In Reply A decline in age-standardized mortality rate of cardiovascular diseases (CVDs) overall from 1990 to 2016 in China could be explained by the advancing medical techniques and cardiovascular care and improved access to health services.1 However, improvement in cardiac surgical care lags behind the gain in overall cardiovascular health. Quality surgical care highly concentrates in the economically developed cities, such as Beijing, Shanghai, and Guangzhou. In contrast, cardiac surgery volume per surgeon and quality is much lower in less developed areas, especially rural areas. This can be partially explained by the following reasons. First, surgical care resources are unevenly allocated across China owing to the extremely unbalanced economic development. Second, high-quality cardiac surgery needs fine support from anesthetists, medical specialists for extracorporeal circulation, and well-trained nurses, and many facilities cannot afford an experienced team. Third, cardiac interventional therapy is increasingly adopted by hospitals in less developed areas for the treatment of coronary artery disease, and those hospitals may not invest in cardiac surgery that costs more.
Liu S, Li Y, Zhou M. Addressing the Cardiovascular Disease Burden in China—Is It Possible Without Surgery?—Reply. JAMA Cardiol. Published online July 24, 20194(9):953. doi:10.1001/jamacardio.2019.2436
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