[HSF] Death on waiting list

Tue Apr 17 01:17:56 EDT 2007

Thanks Dave and others,

I've posted this problem just to provide some evidence, supported by Dave's
obeservations. We do not CREATE WLs, but we receive them. From whom? From
the government and from the cardiologists. I am not talking about private
practice, which (one way or another) is independent from official state
health care policy. I don't know if you are aware of this, but here, in the
region of the Eastern Europe (and particularly in Serbia), there is true
epidemic of serious CVD. Rough numbers are: 5000 surgeries (3 centres, 15
fully expirienced and 35 less expirienced surgeons, more than 6 million
population) and 3 times more PCIs annualy (still increasing). Terrible load
of advanced CAD (still about 60% of all cases), late and difficult valvular
HD, acute aortic dissections ... Thus, our WLs are crowded with seriously
ill persons, making our position very difficult, trying to make the most
appropriate (or any) triage. 
Government is trying to explain that such WLs are common thing in even more
developed coutries, and I wanted to provide contra argument, because I think
that main problem is bad organization (small numebr and wrong distribution
of centres, as well as very small number of surgeons ... Etc). Moreover,
there is still no private cardiac sugery here. Seems that Francis Robicsek
was right, asking: "Is cheap medicine good medicine?"

Mladen

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-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of David Harris
Sent: 16. april 2007 23:41
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Death on waiting list

In South Africa the waiting list in the state hospitals are anything from 4
to 10 months, depending on the region...very, very frustrating, and I
estimate the mortality is not more than 10%, from the records we kept. It is
interesting that the patients already have waited 6 months to a year before
getting to the cardiology clinic. Patients with mainstems, severe coronary
disease with ischaemic cardiomyopathy, AS with gradients in the 100`s are
more often than not still around after a year. They will usually then
present as emergencies, and then get priority, so usually not die.

In the private sector, where I now do most of my work, the wait depends on
the surgeon. We are pushed to do healthy elective patients on the same day
by the cardiologists,but always wait at least until the next day, unless its
really urgent. We generally try to rather get them home for a few days. It
is good to let the contrast clear out, and our feeling is that you may get
less of a surgical inflammatory response by waiting. Just track the
creatinine and CRP for 3 days.
We all know about the creat, but watch the CRP go over 150 in some cases.
Also, there is often an enzyme leak post angio, usually because the
cardiologist has been trying to wedge in a stent, and this may end up with a
resus! All without your knowledge. You should hang around the cath lab a
bit, and see how unstable the cardiologists can make them. So we wait a bit,
from what we have seen, a few days does more good than harm.

We often comment on how much easier the patients are in private practice,
and in the state hospital a `routine` case is often referred to as a
`private patient`.

The long waiting lists are horrific, as patients are often cancelled a few
times due to more emergent cases jumping the list. The system is a
reflection of the state spending less money on health, trying to maintain
control on health systems, and simply the usual consequence of a state run,
inefficient department.

Dave Harris

--- Ben Bidstrup <benjamin.bidstrup at bigpond.com>
wrote:

> But does that give the team time to fully assess the patient?
> 
> >In Israel the waiting time is about the time it
> takes our Blood Bank
> >to prepare 2 units of cross-matched packed cells...
> >
> >Jay Lavee
> >
> >----- Original Message ----- From: "Salerno, Tomas"
> <TSalerno at med.miami.edu>
> >To: <OpenHeart-L at lists.hsforum.com>;
> <OpenHeart-L at lists.hsforum.com>
> >Sent: Monday, April 16, 2007 7:35 AM
> >Subject: RE: [HSF] Death on waiting list
> >
> >>waiting lists in the USA are in general about one
> hour
> >>
> >>TS
> >>
> >>________________________________
> >>
> >>From: openheart-l-bounces at lists.hsforum.com on
> behalf of Tea Acuff
> >>Sent: Mon 4/16/2007 12:32 AM
> >>To: OpenHeart-L at lists.hsforum.com
> >>Subject: Re: [HSF] Death on waiting list
> >>
> >>
> >>
> >>About the only waiting going on in the United
> States of America (no
> >>ugly "American" short hand) is over the weekend.
> Excepting the
> >>Veterans Administration Hospitals of course.
> >>tea edward acuff junior medical doctor
> >>
> >>
> >>----- Original Message ----
> >>From: Tina i Mladen Kocica <kocica at sezampro.yu>
> >>To: OpenHeart-L at lists.hsforum.com
> >>Sent: Sunday, April 15, 2007 9:59:59 PM
> >>Subject: [HSF] Death on waiting list
> >>
> >>
> >>Our heart surgery waiting lists (WL), here in
> Serbia, are permanently
> >>growing, with today average of about 1000 people
> per centre annualy. It
> >>seems that we do not make them properly, since
> death rate on WL is also
> >>permanetly increasing (from 8% three years ago to
> 15% last year).
> >>Questions:
> >>1) General opinion about WL for heart surgery
> (ethics)?
> >>2) Criteria? Who makes them?
> >>3) Your annual WL load?
> >>4) Your WL mortality?
> >>
> >>Regards,
> >>Mladen
> >>
> >>Mladen J. Kocica, M.D.
> >>
> >>Clinic for Cardiac Surgery
> >>
> >>Institute for Cardiovascular Diseases
> >>
> >>UC Clinical Centre of Serbia
> >>
> >>8th Kosta Todorovic St.
> >>
> >>11000 Belgrade
> >>
> >>Serbia
> >>
> >>Tel: + 381 (11) 3670609
> >>
> >>Fax: + 381 (11) 3610880
> >>
> >>E-mail:  <mailto:kocica at sezampro.yu>
> kocica at sezampro.yu
> >>
> >>URL:  <http://www.kocica.org/> www.kocica.org
> >>
> >>URL:  <http://www.ctsnet.org/home/mkocica>
> www.ctsnet.org/home/mkocica
> >>
> >>URL:  <http://www.srscvs.org/> www.srscvs.org
> >>
> >>
> >>
> >>
> >>
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> 
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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=== message truncated ===

Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587
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