Figure 1
CHD Patient Care Continuum.
Figure 2
Kerala Pediatric Cardiac Care: Situation Analysis 2016 and 2019.*
* Some private centers in the initial assessment were not empaneled (selected) by the government and later either discontinued their pediatric cardiac services or closed completely.
Figure 3
Congenital Heart Disease Demographics in Kerala, 2016.
CHD: Congenital Heart Disease; est.: estimated.
Figure 4
Kerala Capacity to Address CHD, 2016.
Table 1
Challenges and Interventions within the Pediatric Cardiac Care Continuum in Kerala (see text for details).
| Challenges | Interventions Undertaken | |
|---|---|---|
| Recognition |
|
|
| Diagnosis & Prioritization |
|
|
| Referral |
|
|
| Stabilization and Transport |
|
|
| Advanced Pediatric Heart Tertiary Care |
|
|
| Follow up care |
|
|
Figure 5
Hridyam Process Map.
Table 2
Hridyam Patient Registrations.
| Year | Age 0–12 months | Age > 1 year | Total |
|---|---|---|---|
| 2017 (Aug–Dec) | 309 | 193 | 502 |
| 2018 | 1409 | 781 | 2190 |
| 2019 | 2237 | 1022 | 3259 |
| Total | 3955 | 1996 | 5951 |
Table 3
Hridyam Patient Surgical Profile.
| Age | Year | Number of Cases (proportion %) | Most Frequent Procedures |
|---|---|---|---|
| Under 1 month | 2017 | 17 (8.2) | |
| 2018 | 83 (13.3) | ||
| 2019 | 166 (13.5) | ||
| Total | 266 (12.9) | Arterial switch, Patent Ductus Arteriosus (PDA) stent, Total Anomalous Pulmonary Venous Connection repair | |
| 1 month to1 year | 2017 | 99 (47.6) | |
| 2018 | 306 (49.0) | ||
| 2019 | 614 (50.0) | ||
| Total | 1,019 (49.5) | Ventricular Septal Defect (VSD) repair, Tetralogy of Fallot repair, PDA device | |
| Over1 year | 2017 | 92 (44.2) | |
| 2018 | 235 (37.7) | ||
| 2019 | 447 (36.4) | ||
| Total | 774 (37.6) | Atrial Septal Defect (ASD) device, ASD repair, PDA device |
Table 4
Hridyam Surgical Outcomes.
| Year | Surgical Cases | ≤30-day Mortality (% of cases) | Late Mortality(% of cases) |
|---|---|---|---|
| 2017 (Aug–Dec) | 208 | 3 (1.4) | 4 (1.9) |
| 2018 | 624 | 22 (3.5) | 21 (3.4) |
| 2019 | 1,227 | 25 (2.0) | 19 (1.5) |
| Total | 2,059 | 50 (2.4) | 44 (2.1) |
Figure 6
Reduction in all-cause and CHD-related infant mortality following the introduction of Hridyam programs in Kerala. By the non-parametric Mann Whitney U test, this improvement is of borderline statistical significance (p = 0.06), probably due to the small sample size of comparing data from two Hridyam years to four pre-Hridyam years.