Morbidity and Mortality Among Pediatric Congenital Heart Disease Patients on Waiting List at Cardiac Center –Ethiopia.
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Date
2025-07
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Addis Ababa University
Abstract
Introduction: Congenital heart diseases are prevalent globally, causing significant morbidity and mortality, particularly in low-to-middle income countries where limited cardiac care infrastructure, like in Ethiopia, leads to protracted surgical waiting lists exceeding 15,000 patients. Despite these known challenges, there is a scarcity of local data on the specific burden of morbidity and mortality, and their predictors among paediatric CHD patients on the surgical waiting lists in Ethiopia.
Objective: Assessed the morbidity and mortality patterns, and their predictors, among paediatric CHD patients waiting open-heart surgery at the Children’s Heart Fund Cardiac Center-Ethiopia.
Methods: A retrospective cohort study was conducted at the Children’s Heart Fund Cardiac Center-Ethiopia, analyzing data from pediatric congenital heart disease patients registered for open-heart surgery between September 1st, 2019, and August 31st, 2021. Patients under 15 years old who were candidates for open-heart surgery constituted the study population. Follow-up was conducted retrospectively until December 31st, 2024. Data on patient demographics, clinical status, nutritional status, and outcomes (survival, date/cause of death, morbidity events) were primarily abstracted from medical records, with phone contact used to ascertain missing information. Statistical analysis involved descriptive statistics, Kaplan-Meier survival curves with log-rank tests, and multivariable Cox proportional hazards models to identify mortality predictors. All analyses were performed using STATA version 15.0 and SPSS version 26.
Result: In this retrospective cohort study of 297 paediatric CHD patients on a waiting list for open-heart surgery, 11.8% underwent surgery, 22.6% died, and 65.7% remained waiting. The overall incidence death rate was 614.4 per 100 person-years of observation, with 67 deaths occurring over 4,000 person-days of follow-up. The median time from enrolment to death was 517 days (17 months), while the median time to surgery was 721 days (24 months). Significant predictors of mortality were weight at enrolment (HR=0.78; 95% CI: 0.66, 0.93), number of OPD visits (HR=0.92; 95% CI: 0.86, 0.99), complication (HR=4.58; 95% CI: 2.53, 8.28), and Cyanotic CHD (HR=2.60; 95% CI: 1.45, 4.66).
Conclusion: This study revealed a high waitlist mortality, a prolonged waiting period, low surgery rate, and high morbidity. Lower weight, fewer outpatient visits, the occurrence of complications, and having cyanotic heart disease are determinants of mortality.
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Congenital heart diseases