Cardiovascular Journal of Africa: Vol 29 No 2 (March/April 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018 AFRICA 115
PASCAR Report
Status of cardiac arrhythmia services in Africa in 2018:
a PASCAR Sudden Cardiac Death Task Force report
MA Talle, A Bonny, W Scholtz, A Chin, G Nel, KM Karaye, JB Anzouan-Kacou, A Damasceno,
YR Lubenga, MU Sani, BM Mayosi
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 elec-
tronic 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 implanta-
tion 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 coun-
tries 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 conduc-
tion 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.
Keywords: cardiovascular diseases, cardiac arrhythmias, Africa,
management, services
Submitted 28/4/18, accepted 18/4/18
Cardiovasc J Afr 2018; 29: 115–121
DOI: 10.5830/CVJA-2018-027
Cardiovascular diseases (CVD) including cardiac arrhythmias
are a major public health problem in low- and middle-income
countries (LMICs) to which all sub-Saharan African (SSA)
countries belong.1,2 Lack of adequate data on the real burden of
cardiac arrhythmias and the need for expensive equipment and
drugs poses a great impediment to the management of patients
with arrythmogenic diseases in SSA.
Accurate diagnosis and treatment of cardiac arrhythmias
require monitoring of electrical activity of the heart, drug
challenges to unmask paroxysmal/concealed arrhythmias, and
non-invasive and invasive imaging techniques, which are not
Cardiology Unit, Department of Medicine, University of
Maiduguri Teaching Hospital, Maiduguri, Nigeria
MA Talle, MD
University of Douala, Cameroon Cardiovascular Research
Network, Douala, Cameroon; Hopital Forcilles, Ferolles-
Attilly, France
A Bonny, MD, MSc
Pan-Africa Society of Cardiology (PASCAR)
W Scholtz, BSc (Hons)
G Nel, MSc
Cardiac Clinic, Department of Medicine, Groote Schuur
Hospital and University of Cape Town, Cape Town, South
Africa
A Chin, MD
Bayero University and Aminu Kano Teaching Hospital,
Department of Cardiology, Kano, Nigeria
KM Karaye, BM BCh, PhD
MU Sani, MD
Felix Houphouet Boigny University, Abidjan, Ivory Coast;
Cardiology Institute of Abidjan, Ivory Coast
JB Anzouan-Kacou, MD
Faculty of Medicine, Eduardo Mondlane University,
Maputo, Mozambique
A Damasceno, MD
Department of Cardiology, University Hospital of Kinshasa,
Democratic Republic of Congo
YR Lubenga, MD
Department of Medicine, Faculty of Health Sciences,
University of Cape Town and Groote Schuur Hospital, Cape
Town, South Africa
BM Mayosi, DPhil, FCP (SA),