Cardiovascular Disease Screening Programs in Low- and Middle-Income Countries: A Systematic Review

Area of Science:

• Global Health
• Cardiovascular Medicine
• Public Health Policy

Background:

• Cardiovascular disease (CVD) is a leading cause of death globally, with a disproportionate impact on low- and middle-income countries (LMICs).
• Effective screening is vital for CVD prevention and early detection, yet its implementation and efficacy in LMICs require further evaluation.

Purpose of the Study:

• To assess the diagnostic accuracy, detection rates, and care linkage of CVD and cardiometabolic risk screening programs within LMICs.
• To understand the real-world performance of various screening strategies in diverse LMIC settings.

Main Methods:

• A systematic review adhering to PRISMA guidelines was conducted, searching databases through November 2025.
• Included studies assessed cardiovascular or major cardiometabolic screening programs in LMICs, focusing on detection rates and linkage to care.
• Narrative synthesis was employed due to study heterogeneity.

Main Results:

• Seventeen studies from Asia, sub-Saharan Africa, and Latin America revealed varied screening approaches, including risk models and community health worker programs.
• Screening detected significant undiagnosed disease (e.g., hypertension up to 55%, high diabetes risk ~40%), with locally adapted risk models outperforming imported ones.
• Despite high detection, significant gaps existed in the care cascade, with low uptake of preventive services (15-58%) and confirmatory testing (22%). Community health worker programs showed high sensitivity and specificity.

Conclusions:

• CVD screening in LMICs successfully identifies unmet cardiometabolic risk, but its public health impact is limited by weak linkage to care.
• Enhancing integrated pathways from screening to treatment is imperative for improving patient outcomes and mitigating the CVD burden in LMICs.