centers. The Coalition will derive people in the United States, there is only 1 center per 33 metrics of quality and performance for the endorsed centers million in Africa. Furthermore, RHD is not restricted to Sub- of training and clinical care and will encourage standardisation Saharan Africa. India, Pakistan, China, and Indonesia together of care to the extent possible. account for 72% of mortality of RHD cases worldwide. (2) The Coalition will advocate mutually agreed policies and We strongly endorse the position that building local capacity is prescriptions to relevant governmental bodies. In addition, the the best solution for this serious public health problem. Many Coalition will engage industry and private sources of philan- lives have been saved by humanitarian “fly-in” missions, but thropy for financial assistance with large-scale initiatives. these efforts are neither sustainable nor cost-effective. The non-governmental organisations associated with these pro- AIM 2 grammes are shifting focus toward building long-term partner- To advocate for the training of cardiac surgeons and other key ships with host countr (...truncated)