Status of cardiac arrhythmia services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force report

Abstract

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.

Fig. 1

Availability of various cardiac arrhythmia services across the African continent. PMK = pacemaker; ICD = implantable cardioverter defibrillator; CRT = cardiac resynchronisation therapy. Ablation includes radiofrequency ablation for atrial flutter and junctional tachycardia (simple ablation) as well as catherter ablation for atrial fibrillation (complex ablation).

Fig. 2

Centres where primary training in cardiac pacing was obtained by cardiologists practicing in Africa. More than 50% of the cardiologists were trained in Africa.

Fig. 3

Centres where short–term fellowship in cardiac pacing was obtained by cardiologists practicing in Africa; 58% have not had formal fellowship training in cardiac pacing.

Fig. 4

Availability of drugs used for unmasking covert cardiac arrhythmias.