Maurice Kakou-Guikahue1, Roland N'Guetta1, Jean-Baptiste Anzouan-Kacou1, Euloge Kramoh1, Raymond N'Dori1, Serigne Abdou Ba2, Maboury Diao2, Moustapha Sarr2, Abdoul Kane2, Adama Kane2, Findide Damorou3, Dadhi Balde4, Mamadou Bocary Diarra5, Mohamed Djiddou6, Gisèle Kimbally-Kaki7, Patrice Zabsonre8, Ibrahim Ali Toure9, Martin Houénassi10, Habib Gamra11, Bachir Chajai12, Benoit Gerardin13, Rémy Pillière13, Pierre Aubry14, Marie-Christine Iliou15, Richard Isnard16, Pascal Leprince16, Yves Cottin17, Edmond Bertrand18, Yves Juillière19, Jean-Jacques Monsuez20. 1. Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Côte d'Ivoire. 2. Department of Cardiology, hôpital Aristide Le Dantec, Dakar, Senegal. 3. Department of Cardiology, CHU de Lomé, Lomé, Togo. 4. Department of Cardiology, CHU Ignace Deen, Conakry, Guinea. 5. Department of Cardiology, hôpital de Bamako, Bamako, Mali. 6. Department of Cardiology, CHU de Nouakchott, Nouakchott, Mauritania. 7. Department of Cardiology, CHU de Brazzaville, Brazzaville, Congo. 8. Department of Cardiology, CHU de Ouagadougou, Ouagadougou, Burkina-Faso. 9. Department of Cardiology, CHU de Niamey, Niamey, Niger. 10. Department of Cardiology, faculté des Sciences et de la Santé, Cotonou, Benin. 11. Department of Cardiology, hôpital Fattouma Bourquiba, Monastir, Tunisia. 12. Department of Cardiology, Clinique Chifa, Marrakech, Morocco. 13. Interventional Cardiology, hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France. 14. Department of Cardiology, hôpital Bichat, 75018 Paris, France. 15. Department of Cardiology, hôpital Corentin-Celton, 92130 Issy-les-Moulineaux, France. 16. Department of Cardiology, hôpital de la Salpêtrière, 75013 Paris, France. 17. Department of Cardiology, CHU de Dijon, 21000 Dijon, France. 18. Department of Cardiology, Cardiology, 84200 Carpentras, France. 19. Department of Cardiology, CHU de Brabois, 54500 Nancy, France. 20. Department of Cardiology, hôpital René-Muret, 93270 Sevran, France. Electronic address: jean-jacques.monsuez@aphp.fr.
Abstract
BACKGROUND: Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM: To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS: The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. RESULTS: The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. CONCLUSION: Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.
BACKGROUND: Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM: To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS: The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. RESULTS: The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. CONCLUSION: Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.
Authors: Julian T Hertz; Francis M Sakita; Godfrey L Kweka; Tumsifu G Tarimo; Sumana Goli; Sainikitha Prattipati; Janet P Bettger; Nathan M Thielman; Gerald S Bloomfield Journal: Circ Cardiovasc Qual Outcomes Date: 2022-03-18
Authors: Matthew F Yuyun; Aimé Bonny; G André Ng; Karen Sliwa; Andre Pascal Kengne; Ashley Chin; Ana Olga Mocumbi; Marcus Ngantcha; Olujimi A Ajijola; Gene Bukhman Journal: Glob Heart Date: 2020-05-08