Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team

Kakou-Guikahue, M.; N’Guetta, Roland; Anzouan-Kacou, J. B.; Kramoh, E.; N'dori, R.; Bâ, Serigne Abdou; Diao, Maboury; Sarr, M.; Kané, A.; Kane, Adama; Damorou, Findide; Balde, Dadhi M; Diarra, Modibo; Djiddou, Mohamed; Kimbally-Kaki, Gisèle; Zabsonré, Patrice; Toure, Ibrahim Ali; Houenassi, Martin; Gamra, Habib; Chajai, Bachir; Gérardin, Benoît; Pillière, Rémy; Aubry, P; Iliou, Marie‐Christine; Isnard, Richard; Leprince, Pascal; Cottin, Yves; Bertrand, É.; Juillière, Yves; Monsuez, Jean‐Jacques

doi:10.1016/j.acvd.2015.12.005

Cited by 55 publications

(65 citation statements)

References 25 publications

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“…Most SSA countries have insufficient health care systems and infrastructure to manage CVDs with strong evidence of very limited number of hospitals equipped with the provision of specialist cardiac services in this region, including shortage of medications [18][19][20]. Tertiary centers for advanced cardiac imaging and invasive cardiac procedures including cardiac catherization, PCI, cardiothoracic and vascular surgical interventions are very sparsely available in most of SSA, apart from South Africa [18,61,123]. Electrophysiological study and catheter ablation centers are present only in very few countries in SSA and 26% of countries surveyed in this region do not have cardiac electronic implantable device implanting services [19].…”

Section: Inadequate Healthcare Infrastructurementioning

confidence: 99%

“…Electrophysiological study and catheter ablation centers are present only in very few countries in SSA and 26% of countries surveyed in this region do not have cardiac electronic implantable device implanting services [19]. Access to these facilities -where they exist -is still heavily limited by poor transport infrastructure, low availability or lack of reliable emergency medical services (EMS), with patients on average taking several hours to several days before arriving at these referral centers [18]. These delays often result in acute myocardial infarction patients, for example, arriving at health facilities outside the time window for thrombolysis and primary PCI.…”

Section: Inadequate Healthcare Infrastructurementioning

confidence: 99%

“…Concurrently, the neglected endemic CVDs of SSA, such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases, remain unconquered [14][15][16][17]. Nevertheless, the growth of cardiac care infrastructure and professionals in SSA have failed to match up with the growing burden and demands of these diseases [18][19][20]. Given mounting concerns about the growing burden of NCDs globally, the 2011 UN High-Level Meeting made a political declaration on non-communicable diseases aimed at achieving the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal), which was further emphasized in the UN Sustainable Development Goals (SDGs) for 2030 adopted in 2015 to reduce by one third premature mortality from NCDs by 2030 [21].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

et al. 2020

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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations. Highlights:-The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.-Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10-20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA. -SSA has 23% of the world's prevalent rheumatic heart disease cases.-The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

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Section: Inadequate Healthcare Infrastructurementioning

confidence: 99%

Section: Inadequate Healthcare Infrastructurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

et al. 2020

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“…PCI facilities are only available in a minority of LMIC hospitals,8 24 although there is huge variation among LMICs. For example, of the 10 countries participating in the AFRICARDIO-2 conference, only five had catheterisation laboratories 25. On the other side, in South Africa 71% of the population live within 120 min of a PCI facility 26.…”

Section: Barriers For MI Systems Of Care Implementation In Lmicsmentioning

confidence: 99%

“…Costs and funding issues also account for the wider availability of PPCI in private rather than in public institutions and, along with the better wages and work conditions, this concentrates specialised personnel in private practice. Sub-Saharan Africa has also limited access to expensive therapies, such as newer fibrinolytic drugs and PCI devices,25 and even in more developed countries, as India11 and Mexico,27 streptokinase remains the most common available fibrinolytic, although fibrin-specific agents should be preferred,12 especially in the prehospital setting. In Brazilian metropolitan areas, basic medications as P2Y12 inhibitors and heparins were also not fully available in prehospital emergency units 9 10…”

Section: Barriers For MI Systems Of Care Implementation In Lmicsmentioning

confidence: 99%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.

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Ultrasound‐gated computed tomography coronary angiography: Development of ultrasound transducers with improved computed tomography compatibility

et al. 2021

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Purpose Cardiovascular disease (CVD) is a leading cause of death worldwide, with coronary artery disease (CAD) accounting for nearly half of all CVD deaths. The current gold standard for CAD diagnosis is catheter coronary angiography (CCA), an invasive, expensive procedure. Computed tomography coronary angiography (CTCA) represents an attractive non‐invasive alternative to CCA, however, CTCA requires gated acquisition of CT data during periods of minimal cardiac motion (quiescent periods) to avoid non‐diagnostic scans. Current gating methods either expose patients to high levels of radiation (retrospective gating) or lead to high rates of non‐diagnostic scans (prospective gating) due to the challenge of predicting cardiac quiescence based on ECG alone. Alternatively, ultrasound (US) imaging has been demonstrated as an effective indicator of cardiac quiescence, however, ultrasound transducers produce prominent streak artifacts that disrupt CTCA scans. In this study, a proof‐of‐concept array transducer with improved CT‐compatibility was developed for utilization in an integrated US‐CTCA system. Methods Alternative materials were tested radiographically and acoustically to replace the radiopaque acoustic backings utilized in low frequency (1–4 MHz) cardiac US transducers. The results of this testing were used to develop alternative acoustic backings consisting of varying concentrations of aluminum oxide in an epoxy matrix via simulations. On the basis of these simulations, single element test transducers designed to operate at 2.5 MHz were fabricated, and the performance of these devices was characterized via acoustic and radiographic testing with micro‐computed tomography (micro‐CT). Finally, a first proof‐of‐concept cardiac phased array transducer was developed and its US imaging performance was evaluated. Micro‐CT images of the developed US array with improved CT‐compatibility were compared with those of a conventional array. Results Materials testing with micro‐CT identified an acoustic backing with a measured radiopacity of 1008 HU, more than an order of magnitude lower than that of the acoustic backing (24,000 HU) typically used in cardiac transducers operating in the 1–4 MHz range. When utilized in a simulated transducer design, this acoustic backing yielded a −6‐dB fractional bandwidth of 57%, similar to the 54% bandwidth of the transducer with the radiopaque acoustic backing. The developed 2.5 MHz, single element transducer based on these simulations exhibited a fractional bandwidth of 51% and signal‐to‐noise ratio (SNR) of 14.7 dB. Finally, the array transducer developed with the acoustic backing having decreased radiopacity exhibited a 56% fractional bandwidth and 10.4 dB single channel SNR, with penetration depth >10 cm in phantom and in vivo imaging using the full array. Conclusions The first attempt at developing a CT‐compatible ultrasound transducer is described. The developed CT‐compatible transducer exhibits improved radiographic compatibility relative to conventional cardiac array transduc...

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Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team

Cited by 55 publications

References 25 publications

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

Implementing myocardial infarction systems of care in low/middle-income countries

Ultrasound‐gated computed tomography coronary angiography: Development of ultrasound transducers with improved computed tomography compatibility

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