Status of cardiac arrhythmia services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force report

Abstract

SummaryBackgroundThere is limited information on the availability of health services to treat cardiac arrhythmias in Africa. MethodsThe Pan–African Society of Cardiology (PASCAR) Sudden Cardiac Death Task Force conducted a survey of the burden of cardiac arrhythmias and related services over two months (15 October to 15 December) in 2017. An electronic questionnaire was completed by general cardiologists and electrophysiologists working in African countries. The questionnaire focused on availability of human resources, diagnostic tools and treatment modalities in each country.ResultsWe received responses from physicians in 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as anti–arrhythmics and anticoagulants prevails. Non–vitamin K–dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of the sub–Saharan African (SSA) countries do not have a registered cardiologist and about one–third do not have pacemaker services. The median pacemaker implantation rate was 2.66 per million population per country, which is 200–fold lower than in Europe. The density of pacemaker facilities and operators in Africa is quite low, with a median of 0.14 (0.03–6.36) centres and 0.10 (0.05–9.49) operators per million population. Less than half of the African countries have a functional catheter laboratory with only South Africa providing the full complement of services for cardiac arrhythmia in SSA. Overall, countries in North Africa have better coverage, leaving more than 110 million people in SSA without access to effective basic treatment for cardiac conduction disturbances. ConclusionThe lack of diagnostic and treatment services for cardiac arrhythmias is a common scenario in the majority of SSA countries, resulting in sub–optimal care and a subsequent high burden of premature cardiac death. There is a need to improve the standard of care by providing essential services such as cardiac pacemaker implantation.

Sudden death of adults in Togo: Autopsy results of a series of 318 cases

“…The prevention of nutritional and metabolic risk factors has reduced this mortality [10]. The most common cardiac pathology was myocardial infarction (n = 102 cases, 58.96%) and accounted for 32.07% of all causes of sudden death, followed by coronary thrombosis, concordant with most reported series in the literature [11,12]. There has been an increase in sudden cardiac deaths on a regular basis over the entire duration of the study, from 7 cases in 2010, to 17 cases in 2018.…”

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

“…These estimates might be underestimated as a significant number of cases of paroxysmal AF might have been missed by a single 12‐lead electrocardiogram. Holter electrocardiogram which can improve the detection rate of AF is unfortunately unavailable in most settings in SSA …”

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

“…There is a very low proportion of physicians to population, with a majority of SSA countries having <5 physicians per 10,000 people [125]. In a recent survey, 18% of the sub-Saharan African countries did not have a registered cardiologist [19,126]. The scarcity of African-born cardiologists signifies that SSA relies heavily on volunteering cardiologists from overseas, who might have the highest motivation, goodwill, and interest to care, but might not have a full insight into the cultural, linguistic, and sociopolitical dynamics of the various SSA communities to deliver effective cardiovascular care.…”