Burden, spectrum, and treatment gaps in cardiac diseases in Ethiopia: an 11-year analysis of 10,999 patients at a National Charity Cardiac Center

Cardiovascular diseases (CVDs) are major causes of premature mortality and disability, especially in settings where timely cardiac surgery or percutaneous interventions are limited. Globally, the prevalence of CVDs is rising, with significant regional differences. Africa bears a high burden of congenital heart disease (CHD) and rheumatic heart disease (RHD) but has limited access to surgical and interventional resources. This study describes the spectrum and management of cardiac diseases at the Cardiac Center of Ethiopia (CCE), highlighting treatment gaps. A hospital-based retrospective descriptive study was conducted from February 1 to June 1, 2023, reviewing records of 10,999 cardiac patients managed between 2012 and 2023. Variables included were demographics, type of heart disease, and management type (surgery or percutaneous intervention). Categorical data were summarized using frequencies and percentages, and continuous data using median and interquartile range (IQR). Among 10,999 patients, the median age was 7.5 years (IQR 3–17.5), and 66.6% were younger than 18 years. CHD was the most common diagnosis (49.6%), followed by valvular heart disease (VHD) (35.4%) and hypertensive heart disease (HHD) (6.6%). Of 8,689 patients with guideline directed indications, only 2,900 (33.4%) received surgical or percutaneous intervention. Among patients with CHD, 950 (56.5%) underwent surgery and 730 (43.5%) received percutaneous treatment. The most common surgical procedures were ventricular septal defect (VSD) patch closure (26.2%), atrial septal defect (ASD) patch closure (19.4%), and patent ductus arteriosus (PDA) ligation (18.7%). The most frequent percutaneous procedures were PDA device closure (43.8%), ASD device closure (27.4%), and balloon pulmonary valvuloplasty (24.7%). Among patients with acquired heart disease, 23.5% underwent surgery and 76.5% received percutaneous intervention, most commonly percutaneous mitral commissurotomy (47.6%). Notably, 3.1% of patients with CHD progressed to an inoperable state, primarily due to delayed surgical or percutaneous intervention, necessitating exclusive medical management of their complications. The cardiac caseload was predominantly pediatric, with congenital heart disease as the most frequent diagnosis and rheumatic heart disease remaining a major acquired condition. Despite availability of surgery and percutaneous interventions, only one-third of patients received guideline directed care, and delays rendered some cases inoperable. These findings highlight the urgent need to expand access to timely cardiac interventions, implement early detection and screening programs, and strengthen prevention strategies for rheumatic heart disease in resource-limited settings.