CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 3 From the Editor’s Desk I am pleased to be able to offer you in, this issue, an array of articles of interest from Africa and other parts of the world. Olorunda and colleagues (page 4) describe percutaneous coronary intervention facilities (PCI) in Nigeria. They examined the national records and concluded that there is a lack of PCI-capable facilities in Nigeria and that there needs to be an investment from the government and stakeholders in Nigeria to increase the access to PCI, given the paradigm shift from communicable to non-communicable diseases. I applaud the authors but respectfully wish to offer an alternative argument. I am not aware (and await to be informed) of any study that shows that increasing access to PCI would make any impact on mortality, at a population level in Africa. On the contrary, there is excellent evidence that simple measures such as stopping smoking (by increasing taxes on tobacco and reducing illegal cigarette sales), improved primary healthcare (PHC) and improved prescription of simple, cheap medications at PHC level may be more valuable to the future health of the African population than PCI facilities, expensive medications, devices, catheters and highly paid staff. The authors point out that the management of acute coronary syndrome (ACS) inNigeria is limitedby anon-existent prehospital emergency medical services system, delays in presentation and limited capabilities for reperfusion. Decades ago, the ISIS studies showed that the simple administration of aspirin orally, early after onset of symptoms of ACS, improved the prognosis. I would be interested to read a cost/benefit analysis of the value to the population as opposed to implementation of the inexpensive, easily applied measures mentioned above. On a related but different theme, AlHabeeb and co-authors (page 12) describe a retrospective, observational research on patients with heart failure at a cardiac centre in Riyadh, to observe the heart failure patients’ management before (January to December 2014) and after (January to December 2015) the establishment of a programme to manage heart failure. The multidisciplinary heart-failure programme resulted in a positive effect, in the form of improved patient care, after including the clinical pharmacist and nurse specialist. My interpretation of the message is that simple, low-cost interventions improve patient outcomes and we should be exploring them. Pat Commerford Editor-in-Chief Professor PJ Commerford
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