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Cardiovascular Disease Screening Programs in Low- and Middle-Income Countries: A Systematic Review
Eyad Jamileh1, Ahmed T Elmewafy2, Mohammad Almeer3
1Royal Blackburn Teaching Hospital; East Lancashire Hospitals Trust, Blackburn, England, United Kingdom.
Insights
Cardiovascular disease (CVD) screening in low- and middle-income countries (LMICs) effectively detects risk, but poor linkage to care hinders its impact. Integrating screening with treatment is crucial for better health outcomes.
Area of Science:
- Global Health
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of death globally, with a significant burden in low- and middle-income countries (LMICs).
- Effective screening is vital for CVD prevention and early detection, yet its implementation and success in LMICs are not well understood.
Purpose of the Study:
- To assess the diagnostic accuracy, detection rates, and care linkage of CVD and cardiometabolic risk screening programs in LMICs.
- To provide evidence for improving CVD screening strategies in resource-limited settings.
Main Methods:
- A systematic review was conducted following PRISMA guidelines, searching databases through November 2025.
- Included studies evaluated screening programs for cardiovascular or major cardiometabolic risk factors in LMICs.
- Primary outcomes were detection rates and linkage to care; secondary outcomes included risk-factor control and clinical events. Results were synthesized narratively due to heterogeneity.
Main Results:
- Seventeen studies from Asia, sub-Saharan Africa, and Latin America were reviewed, using diverse screening methods like risk models and community health worker programs.
- Screening identified high rates of undiagnosed hypertension (up to 55%) and diabetes risk (approx. 40%).
- Significant gaps were observed 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 individuals with unmet cardiometabolic risk.
- Weaknesses in linking individuals from screening to ongoing care significantly limit the overall impact of these programs.
- Enhancing integrated screening-to-treatment pathways is imperative to improve patient outcomes and reduce CVD burden in LMICs.
Background:
Cardiovascular disease (CVD) is the leading global cause of mortality and disproportionately affects low- and middle-income countries (LMICs). Although screening is essential for prevention and early detection, its effectiveness and implementation in LMICs remain unclear.
Objectives:
The objective of the study was to evaluate the diagnostic performance, detection yield, and linkage-to-care outcomes of CVD and major cardiometabolic risk-factor screening programs in LMICs.
Methods:
We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO, CRD420251241426). Databases were searched through November 2025. Observational and interventional studies assessing cardiovascular or major cardiometabolic screening programs in LMICs were included. Primary outcomes were detection rates and linkage to care. Secondary outcomes included risk-factor control, cardiovascular events, mortality, and cost-effectiveness. Owing to heterogeneity, results were synthesized narratively.
Results:
Seventeen studies from Asia, sub-Saharan Africa, and Latin America were included. Screening approaches comprised risk-prediction models, point-of-care testing, community health worker-led programs, and mobile health platforms. Diagnostic performance ranged from area under the curve 0.64 to 0.91. Locally adapted risk models generally outperformed imported scores, whereas simplified tools showed acceptable discrimination. Screening identified a substantial burden of undiagnosed disease, with up to 55% meeting hypertension criteria and approximately 40% classified as high risk for diabetes. However, considerable attrition occurred across the care cascade, with preventive service uptake ranging from 15% to 58% and confirmatory testing as low as 22%. Community health worker-led programs demonstrated >90% sensitivity and specificity compared with clinician assessment.
Conclusions:
CVD screening programs in LMICs can effectively identify unmet cardiometabolic risk, but weak linkage to care limits impact. Strengthening integrated screening-to-treatment pathways is essential to improve outcomes.
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