By Diego Vanegas
Latin America has a population of 600 million people, and 20 million of those suffer from atrial fibrillation. Heart failure, Chagas disease and other cardiac arrhythmias are also highly prevalent.
Public health expenditure in Latin America is directed mainly to tackle diseases and social problems that kill the young population amongst those, infectious diseases such as HIV/AIDS, malaria and tuberculosis, and not to treat cardiac diseases (including arrhythmias), which mainly affect older people.
Gross domestic product per capita and public health budget vary largely among different Latin American countries, implying that public health programmes are not uniformly supported in the region. Limited governmental budget, restrictions to health investment and bureaucracy are factors which exert negative impact on the better use of public resources. In addition, treatments for arrhythmias such as ablation, 3D mapping, implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy (CRT) are considered very expensive for Latin American economies and therefore are not included in the basic universal health coverage for the majority of countries.
According to the 11th World Survey in Cardiac Pacing (2009), 70% of pacemaker implants in some Latin American countries are single-chamber devices. This trend, based on economical constraints, overpasses scientific guidelines, which recently have emphasised that long-term effect of single-chamber pacing results in higher incidence of atrial fibrillation, stroke and heart failure.
European countries with the lowest ICD implant rates have around 70 implants per million persons. In Latin America, there are just 20 ICD implants per million. One potential explanation can be found in the cost-effectiveness analysis conducted by Brazilian investigators. They found that ICD implantation was proportionally more expensive in Brazil than in developed countries. This situation has limited ICD implantation for primary prevention in a country with near 200 million people.
Catheter ablation of cardiac arrhythmias in Latin America is underused due to different factors: 1) it is not present in the majority of national public health systems; 2) private health systems in some countries do not pay for these procedures, arguing that there is no regional cost-effectiveness analysis to support their use; 3) it is a very expensive treatment in private facilities, not affordable for the general population.
In conclusion, current public health policies in Latin America have an adverse impact on the treatment of cardiac arrhythmias.
It is fundamental for the industry to evaluate the price of medical devices in Latin America. Furthermore, there is a massive need for education on cardiac arrhythmias and their treatments targeting governments, the medical community and the general population.
Diego Vanegas, director, Unidad de Electrofisiología y Dispositivos de Estimulación Cardiaca, Hospital Militar, Bogotá, Colombia
