Prenatal diagnosis lowers neonatal cardiac care costs in resource-limited settings

Background: Prenatal diagnosis of critical CHDs and planned peripartum care is an emerging concept in resource-limited settings. Objective: To report the impact of prenatal diagnosis and planned peripartum care on costs of neonatal cardiac care in a resource-limited setting. Methods: Prospective study (October 2019 to October 2020). Consecutive neonates undergoing surgery or catheter-based interventions included. Patients were divided into prenatal (prenatal diagnosis) and post-natal (diagnosis after birth) groups. Costs of cardiac care (total, direct, and indirect) and health expenses to income ratio were compared between study groups; factors impacting costs were analysed. Results: A total of 105 neonates were included, including 33 in prenatal group. Seventy-seven neonates (73.3%) underwent surgical procedures while the rest needed catheter-based interventions. Total costs were 16.2% lower in the prenatal group (p = 0.008). Direct costs were significantly lower in the prenatal group (18%; p = 0.02), especially in neonates undergoing surgery (20.4% lower; p = 0.001). Health expenses to income ratio was also significantly lower in the prenatal group (2.04 (1.03–2.66) versus post-natal:2.58 (1.55–5.63), p = 0.01);, particularly in patients undergoing surgery (prenatal: 1.58 (1.03–2.66) vs. post-natal: 2.99 (1.91–6.02); p = 0.002). Prenatal diagnosis emerged as the only modifiable factor impacting costs on multivariate analysis. Conclusion: Prenatal diagnosis and planned peripartum care of critical CHD is feasible in resource-limited settings and is associated with significantly lower costs of neonatal cardiac care. The dual benefit of improved clinical outcomes and lower costs of cardiac care should encourage policymakers in resource-limited settings towards developing more prenatal cardiac services.

Cost analysis of treating cardiovascular diseases in a super-specialty hospital

Cardiovascular care is expensive; hence, economic evaluation is required to estimate resources being consumed and to ensure their optimal utilization. There is dearth of data regarding cost analysis of treating various diseases including cardiac diseases from developing countries. The study aimed to analyze resource consumption in treating cardio-vascular disease patients in a super-specialty hospital. An observational and descriptive study was carried out from April 2017 to June 2018 in the Department of Cardiology, Cardio-Thoracic (CT) Centre of All India Institute of Medical Sciences, New Delhi, India. As per World Health Organization, common cardiovascular diseases i.e. Coronary Artery Disease (CAD), Rheumatic Heart Disease (RHD), Cardiomyopathy, Congenital heart diseases, Cardiac Arrhythmias etc. were considered for cost analysis. Medical records of 100 admitted patients (Ward & Cardiac Care Unit) of cardiovascular diseases were studied till discharge and number of patient records for a particular CVD was identified using prevalence-based ratio of admitted CVD patient data. Traditional Costing and Time Driven Activity Based Costing (TDABC) methods were used for cost computation. Per bed per day cost incurred by the hospital for admitted patients in Cardiac Care Unit, adult and pediatric cardiology ward was calculated to be Indian Rupee (INR) 28,144 (US$ 434), INR 22,210 (US$ 342) and INR 18,774 (US$ 289), respectively. Inpatient cost constituted almost 70% of the total cost and equipment cost accounted for more than 50% of the inpatient cost followed by human resource cost (28%). Per patient cost of treating any CVD was computed to be INR 2,47,822 (US $ 3842). Cost of treating Rheumatic Heart Disease was the highest among all CVDs followed by Cardiomyopathy and other CVDs. Cost of treating cardiovascular diseases in India is less than what has been reported in developed countries. Findings of this study would aid policy makers considering recent radical changes and massive policy reforms ushered in by the Government of India in healthcare delivery.

A Case Study in Micro-Learning and Alternate Credentials Before Their Time

In this chapter, the journey of how the Cardiac Care on the Web online program came to be will be described, along with how the guiding principles framing the program development and delivery, as applied more than 20 years ago, still hold relevance today. Furthermore, how the program's micro-credential status has been sustained and has paved the way for micro-certifications at Laurentian University today will be discussed. Finally, this case study offers the authors the chance to review past and present literature and to reflect on next steps for Cardiac Care on the Web given the present emergence of micro-credentials in digital format.

Case Report: Traumatic Stress and Developmental Regression: An Unintended Consequence of Complex Cardiac Care

This brief case report outlines a novel approach to supporting the development of a pediatric complex cardiac care patient. Patient X is a 19-month old patient who spent 5.5 months in hospital and underwent multiple surgeries including heart transplantation. This case report explores the impacts of his condition and care on his development and family functioning within the framework of an integrated care model. This case report is uniquely complimented by outpatient neurodevelopmental follow up, dyadic trauma-informed intervention and use of telemedicine allowing for a deeper understanding of the family adaptation that provide novel insight into long-term trajectory beyond discharge. Throughout care Patient X met criteria for both a traumatic stress disorder and global developmental delay. This case study highlights the threat complex care poses to neurodevelopment, pediatric mental health and family dynamics as well as opportunities for intervention.

Association of Total Ischemic Times and In-Hospital Outcomes of Acute STEMI Patients who Underwent Primary Angioplasty at a Tertiary Cardiac Care Facility

Aims: To determine the association between total ischemic time and in-hospital outcome of acute ST elevation myocardial infarction (STEMI) patients who underwent primary angioplasty. Study Design: Prospective observational study. Place & Duration of Study: Department of Cardiology, Dow university of health sciences Karachi between October 2017 till March 2021. Methodology: Data for total ischemic time analysis were collected from 366 STEMI patients who consecutively underwent primary angioplasty. Total ischemic time was measured from the onset of chest pain to o the first balloon inflation during primary angioplasty and in hospital outcome was measured. Results: Total ischemic times were available in 366 STEMI patients which was ≥ 30 minutes and < 24 hours: ≤ 2 hours in 15.5%, >2-3 hours in 11.4%, >3-5 hours in 25.4%, and >5 hours in 47.5% of STEMI patients. In addition, STEMI patients with total ischemic times <5 hours demonstrated complete ST-segment resolution and reduced death rate than those with total ischemic times >5 hours. Conclusion: This study showed that shorter ischemic times are significantly related to improved myocardial reperfusion and decreased mortality.