The emerging problem of coronary heart disease in Kenya

Jablonski-Cohen, M. S.; Kosgei, Rose J.; Rerimoi, A. J.; Mamlin, Joseph J.

doi:10.4314/eamj.v80i6.8704

Cited by 4 publications

(3 citation statements)

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“…Among the world's poorest billion people (majority in SSA), IHD was found to account for only a relatively low 12% of the CVD DALYs, compared with 51% of DALYs in HIC [58]. Nevertheless, in the 2000s it was noted that IHD measures and its risks factors were beginning to rise in SSA [5,11,59,60], with mortality tending to occur at relatively younger ages when compared to high-income regions [11,50,61,62]. Between 1990 and 2017, the number of deaths from IHD in SSA witnessed a crude percentage increase of 74% [2].…”

Section: Ischemic Heart Diseasementioning

confidence: 99%

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

et al. 2020

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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations. Highlights:-The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.-Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10-20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA. -SSA has 23% of the world's prevalent rheumatic heart disease cases.-The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

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Section: Ischemic Heart Diseasementioning

confidence: 99%

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

et al. 2020

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“…A high index of suspicion and broad differential, however, are necessary to perform an electrocardiogram in a patient with nonspecific signs or symptoms and this probably contributes to the low prevalence estimates [190]. Definitive diagnosis can be curtailed by the lack of high-technology diagnostic testing (i.e., nuclear or angiographic imaging) and the fact that enzyme testing is not available in many centers.…”

Section: Ischemic Heart Diseasementioning

confidence: 99%

Heart Failure in Sub-Saharan Africa

Bloomfield

Barasa²,

Doll³

et al. 2013

CCR

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The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.

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“…4 Coronary artery disease (CAD), once thought to be rare among native Africans, is increasingly being diagnosed. 5,6 In a recent prospective survey carried out at an urban hospital in Kenya, acute coronary syndromes (ACS) contributed to 5.1% of all admissions to the critical care units. 7 An autopsy study by Ogeng'go et al reported that cardiovascular deaths comprised 13.2% of all autopsies performed during the study period.…”

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confidence: 99%

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

Varwani

Jeilan

Ngunga

et al. 2019

CVJA

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Background: Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking. was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events. Results: A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%. Conclusion: In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.

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The emerging problem of coronary heart disease in Kenya

Cited by 4 publications

References 0 publications

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

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

Heart Failure in Sub-Saharan Africa

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

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