Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team
Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team
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DOI：
10.1016/j.acvd.2015.12.005
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发表时间：
2016-06-01
影响因子：
3
通讯作者：
Monsuez, Jean-Jacques
中科院分区：
文献类型：
--
作者：
Kakou-Guikahue, Maurice;N'Guetta, Roland;Monsuez, Jean-Jacques
背景。 - 尽管高收入国家的冠状动脉疾病死亡率有所下降，但撒哈拉以南非洲地区急性冠状动脉综合征（ACS）的发病率却在增加，其管理仍然是一个挑战。目标。 - 基于现实考虑，提出优化撒哈拉以南非洲 ACS 管理的共识声明。方法。 - AFRICARDIO-2 会议（亚穆苏克罗，2015 年 5 月）回顾了 10 个撒哈拉以南国家（贝宁、布基纳法索、刚果布拉柴维尔、几内亚、科特迪瓦、马里、毛里塔尼亚、尼日尔、塞内加尔、多哥）的 ACS 持续特征，并分析了是否可以利用现成的医疗设施改进战略和政策。结果。 - ACS患者的结局受到明确确定的因素的影响，包括：延迟到达首次医疗接触、实现有效的医院转运、从症状出现到再灌注治疗的时间增加、初级急救设施有限（特别是在农村地区）和紧急医疗服务（EMS）院前管理，因此适合心肌再灌注（溶栓治疗和/或经皮冠状动脉介入治疗[PCI]）的患者数量有限。 10个参与国家只有5个导管实验室，PCI率非常低。然而，近年来，非洲大城市（阿比让和达喀尔）的转诊心脏病科建立了导管实验室。改善患者护理和结果应针对有限但选定的目标：提高对 ACS 症状的认识和认识；农村医疗保健专业人员的教育；开发和管理农村地区或小城市的一线医疗机构、大城市的急诊室、EMS、医院心脏病科和导管实验室之间的网络。结论。 - 面对撒哈拉以南非洲地区 ACS 日益流行的情况，应制定医疗保健政策以克服阻碍最佳管理的多重缺点。欧洲和/或北美的管理指南应适应非洲的具体情况。鉴于现有的医疗机构、组织和少数心脏病学团队，我们的共识声明旨在基于现实考虑来优化患者管理。 (C) 2016 Elsevier Masson SAS。版权所有。
Background. - Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge.Aim. - To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations.Methods. - The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities.Results. - The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories.Conclusion. - Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available. (C) 2016 Elsevier Masson SAS. All rights reserved.