Status of cardiac arrhythmia services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force report
M A Talle1, A Bonny2, W Scholtz3
1Cardiology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.
Insights
Cardiac arrhythmia services are scarce in Africa, with limited access to essential treatments like pacemakers, especially in sub-Saharan Africa. This results in suboptimal care and increased premature cardiac deaths, highlighting a critical need for improved healthcare infrastructure.
Area of Science:
- Cardiology
- Public Health
- Healthcare Access
Background:
- Limited information exists on the availability of health services for treating cardiac arrhythmias across Africa.
- Cardiac arrhythmias pose a significant health challenge, yet resources for their management are poorly documented continent-wide.
Purpose of the Study:
- To survey the availability of cardiac arrhythmia services and resources in African countries.
- To assess the human resources, diagnostic tools, and treatment modalities for cardiac arrhythmias in Africa.
Main Methods:
- A survey was conducted by the Pan-African Society of Cardiology (PASCAR) Sudden Cardiac Death Task Force in 2017.
- An electronic questionnaire was distributed to cardiologists and electrophysiologists across African nations, focusing on service availability.
Main Results:
- Responses were received from 33 African countries, revealing limited use of basic cardiovascular drugs and low Non-vitamin K-dependent oral anticoagulant (NOAC) usage.
- Sub-Saharan African countries face critical shortages: 18% lack a cardiologist, many lack pacemaker services, and pacemaker implantation rates are 200-fold lower than in Europe.
- Less than half of African countries have functional catheter laboratories, with significant disparities between North Africa and sub-Saharan Africa, leaving over 110 million people underserved.
Conclusions:
- A significant lack of diagnostic and treatment services for cardiac arrhythmias is prevalent in most sub-Saharan African countries.
- This scarcity leads to suboptimal patient care and a high burden of premature cardiac death.
- Improving the standard of care necessitates enhancing essential services, including cardiac pacemaker implantation.
Background:
There is limited information on the availability of health services to treat cardiac arrhythmias in Africa.
Methods:
The 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.
Results:
We 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.
Conclusion:
The 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.
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