Cardiac Surgery to Manage Rheumatic Heart Disease in Africa Is Complex - a Geographic Perspective.

Background: Rheumatic heart disease (RHD) is the most common form of acquired heart disease in Africa, often requiring surgical intervention. Previous studies have demonstrated the need for more cardiac surgeons in Africa but have not outlined their distribution relative to populations and incident cases. Objective: We estimate rheumatic heart disease incidence and cardiac surgical capacity to manage RHD in Africa. By characterizing geographic catchment areas served by the nearest cardiac surgeon(s), we estimate patient travel distance and the unmet surgical need. Methods: Subnational population, RHD incidence, cardiac surgeon, and geographic data were collected from credible, publicly accessible sources. Quantum Geographic Information System (QGIS 3.32) was used to create a subnational map of Africa and conduct nearest neighbor analyses to determine the location and distance of each subnational region's nearest cardiac surgeon. Catchment areas were defined and characterized. Incident RHD case-to-capacity ratios (ICCR) and surgical need were calculated. Incident RHD and surgical need were mapped at the subnational level across Africa. The human development index (HDI) of each region was then incorporated to assess the impact of socioeconomic disparities. Results: A total of 779 subnational regions from 54 countries were included in the analysis. The African continent has an estimated 509 cardiac surgeons practicing in 74 subnational regions (corresponding to 74 catchment areas) and 1,027,974 incident cases of RHD annually. The average distance to travel for care by a cardiac surgeon was found to be 312.01 km (193.87 miles). The ICCR due to RHD for the African continent was 10.64. Conclusions: Access to cardiac surgical care is limited across Africa despite the high incidence of RHD. While nearly all areas of the continent would benefit from increasing cardiac surgical capacity, attention should be paid towards strategic development of geographically accessible cardiac surgical centers to equitize care for RHD.