Lifelong care for patients with congenital heart disease in Asia

Asia is the largest continent by land area and population, with diverse geography, climate, culture, language, religion, and economic situation.According to the World Bank, Asian countries can be organized by income as follows: high-income countries [countries with a population of over 10 million people and gross national income (GNI) per capita of approximately $13 000 or more annually (e.g.Hong Kong, Japan, Singapore, South Korea, and Taiwan)], upper-middle-income countries [countries with a GNI per capita of approximately $4000 or more (e.g.China, Malaysia, and Thailand)], lower-middle-income countries [countries with a GNI per capita of $1000 or more (e.g.Bangladesh, Cambodia, India, Indonesia, Pakistan, the Philippines, Mongolia, and Vietnam)], and low-income countries [countries with a GNI per capita of $1000 or less (e.g.Timor-Leste)].Congenital heart disease (CHD) is the most common congenital disease and includes simple defects, such as ventricular septal defects, and the most severe conditions, such as hypoplastic left heart syndrome.CHD requires invasive treatment in childhood and lifelong medical follow-up.Challenges in CHD care vary by country.In lower-to-middle-income Asian countries, diagnosis, and treatment during early childhood may not be sufficient.A systematic review reported more school-aged children with unrepaired CHD in lower-middle-income Asian countries than in upper-middle-income countries. 1The prevalence of children diagnosed with CHD for the first time at school age has also been reported to be higher in lower-middle-income countries than in upper-middle-income countries. 1For instance, in India, a lowermiddle-income country, only one in four children with CHD receives optimal cardiac care.Furthermore, the most severe CHD cases are not counted correctly as many births occur at home.More challenges include the maldistribution of medical facilities, the high burden of medical costs on families owing to the absence of medical insurance, insufficient awareness among healthcare professionals about the need for CHD care, and lack of a system to follow-up patients with CHD throughout their lives. 2he problems in lower-middle-income Asian countries are manifold but could be handled through international cooperation and the provision of structured programmes.For example, Kahn et al. 3 reported that participation in The International Quality Improvement Collaborative for Congenital Heart Surgery and implementation of the 'nurse-empowered team-based approach' reduce surgical site infections and length of intensive care unit (ICU) stay in a single centre in Pakistan.Additionally, Staveski et al. 4 reported that a structured