Abstract

Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16–22% in heart failure, 10–28% in rheumatic heart disease, 3–7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9–79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries.Highlights:- Atrial fibrillation/flutter prevalence is 16–22% in heart failure, 10–28% in rheumatic heart disease, 3–7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9–79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.

Highlights

  • About 1.1 billion people live in 49 countries of sub-Saharan Africa (SSA) accounting for approximately 15% of the world population [1]

  • 32 million people in SSA are currently living with some form of diagnosed cardiovascular diseases (CVDs) and it is estimated that there are many more living with undiagnosed CVD, and 3.6 million incident cases are reported annually [2, 3]

  • Bradyarrhythmias & CIEDS -Pacing indication: Commonest is atrioventricular block accounting for 45 -100% of all cases across studies, trailed by sick sinus syndrome. -Type of device: Single chamber ventricular pacemakers are the most frequently implanted, trailed by dual chamber devices. -18% of countries in SSA still do not perform permanent pacemaker (PPM) implantations - Implant rates: PPM implantation and operator rates are low at 2.79 and 0.772 per million population respectively

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Summary

Introduction

About 1.1 billion people live in 49 countries of sub-Saharan Africa (SSA) accounting for approximately 15% of the world population [1]. The leading causes of mortality in SSA have been communicable diseases, and non-communicable diseases (NCDs) were not considered to be a public health priority [2, 3]. NCDs are projected to overtake infectious diseases and account for more than half of all deaths by 2030 in SSA [7]. Among NCDs, cardiovascular diseases (CVDs) are the leading cause of death accounting for 37% of all NCDs deaths and approximately 13% of all deaths in SSA [3]. 32 million people in SSA are currently living with some form of diagnosed CVD and it is estimated that there are many more living with undiagnosed CVD, and 3.6 million incident cases are reported annually [2, 3]

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