A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa
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
Affiliations
Matthew F. Yuyun
Department of Medicine, Harvard Medical School, Boston; Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston
Aimé Bonny
District Hospital Bonassama, Douala/University of Douala; Homeland Heart Centre, Douala, CM; Centre Hospitalier Montfermeil, Unité de Rythmologie, Montfermeil
G. André Ng
National Institute for Health Research Leicester Biomedical Research Centre, Department of Cardiovascular Sciences, University of Leicester
Karen Sliwa
Hatter Institute for Cardiovascular Research in Africa, University of Cape Town
Andre Pascal Kengne
South African Medical Research Council and Department of Medicine, University of Cape Town
Ashley Chin
The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town
Ana Olga Mocumbi
Instituto Nacional de Saúde and Universidade Eduardo Mondlane, Maputo
Marcus Ngantcha
Homeland Heart Centre, Douala
Olujimi A. Ajijola
Ronald Reagan UCLA Medical Center Los Angeles
Gene Bukhman
Department of Medicine, Harvard Medical School, Boston; Division of Cardiovascular Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston; Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston; NCD Synergies project, Partners In Health, Boston
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.
