Global Paradigm Shift in Approach to Cardiovascular Disease 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 years Brownian Motion - Factuals

Bill Gates Foundation

57 Million Deaths Worldwide in 2002 F Communicable disease 18.3 million F Noncommunicable disease 33.5million F Trauma 5.2 million u CV disease 17 million –Ischemic 7 million –Rheumatic 400,000 –Congenital 300,000

Cardiac Cases Worldwide Number of Cases per Million

Preventive Medicine Curative Medicine Traditional Approach

Traditional Preventive Strategies F Infrastructure F Bricks and mortar F Vaccination F Primary Care F Hospitals F Medical Centers F Medical Education

The D-Day Approach

Key themes of modern public health practice F Leadership of the entire healh system F Collaborative actions across all sectors F Multidisciplinary approach to all determinants of health F Political engagement in development of public health policy F Partnership with the populations served The Lancet 2004;363:285 (

Product Line Disease Specific Conflict/Competition/Collaboration Continuum of Care Integrated Approaches PreventionPromotionDiagnosisTreatmentRehabilitation

Individual with Disease High Risk Individual Family Society Type of Intervention Societal Policies which create an environment that promotes health. Family and intergenerational level prevention to promote healthy lifestyles through all stages of life. Primary Prevention by control of risk factors Secondary Prevention measures High tech interventions in the very 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, and basic curative services at health posts, health centers, and satellite clinics) The health care dilemma in Ghana. The distribution of funds and personnel for primary health care compared to costly hospital-based care is in inverse proportion to the numbers of people that need to be reached. The health care pyramid for Ghana is upside down! Population to be servedHealth expenditures* *Approximations based on 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 SurgeryRadiology Medicine Surgery MedicineRadiology GI Endocrine Vascular Traditional (Department-Based) PracticesDisease-Based Practices

Global Strategy Research\ Development Administrative\ Political\ Logistical Clinical Home Abroad Educational\ Training

Global Strategy Clinical Home Abroad F Selected referrals abroad F Regional hubs F Donor/host relation

Global Strategy Educational\ Training F Teaching teams in country F Internet F Regional consultants F Telemedicine F Selective training abroad - short term

GPS NAVSTAR Global Positioning System Copy/paste Plug/play Internet

Global Strategy Research\ Development F Bench/Bush/Bedside F Yacoub Model F Where pathology is? F Ethical considerations - Helsinki principles

Global Strategy Administrative\ Political\ Logistical F Strategy F Organizational chart F Memorandum of Understanding F Ego/Money F Marketing F Equipment/Supply - Inventory F 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 Programs F Upscale - learn from F Lateral - sister relation F Upgrade - need help, usually “stuff” F Rejuvenate - failed F De Novo - start from nothing Upscale Lateral Upgrade Rejuvenate DeNovo

PreventionPromotionDiagnosisTreatmentRehabilitation Horizontal Approach Teamwork - Collaboration

Ego Money

# of cases $ reimbursement salary - surgeon # of CT surgeons complexity-high risk expectancy of good results USA Cardiac Surgery

TEAM W ORK

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.