Current cardiac arrhythmia services in Africa: A Pan-African Society of Cardiology (PASCAR) Cardiac Arrhythmia and Pacing Task Force Report

Abstract

There is limited information on managing cardiac arrhythmias in Africa. The pan-African Society of Cardiology (PASCAR) conducted from 2011 to 2017 several surveys on cardiac arrhythmia services across African countries. The questionnaire filled in by cardiologists focused on availability of human resources, diagnostic tools and treatment modalities in each country. Additional information came from manufacturers. We received responses from 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as antiarrhythmics and anticoagulants prevails. Non-vitamin K dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of sub-Saharan African (SSA) countries do not provide basic cardiac work-up 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] center and 0.10 [0.05–9.49] operator per million population. 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 arrhythmia treatments. The lack of human expertise, diagnostic and treatment services for cardiac arrhythmias is a common scenario in the vast majority of SSA countries, resulting in suboptimal care and subsequent high burden of premature cardiac death. There is a need to improve the standard of arrhythmia care by providing essential services such as rhythm monitoring, access to anticoagulation and to essential antiarrhythmic drugs, and cardiac pacemaker implantations.