Key result
Arrhythmia treatment access varies widely across Africa, with pacemaker implants averaging ~3 per million.
Why the study?
Cardiac arrhythmia services are a neglected field of cardiology in Africa with limited comprehensive contemporary data on access and use.
Cross-Sectional (n=23)
Yes
There is a severe lack of access to cardiac arrhythmia services, including CIEDs and ablation procedures, across most African countries, highlighting a critical need for increased resources and infrastructure.
Signals urgent arrhythmia care gaps across Africa; leaves open scalable interventions pending prospective data.
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.
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Bonny et al. (2019) conducted a cross-sectional in Cardiac arrhythmias (n=23). Cardiac arrhythmia services was evaluated on Availability of human resources, drugs, cardiac implantable electronic devices, and ablation procedures. Access to cardiac arrhythmia treatments varied widely across 23 African countries, with pacemaker implantation rates averaging 2.79 per million population where available.
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