Global Paradigm Shift Global Paradigm Shift in Approach to in Approach to

Cardiovascular DiseaseCardiovascular Disease

A. Thomas Pezzella, M.D.A. Thomas Pezzella, M.D.

World Heart Foundation/

International Children’s Heart Fund

A. Thomas Pezzella, M.D., F.A.C.S.

James L. Cox, M.D. - World Heart Foundation

Albert Einstein - Nobel Prize - 100 years - 1905

Brownian Motion - Factuals

Bill Gates Foundation

57 Million Deaths Worldwide in 200257 Million Deaths

Worldwide in 2002

Communicable disease 18.3 million

Noncommunicable disease 33.5million

Trauma 5.2 million

CV disease 17 million

– Ischemic 7 million

– Rheumatic 400,000

– Congenital 300,000

Cardiac Cases WorldwideCardiac Cases Worldwide

0200400600800

100012001400

1222

786

569

169 14737 25 18

Nu

mb

er

of

Cases p

er

Million

Preventive

Medicine

Curative

Medicine

Traditional Approach

                      

Traditional Preventive Strategies

Infrastructure

Bricks and mortar

Vaccination

Primary Care

Hospitals

Medical Centers

Medical Education

The D-Day Approach

Key themes of modern public health practiceKey themes of modern public health practice Leadership of the entire healh system

Collaborative actions across all sectors

Multidisciplinary approach to all determinants of health

Political engagement in development of public health policy

Partnership with the populations served

The Lancet 2004;363:285 (www.thelancet.com)

Product Line

Disease Specific

Conflict/Competition/Collaboration

Continuum of Care

Integrated Approaches

Prevention Promotion

Diagnosis Treatment Rehabilitation

Individual with

Disease

High Risk Individual

Family

Society

Type of Intervention

Societal Policies which create an environment that promoteshealth.Family and intergenerational level prevention to promote healthy lifestyles through all stages of life.

Primary Prevention by controlof risk factors

Secondary Prevention measures

High tech interventions in thevery sick, high risk individuals with CVD.Multilevel integrated strategies for the prevention of CVD. The size of

the box approximates the relative size of the population impact.

TERTIARY HOSPITAL CARE(specialized services)

SECONDARY HOSPITAL CARE(hospital services)

PRIMARY HEALTH CARE(promotive, preventive, andbasic curative services athealth posts, health centers,and satellite clinics)

The health care dilemma in Ghana. The distribution of funds and personnel for primary healthcare compared to costly hospital-based care is in inverse proportion to the numbers of peoplethat need to be reached. The health care pyramid for Ghana is upside down!

Population to be served

Health expenditures*

*Approximations based on1975-1976 annual estimates

$50,000,000

(45%)

$45,000,000

(40%)

$9,000,000

(90%) $17,000,000

(15%)

100,000 (1%)

900,000 (9%)

If I can stop one heart from breaking,

I shall not live in vain;If I can ease one life the aching,

Or cool one pain,Or help one fainting robin

Unto his nest again,I shall not live in vain.

Emily Dickinson

Vascular

Endocrine

GI

Vascular

Endocrine

GI Vascular

Endocrine

GI

Radiology

Medicine

Surgery

Radiology

Medicine

Surgery Radiology

Medicine

Surgery

Surgery

Medicine Radiology

GI

Endocrine Vascular

Traditional (Department-Based) Practices Disease-Based Practices

Global Strategy

Research\Developme

nt

Administrative\Political\Logistical

Clinical

Home

Abroad

Educational\

Training

Global Strategy

Clinical

Home

Abroad

Selected referrals abroad

Regional hubs

Donor/host relation

Global Strategy

Educational\

Training Teaching teams in country

Internet

Regional consultants

Telemedicine

Selective training abroad - short term

GPS NAVSTAR Global

Positioning System

Copy/paste

Plug/play

Internet

Global Strategy

Research\Developme

nt

Bench/Bush/Bedside

Yacoub Model

Where pathology is?

Ethical considerations - Helsinki principles

Global Strategy

Administrative\Political\Logistical

Strategy

Organizational chart

Memorandum of Understanding

Ego/Money

Marketing

Equipment/Supply - Inventory

Health care “poaching”

Medical Personnel Diaspora

The Planet - No Boundaries

Terns

Wildebeest

GOALS

ATTITUDE

FOCUS                                                   

N. AMERICA

USA

Canada

Central America

- Mexico

- Central

- Caribbean

S. AMERICA

EUROPE

Western/Eastern

North Africa

Middle East

AFRICA

West/Central

East/South

- China

- Mongolia

- Tibet

India

Pakistan

Australia/ New Zealand

Pacific

Rim

Global Scheme

Types of ProgramsTypes of Programs

Upscale - learn from

Lateral - sister relation

Upgrade - need help, usually “stuff”

Rejuvenate - failed

De Novo - start from nothing

Upscale

Lateral

Upgrade

Rejuvenate

DeNovo

Prevention

Promotion

Diagnosis Treatment Rehabilitation

Horizontal ApproachTeamwork - Collaboration

Ego Money

# of cases$ reimbursement

salary - surgeon

# of CT surgeons

complexity-high risk

expectancy of good results

USACardiac Surgery

TEAMWORK

You can accomplish

anything in life,

provided that you do

no mind who gets the

credit. 

Harry Truman

Objects in mirror

are closer than

they appear.