Cardiac arrhythmia services in Africa from 2011 to 2018: the second report from the Pan African Society of Cardiology working group on cardiac arrhythmias and pacing
Cardiac arrhythmia services in Africa from 2011 to 2018: the second report from the Pan African Society of Cardiology working group on cardiac arrhythmias and pacing
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DOI：
10.1093/europace/euz354
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发表时间：
2020-03-01
期刊：
影响因子：
6.1
通讯作者：
Sliwa, Karen
中科院分区：
文献类型：
--
作者：
Bonny, Aime;Ngantcha, Marcus;Sliwa, Karen
心律失常服务在非洲是一个被忽视的心脏病学领域。为了提供全面的当代信息的访问和使用的心律失常服务在Africa.Methods和结果的人力资源，药物的可用性，心脏植入式电子设备（CIED），和消融程序的数据，寻求泛非心脏病学会的成员国。从31个国家中的23个国家收到了数据。在大多数国家，医疗保健服务主要由家庭收入支持。维生素K拮抗剂（VKA）、地高辛和胺碘酮在所有国家都有供应，而其他药物的供应情况差别很大。非VKA口服抗凝剂（NOAC）在非洲市场的存在不平等，而国际标准化比率监测具有挑战性。4个国家（18%）没有提供起搏器植入，而在可用的情况下，植入率和手术率分别为每百万人口2.79和0.772。起搏器植入率/百万人口最高的国家依次为突尼斯、毛里求斯、南非、阿尔及利亚和摩洛哥。分别在15个（65%）和12个（52%）国家进行了植入式心律转复除颤器和心脏起搏治疗（CRT）。5个国家（22%）使用了修复后的CIED。在8个（35%）国家进行了电生理学检查，但仅在马格里布和南非的国家进行了复杂消融。在非洲发现，独立企业发展的成本差异很大，与人均国内生产总值严重不匹配。从第一份报告中，三个国家已经开始执行简单的ablations.Conclusion获得心律失常治疗的差异很大，在非洲，数亿人仍然有死于心脏传导阻滞的风险。增加经济和人力资源以及基础设施是改善非洲心律失常服务的关键目标。
Aims Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa.Methods and results Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations.Conclusion The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.