Cardiac arrhythmias in low- and middle-income countries

Mkoko, Philasande; Bahiru, Ehete; Ajijola, Olujimi A.; Bonny, Aimé; Chin, Ashley

doi:10.21037/cdt.2019.09.21

Cited by 19 publications

(20 citation statements)

References 74 publications

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“…vii) No local AF clinical practice guidelines or prospective registries. viii) Lack of or inadequate public health policies or healthcare system: Few LMICs provide universal health coverage to their populations [147][148][149], resulting in heterogeneous access to healthcare infrastructure. Public health orientation and patient education may not be priorities and will adversely affect adherence to rhythm-control drugs.…”

Section: Challenges and Roadblocks For Rhythm-control Strategies In Lmicsmentioning

confidence: 99%

“…These drugs are usually well tolerated and globally available at relatively low cost [ 123 ]. Rate-control therapy can be applied in ambulatory settings, but may necessitate 24-hour ECG monitoring, not readily available in LMICs [ 124 ]. Rhythm-control is medically more complex as it may involve initial interventions such as pharmacological or electrical cardioversion that require a medical center/hospital setting and prescription of antiarrhythmic drugs for maintenance of sinus rhythm [ 125 ].…”

Section: Rate-control and Rhythm-control Strategies – Perspective And Challengesmentioning

confidence: 99%

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World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them.Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness.In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow.This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

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Section: Challenges and Roadblocks For Rhythm-control Strategies In Lmicsmentioning

confidence: 99%

Section: Rate-control and Rhythm-control Strategies – Perspective And Challengesmentioning

confidence: 99%

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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“…There is limited information on the true burden of disease, current management strategies, and cost-effectiveness for managing patients with AF in LMICs. 92 …”

Section: Economic Burdenmentioning

confidence: 99%

Atrial fibrillation in low- and middle-income countries: a narrative review

Santos

Goulart

Olmos

et al. 2020

European Heart Journal Supplements

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Preventing premature non-communicable disease mortality necessitates a thorough review of one of the most important risk factors for stroke, which is atrial fibrillation (AF). The latter and AF-related stroke are still considered to be problems of high-income countries and are frequently overlooked in low- and middle-income countries (LMICs). In this narrative review, we provide an overview of studies that evaluated at least one of the following determinants of AF burden in LMICs: current epidemiology and trends, stroke prevention, health outcomes, and economic burden. Studies focusing on samples close to the general population (including community- and primary care-based samples) indicate sex-specific prevalence rates up to 7.4% in LMICs. Although AF prevalence is still higher in high-income countries than LMICs, the gap in AF burden between these two groups has been reducing in the past three decades. Oral anticoagulant (OAC) therapy for stroke prevention is underused in LMICs, and there are little data on OAC therapy in relation to stroke risk scores, such as CHA2DS2-VASc. Available data also points to higher morbidity and mortality for patient with AF in LMICs than their counterparts in high-income countries. Data on the consequent economic burden in LMICs is scarce, but it is reasonable to consider it will follow the same trend as that observed for health outcomes. Raising the visibility of AF as a public health problem in LMICs is necessary as a first step to providing adequate care for patients with this condition.

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“…The World Heart Federation (WHF) identifies three main areas of care gaps in the management of Atrial Fibrillation (AF) in low-and middle-income countries (LMICs) including inadequate screening for AF among high-risk individuals, low rates of treatment initiation of anticoagulation, and the lack of country specific AF data to tailor interventions [7]. Concerning Bradyarrhythmia, the two main problems reported by Mkoko et al, is the lack of trained specialists for cardiac stimulation and the high cost of the procedure [3]. The challenge of prevention of sudden cardiac death in Africa mainly concerns incorrect consideration of antiarrhythmic drugs as equally to intracardiac defibrillator and the high cost of this procedure.…”

Section: Challenges In the Management Of Cardiac Arrhythmia In Africamentioning

confidence: 99%

“…Atrial fibrillation, bradyarrhythmias, and conduction system diseases account for the most rhythm conditions [2]. In Africa, the rate of CA increased gradually following the epidemiological transition of diseases [3]. According to a recent systematic review conducted by Matthew F. Yuyun et al, there are few available health professionals who can adequately manage CA in Africa [4].…”

Section: Introductionmentioning

confidence: 99%