Acute myocardial infarction in sub-Saharan Africa: the need for data
Julian T Hertz1, Joseph M Reardon2, Clarissa G Rodrigues3
1Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, United States of America.
Insights
Prevalence of acute myocardial infarction in sub-Saharan Africa is poorly documented. More population-based data and standardized diagnostic criteria are needed to guide cardiovascular disease prevention and treatment strategies in the region.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease burden is increasing in low- and middle-income countries.
- Trends in acute myocardial infarction prevalence in sub-Saharan Africa are not well described.
- Growing recognition of cardiovascular disease necessitates understanding regional prevalence data.
Purpose of the Study:
- To systematically review and describe the prevalence of acute myocardial infarction (AMI) in sub-Saharan Africa.
- To identify existing data on AMI prevalence within the sub-Saharan African region.
- To highlight gaps in population-based data for AMI in sub-Saharan Africa.
Main Methods:
- Systematic review of multiple databases (PubMed, EMBASE, Global Health Archive, CINAHL, Web of Science).
- Inclusion of observational studies reporting AMI incidence or prevalence in sub-Saharan Africa, defined by EKG or biomarkers, published after 1992.
- Quality assessment and data extraction by two independent reviewers.
Main Results:
- Seven studies met inclusion criteria, encompassing 92,378 participants across five countries.
- Methodological quality scores ranged from 3 to 7 out of 8.
- Reported prevalence of acute myocardial infarction varied widely, from 0.1% to 10.4%.
Conclusions:
- Insufficient population-based data exists on acute myocardial infarction prevalence in sub-Saharan Africa.
- Need for well-designed registries and surveillance studies with common diagnostic criteria.
- Improved data is critical for effective prevention and treatment strategies for cardiovascular disease in the region.
Background:
Trends in the prevalence of acute myocardial infarction in sub-Saharan Africa have not been well described, despite growing recognition of the increasing burden of cardiovascular disease in low- and middle-income countries. The aim of this systematic review was to describe the prevalence of acute myocardial infarction in sub-Saharan Africa.
Methods:
We searched PubMed, EMBASE, Global Health Archive, CINAHL, and Web of Science, and conducted reference and citation analyses. Inclusion criteria were: observational studies, studies that reported incidence or prevalence of acute myocardial infarction, studies conducted in sub-Saharan Africa, and studies that defined acute myocardial infarction by EKG changes or elevation of cardiac biomarkers. Studies conducted prior to 1992 were excluded. Two independent reviewers analyzed titles and abstracts, full-texts, and references and citations. These reviewers also performed quality assessment and data extraction. Quality assessment was conducted with a validated scale for observational studies.
Findings:
Of 2292 records retrieved, seven studies met all inclusion criteria. These studies included a total of 92,378 participants from highly heterogeneous study populations in five different countries. Methodological quality assessment demonstrated scores ranging from 3 to 7 points (on an 8-point scale). Prevalence of acute myocardial infarction ranged from 0.1 to 10.4% among the included studies.
Interpretation:
There is insufficient population-based data describing the prevalence of acute myocardial infarction in sub-Saharan Africa. Well-designed registries and surveillance studies that capture the broad and diverse population with acute myocardial infarction in sub-Saharan Africa using common diagnostic criteria are critical in order to guide prevention and treatment strategies.
Registration:
Registered in International Prospective Register of Systematic Reviews (PROSPERO) Database #CRD42012003161.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...