Related Experiment Video
Updated: Jun 28, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Factors Associated With Lack of Long-Term Follow-Up Data After Global Cardiac Surgery Missions
Christine M Lannon1,2, Nadine Nuchovich2, Clauden Louis2,3
1Texas A&M School of Engineering Medicine, Houston, TX, USA.
Insights
Follow-up rates in cardiac surgery missions are low (14.7%) and depend more on mission location and surgical intervention type than patient socioeconomic factors. Missions need tailored strategies to improve long-term patient follow-up.
Area of Science:
- Global Health
- Cardiovascular Surgery
- Health Services Research
Background:
- Humanitarian medical missions aim to improve cardiac surgery access in low- and middle-income countries.
- Limited evidence exists regarding factors affecting long-term patient follow-up data in these missions.
- This study investigates determinants of patient follow-up after cardiac surgery missions.
Purpose of the Study:
- To analyze factors influencing long-term patient follow-ups in repeated short-term cardiac surgery missions.
- To identify demographic, socioeconomic, and surgical predictors of follow-up success.
- To inform strategies for improving post-mission patient care and data collection.
Main Methods:
- Retrospective analysis of CardioStart International's database (RedCap).
- Inclusion of 550 pediatric and adult patients undergoing cardiac surgery.
- Investigation of 11 socioeconomic indicators and surgical variables.
Main Results:
- Overall follow-up rate was 14.7%, with significant geographic variation (e.g., Dominican Republic 30.4%, Vietnam 43.2%, Brazil/Nepal/Tanzania 0%).
- Socioeconomic factors, except phone access (negatively correlated), were largely insignificant.
- Congenital heart defect patients with higher Risk Adjusted Congenital Heart Surgery scores showed better follow-up; ventricular septal defects had higher rates than atrial septal defects.
Conclusions:
- Patient follow-up is primarily influenced by mission-specific factors like location and intervention type, not socioeconomic status.
- Site-specific barriers require tailored organizational policies and resource allocation to enhance follow-up.
- Future missions should adapt strategies based on location and surgical complexity to improve long-term outcomes.
Abstract:
Background: Humanitarian medical missions attempt to lessen the burden of limited access to cardiac surgery in low- and middle-income countries. While organizations express difficulties obtaining follow-up information, there is currently little evidence to support the various assumptions for lack of data. This study examines the factors influencing long-term patient follow-ups on repeated short-term cardiac surgery missions across nine countries. Methods: A retrospective analysis of CardioStart International's database (RedCap) was conducted to investigate demographic, socioeconomic, and surgical factors associated with follow-ups. Results: A total of 550 pediatric (50%) and adult (50%) cardiac surgery patients displayed a follow-up rate of 14.7%, with no significant difference between populations (P = 1). Mean follow-up time was 1.5 years postoperative. Countries were highly variable, with Dominican Republic and Vietnam showing follow-up rates of 30.4% and 43.2%, respectively, while Brazil, Nepal, and Tanzania had no follow-ups (P < 0.0001). The 11 surrogate factors for socioeconomic status, including home amenities and technology access, were predominantly insignificant, with the exception of phone access showing an unexpectedly decreased follow-up rate (11.6%, P = 0.006). Surgical intervention was a significant factor (P = 0.009). No adult cardiac surgery trends were noted; however, congenital cases demonstrated increased follow-ups in patients with higher Risk Adjusted Congenital Heart Surgery scores, with ventricular septal defects (32.5%) exceeding atrial septal defects (7.3%). Conclusions: Follow-ups correlate with mission factors, including location and types of intervention, more so than previously assumed socioeconomic and technological factors. Thus, certain missions may require more allocation of resources and adapted organizational policies to overcome site-specific barriers to follow-up.
