A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India

Background: Congenital heart disease (CHD) has emerged as a leading contributor to infant mortality in many low-and middle-income countries (LMICs). We report early results of a population health program for CHD, implemented in the state of Kerala, India. Objective: Report on early results of a popu...

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Autores principales:	Sreehari M. Nair, Bistra Zheleva, Adriana Dobrzycka, Peter Hesslein, Rajeev Sadanandan, R. Krishna Kumar
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	congenital heart disease congenital heart surgery population health newborn screening Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/0525678f750945298014f6cf57782544
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spelling	oai:doaj.org-article:0525678f750945298014f6cf577825442021-11-08T08:07:54ZA Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India2211-817910.5334/gh.1034https://doaj.org/article/0525678f750945298014f6cf577825442021-10-01T00:00:00Zhttps://globalheartjournal.com/articles/1034https://doaj.org/toc/2211-8179Background: Congenital heart disease (CHD) has emerged as a leading contributor to infant mortality in many low-and middle-income countries (LMICs). We report early results of a population health program for CHD, implemented in the state of Kerala, India. Objective: Report on early results of a population-based program implementation in a LMIC to reduce mortality from CHD. Methods: We retrospectively analyzed the results of an innovative population-based program to address CHD. We devised, implemented and evaluated measures in the care continuum to address deficiencies in CHD care in Kerala, India, through structured capacity building initiatives that enabled early detection, prompt stabilization and expedited referral to a tertiary center. A comprehensive web-based application enabled real-time case registration, prioritization of treatment referrals, and tracking every child registered with CHD. Advanced pediatric heart care was delivered through a public-private partnership. Results: Early identification, referral, and treatment of infants with CHD were improved. The web-based application, ‘'Hridyam',’ registered 502 cases in 2017 (Aug–Dec), 2190 in 2018 and 3259 in 2019; infants < 1 year of age constituted 56, 62 and 63% in these years, respectively. The number of heart operations managed through 'Hridyam' rose from 208 to 624 and 1227 in the same years, with overall 30-day mortality of 2.4%. Overall- and CHD-related infant mortality in Kerala fell by 21.1% and 41.0%, respectively, over the same interval. Unmet challenges include lack of universal catchment and a 5% preoperative mortality rate. Conclusion: We demonstrate successful implementation of a population-based and real-time approach to reduce CHD mortality. We speculate that 'Hridyam' has contributed to the observed decline in Kerala’s IMR from 12 to 7 between 2016 and 2019. This model has potential applications for other conditions, and in other jurisdictions, especially LMICs considering building CHD capacity.Sreehari M. NairBistra ZhelevaAdriana DobrzyckaPeter HessleinRajeev SadanandanR. Krishna KumarUbiquity Pressarticlecongenital heart diseasecongenital heart surgerypopulation healthnewborn screeningDiseases of the circulatory (Cardiovascular) systemRC666-701Public aspects of medicineRA1-1270ENGlobal Heart, Vol 16, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	congenital heart disease congenital heart surgery population health newborn screening Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270
spellingShingle	congenital heart disease congenital heart surgery population health newborn screening Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270 Sreehari M. Nair Bistra Zheleva Adriana Dobrzycka Peter Hesslein Rajeev Sadanandan R. Krishna Kumar A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India
description	Background: Congenital heart disease (CHD) has emerged as a leading contributor to infant mortality in many low-and middle-income countries (LMICs). We report early results of a population health program for CHD, implemented in the state of Kerala, India. Objective: Report on early results of a population-based program implementation in a LMIC to reduce mortality from CHD. Methods: We retrospectively analyzed the results of an innovative population-based program to address CHD. We devised, implemented and evaluated measures in the care continuum to address deficiencies in CHD care in Kerala, India, through structured capacity building initiatives that enabled early detection, prompt stabilization and expedited referral to a tertiary center. A comprehensive web-based application enabled real-time case registration, prioritization of treatment referrals, and tracking every child registered with CHD. Advanced pediatric heart care was delivered through a public-private partnership. Results: Early identification, referral, and treatment of infants with CHD were improved. The web-based application, ‘'Hridyam',’ registered 502 cases in 2017 (Aug–Dec), 2190 in 2018 and 3259 in 2019; infants < 1 year of age constituted 56, 62 and 63% in these years, respectively. The number of heart operations managed through 'Hridyam' rose from 208 to 624 and 1227 in the same years, with overall 30-day mortality of 2.4%. Overall- and CHD-related infant mortality in Kerala fell by 21.1% and 41.0%, respectively, over the same interval. Unmet challenges include lack of universal catchment and a 5% preoperative mortality rate. Conclusion: We demonstrate successful implementation of a population-based and real-time approach to reduce CHD mortality. We speculate that 'Hridyam' has contributed to the observed decline in Kerala’s IMR from 12 to 7 between 2016 and 2019. This model has potential applications for other conditions, and in other jurisdictions, especially LMICs considering building CHD capacity.
format	article
author	Sreehari M. Nair Bistra Zheleva Adriana Dobrzycka Peter Hesslein Rajeev Sadanandan R. Krishna Kumar
author_facet	Sreehari M. Nair Bistra Zheleva Adriana Dobrzycka Peter Hesslein Rajeev Sadanandan R. Krishna Kumar
author_sort	Sreehari M. Nair
title	A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India
title_short	A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India
title_full	A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India
title_fullStr	A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India
title_full_unstemmed	A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India
title_sort	population health approach to address the burden of congenital heart disease in kerala, india
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/0525678f750945298014f6cf57782544
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A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India

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