Aimé Bonny1,2,3, Marcus Ngantcha2, Matthew F Yuyun4, Kamilu M Karaye5, Wihan Scholtz6, Ahmed Suliman7, George Nel6, Yazid Aoudia8, Adama Kane9, Abdelhamid Moustaghfi10, Emmy Okello11, Martin Houenassi12, Arn Sonou12, Ali Niakara13, Yves Ray Lubenga14, Anicet Adoubi15, James Russel16, Albertino Damasceno17, Ali Ibrahim Touré18, Abdoul Kane19, Alioune Tabane19, Mohammed Jeilan20, Alassane Mbaye21, Kemi Tibazarwa22, Yousef Ben Ameur23, Mamadou Diakité24, Saad Subahi7, Bundhoo Kaviraj25, Mahmoud U Sani5, Olujimi A Ajijola26, Ashley Chin27, Karen Sliwa28. 1. Hôpital de District de Bonassama, Université de Douala, Cameroun. 2. Cameroon Cardiovascular Research Network, Douala, Cameroon. 3. Hôpital Forcilles, Ferolles Attilly, France. 4. VA Boston Healthcare System, Boston, MA, USA. 5. Bayero University Kano, Aminu Kano Teaching Hospital, Kano, Nigeria. 6. Pan African Society of Cardiology, Head Office, Cape Town, South Africa. 7. Khartoum ENT Hospital, Department of Cardiology, Khartoum, Sudan. 8. Centre Hospitalier Mustapha, service de cardiologie Alger, Algeria. 9. Hôpital Gaston Berger, Saint Louis, Senegal. 10. Clinique Privée de Casablanca, service de cardiologie, Casablanca, Maroc. 11. Uganda Heart Institute, Kampala, Uganda. 12. Université Abomey Calavi, Service de Cardiologie, Cotonou, Benin. 13. Clinique Privé Cardiologique de Ouagadougo, Ouagadougou, Burkina Faso. 14. Centre Hospitalier Universitaire de Kinshasa, service de cardiologie, Republique Démocratique du Congo. 15. Institut de Cardiologie d'Abidjan, Abidjan, Côte d'Ivoire. 16. University Teaching Hospital of Freetown, Department of Internal Medicine, Sierra Leone. 17. Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique. 18. CHU Lomardé, service de médecine interne, Niamey, Niger. 19. Hôpital general du Grand Yoff, Service de cardiologie, Dakar, Senegal. 20. AgaKhan Teaching Hospital, Department of Cardiologie, Nairobi, Kenya. 21. Hôpital Aristide Le Dantec, Service de Cardiologie, Dakar, Senegal. 22. Aga Khan Hospital, Dar es Salaam, Tanzania. 23. CHU Farhat Hached, Sousse, Tunisia. 24. Centre Hospitalier Universitaire de Bamako, Mali. 25. Department of Cardiology, Dr A.G Jeetoo Hospital, Port Louis, Mauritius. 26. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 27. UCT University Cape Town, Groote Schuur Hospital, Cape Town, South Africa. 28. Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Soweto Cardiovascular Research Group, Cape Town, South Africa.
Abstract
AIMS: Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. METHODS AND RESULTS: Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. CONCLUSION: The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. METHODS AND RESULTS: Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. CONCLUSION: The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Gladys M K Tchanana; Marcus Ngantcha; Matthew F Yuyun; Olujimi A Ajijola; Samuel Mbouh; Steve C T Tchameni; Ahmed Suliman; Aimé Bonny Journal: BMJ Open Sport Exerc Med Date: 2020-08-23
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