State of Assisting Children with Cardiorheumatological Pathology
Pediatric cardiorheumatology was and remains one of the most difficult problems of modern pediatric science and practice, due to rising incidence of circulatory diseases, congenital heart disease and pathology of the musculoskeletal system in children and adolescents. This places pediatric cardiorheumatologists, children’s doctors and general practitioners before important challenges of early diagnosis, treatment and prevention of cardiovascular pathology.
In Ukraine, the situation with cardiovascular diseases (CVD) in the general population is difficult, because in the structure of mortality and disability of working population of Ukraine, heart and blood vessel diseases make up more than 65 %.
From the standpoint of evidence-based medicine and in epidemiological studies, there have been shown that one of the most significant factors determining mortality of working age population is increased blood pressure. Vascular dysfunction in childhood with a high probability transform into ischemic and hypertensive disease at a young age.
Last year in Ukraine there were registered 2,821 (in 2012 — 4,029) babies with essential hypertension — 0.37 per 1,000 children, and must be a lot more, especially among adolescents.
So, you can not solve the problem of adult morbidity without solving the task of early detection, treatment and prevention of cardiac pathology in childhood.
Heart disease rate is also characterized by further progression in the population, in 2014 it was 8.74 per 1,000 children, or 66,391 new CVD events (in 2013 — 79,144, or 9.9 new cases per 1,000 children). Their prevalence among children aged 0–17 years last year amounted to 263.3 thousand of cases (in 2013 — 309.8 thousand of cases), or 34.67 per 1,000 children.
This decrease is likely caused by incomplete statistical information coming to the Center of Medical Statistics of the Ministry of Healthcare of Ukraine due to the socio-economic situation in the Donbas and Crimea annexation. Obviously, a certain role is played by a decrease in suspicion of CVD and congenital heart defects (CHD) in some regions.
The share of CVD is 2.02 % of the total number of childhood diseases.
The number of newly diagnosed cases of cardiovascular diseases is highest in adolescence — 16.24 per 1,000 children. It is a well-known fact that this pathology in this age group of children, together with other factors (obesity, lack of exercise, smoking, chronic infection foci) is the basis for the formation of cardiovascular morbidity in adults. Compared with last year, the morbidity rate in all age cohorts of children, who have been diagnosed with heart and blood vessel diseases, decreased.
Mortality rate due to circulatory diseases among children in 2014 decreased to 0.183 per 10,000 children — in total, 139 children died due to cardiovascular diseases, of them 54 were under 1 year of age (in 2013, 157 children died due to CVD (0.197 per 10,000 population), of them 72 were under 1 year of age). Children from the cities die of CVD more often than children from rural areas — 86 cases against 53 (in 2013 — 92 cases against 65).
The highest death rates from cardiovascular diseases in children were in Transcarpathian, Chernivtsi, Zaporizhzhia, Ternopil, Dnipropetrovsk, Kyiv, Rivne, Cherkassy regions.
Most child deaths due to CVD are caused by organic diseases of the heart (cardiomyopathy, carditis) and blood vessels, life-threatening heart rhythm disorders involving heart failure become increasingly important.
In the structure of congenital anomalies in children, 23.8 % are congenital anomalies of the circulatory system, whose growth rate compared to 2010 is about 3.5 %. Therefore, early diagnosis and adequate specialized care for children with congenital heart disease remains one of the most urgent problems of pediatric cardiorheumatology. The incidence of this pathology is growing steadily. This process continued in 2014 too, when it was 1.3 ‰ (in 2013 — 1.37 ‰). 9,882 cases of congenital heart disease (in 2013 — 11,032) were newly diagnosed.
Over 2014, in children under 1 year of age, there were lesser cases of the CHD — 4,987, while last year — 5,653 cases.
Now in Ukraine in general there are 60,360 children with CHD — 7.95 per 1,000 children (in 2013 — 66,984, or 8.38 per 1,000 children).
More than 5.5 thousand children with congenital heart defects born every year in Ukraine, most of them require cardiosurgical care. The structure of the CHD changes towards increasing the share of more severe clinical and combined forms of congenital heart diseases.
Evidence of systemacity in the work of pediatric cardiorheumatological service is an increase in the detection of CHD in children under 1 year of age, observed over the last decade.
Staffing of pediatric cardiorheumatological service became worse over the last year and is poor. Today in the regions there are 251 permanent specialists (0.03 per 1,000 children) in 304 positions that is less than last year, and is due to the disposal of doctors from the annexed the Crimea and Donbas. Given the plurality in healthcare institutions, there are occupied 254.5 positions, 172 (67 %) of which are in outpatient facilities and 12.75 — in the central district hospitals.
Staffing level of pediatric cardiorheumatologists in terms of key employees — 76.32 %, taking into account the plurality — 83.72 %.
In Ukraine, there are 937 cardiorheumatological beds, of which 35 — rheumatological (1,152 — in 2013), or 1.24 per 1,000 children with a standard of 1.5 beds per 10,000 children. A significant decrease in the number of hospital beds is due to the loss of hospitals in Crimea, Sevastopol and uncontrolled part of Donetsk and Luhansk regions.
The average duration of hospital stay of cardiorheumatological patient — 10.15 days (10.87 — in 2011), bed turnover rate amounted to 31.9. In 2014, on specialized beds there were treated over 30,000 sick children. The average term of the work of cardiorheumatological bed last year was 324 days (in 2013 — 323.9 days).
Stabilization of the incidence and prevalence parameters of CVD in children, in parallel with a decrease in mortality due to CVD and CHD, show systematic local work of pediatric and cardiorheumatological services in terms of improved detection and improved treatment results, with a significant shortage of professionally trained personnel and insufficient material and technical equipment, especially at the level of modern diagnostic technologies.
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