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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
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Given the disparities in care already in place, it is obvious
that the requirements for improvement in various regions will
differ substantially. One might also question how realistic it is
to promote arrhythmia care in those areas where the healthcare
infrastructure is weak, and even primary care is poorly organised
and underfunded.
Ideally, basic arrhythmia services would include non-invasive
diagnostic work up, intravenous and oral anti-arrhythmia
drugs (including parenteral ones), anticoagulants (including
NOACs), procedures such as pacemaker implantations, ICDs for
secondary prevention, CRT and simple radiofrequency catheter
ablations. Re-use of cardiac devices should be promoted to a
greater extent, to include those unable to afford new devices.
16
This will require significant investment in facilities and training
of physicians in some areas.
For this reason, the development of arrhythmia services
could initially be congregated in a few selected centres in Africa
as centres of excellence, which could eventually also function as
training sites for arrhythmia specialists. In this regard, countries
of North Africa, Kenya, Senegal and South Africa are well
equiped to drive such a south–south cooperation. In addition,
telemedicine and e-cardiology, including ECG monitoring, will
help to diagnose cardiac arrhythmias in patients living in poor-
resource settings lacking healthcare professionals.
Study limitations
The data of the survey highlighting availability of facilities and
treatments were mainly obtained on a declarative basis. Also,
some countries in SSA had multiple responders while some
had none or only one responder. These may have resulted in
incomplete data. However, the data still provide an insight into
the availability of cardiac arrhythmia services in Africa, which
could be used for advocacy and planning.
Conclusion
This new pan-African survey on managing arrhythmias in
Africa describes the current status and challenges of managing
cardiac arrhythmias in different geographical regions of Africa.
There are also huge disparities in diagnostic and treatment
facilites in Africa. The increasing burden of cardiac arrhythmias
and premature cardiac death calls for better understanding of
cardiac arrhythmias, promoting awareness of the importance
of arrhythmogenic cardiac disorders in the spectrum of tropical
cardiac diseases, and improved cardiac arrhythmia services in
Africa.
The database of this survey was obtained through the collective efforts of
several medical doctors and local distributors, to whom we are immensely
grateful. The following physicians participated in the study by collecting
relevant data from their countries:
Algeria: Yazid Aoudia; Angola: Sandra Castelo; Burkina Faso: Georges
Millogo and Jonas Kologo; Cameroon: Anastase Dzudie; Kenya: Mohammed
Jeilan; Mauritius: Kaviraj Bundhoo; Niger: Ibrahim Toure Ali; Nigeria: Aje
Akinyemi; Senegal: Adama Kane; Sierra Leonne: Russell James Baligeh
Walter; South Africa: Adele Greyling and Andrew Thornton; Sudan:
Mohamed Awad Awad, Elbadri Azza, Anas Babiker, Ibrahim Lway, Eltalib
Khalid, Ali Mustafa Ibrahim Mohammed, Mohammed Murtada, Elsayed
Osman, Khaleifa Sahar and Mohamed Khadja Abdalhakam Taifour;
Tanzania: Mohamed Hanee Mehboob.
We thank Marcus Ngantcha from Cameroon for data managment. Mr
Musi Ngidjol Pierre Joseph from Cameroon designed the figures.
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