Adult and Paediatric Cardiac Intervention in Timor-Leste: Disease Burden, Demographics and Clinical Outcomes

• Published in: Heart, lung & circulation lung & circulation, 2020-08, Vol.29 (8), p.1112-1121
• Main Authors: Paratz, Elizabeth D., Mock, Nicki, Cochrane, Andrew, Harper, Richard W., Larobina, Marco, Wilson, William M., Appelbe, Alan, Eggleton, Simon, Kushwaha, Virag V., da Silva Almeida, Inez T., Monteiro, Andre, Bayley, Noel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cardiac Surgical Procedures; Cardiology; Child; Child, Preschool; Congenital heart disease; Cost of Illness; Female; Heart Defects, Congenital - economics; Heart Defects, Congenital - epidemiology; Heart Defects, Congenital - surgery; Humans; Incidence; Male; Mass Screening - methods; Middle Aged; Retrospective Studies; Rheumatic heart disease; Rheumatic Heart Disease - economics; Rheumatic Heart Disease - epidemiology; Rheumatic Heart Disease - surgery; Surgery; Timor-Leste; Timor-Leste - epidemiology; Young Adult
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2019.10.008

The East Timor Hearts Fund (ETHF) is a charitable organisation of Australian cardiologists providing outreach screening in Timor-Leste. For patients requiring intervention, ETHF arranges logistics, procedures, and postoperative care. The aim of this project is to evaluate outcomes of patients requiring intervention. The ETHF database of all patients was utilised to identify patients with disease warranting surgical or percutaneous intervention. Both patients who underwent intervention and those who did not proceed to intervention were included in this study. Patients who had intervention arranged by other organisations but have then had follow-up with ETHF were also included. Overall demographics and pre and postoperative factors were assessed, with sub-group analysis of adult and paediatric patients to identify any differences in care. Of 221 patients requiring intervention, 101 patients underwent intervention, receiving 22 different operations or procedures. Patients were predominantly young (median age 17.5 years) and female (64.7%), with rheumatic heart disease (63.8%). Twenty-four (24) (33.3%) women aged 15–45 years old with cardiac disease warranting intervention were documented as pregnant or breastfeeding at time of clinic assessment. Of patients who did not proceed to intervention, adults were more likely to be lost to follow-up (42.4% vs 18.5%) while paediatric patients were more likely to experience progression of disease (18.5% vs 7.5%, p=0.005). Median waitlist time was 5 months, with no significant difference between adults and children, correlating with a preoperative mortality rate of 5.4%. For patients who underwent intervention, post-procedure mortality was extremely low (0.9%) and attendance of at least one post-procedure review was excellent (99.0%). Eleven (11) (10.9%) patients have required repeat intervention, with no difference in rates between adult and paediatric patients. Length of follow-up extends up to 20 years for some patients. The Timor-Leste interventional cohort was predominantly a young female population with rheumatic and congenital cardiac disease. There were also high rates of pregnancy amongst female patients with severe cardiac disease. Delayed access to intervention may result in preoperative adverse events and mortality, and is a key target for improvement. Patients who undergo intervention have very low post-procedural mortality, good adherence to early medical follow-up and good long-term outcomes.