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Arch Cardiovasc Dis ; 109(6-7): 376-83, 2016.
Article in English | MEDLINE | ID: mdl-27020513

ABSTRACT

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.


Subject(s)
Acute Coronary Syndrome/therapy , Cardiac Catheterization , Delivery of Health Care, Integrated/organization & administration , Developing Countries , Health Services Accessibility/organization & administration , Percutaneous Coronary Intervention , Thrombolytic Therapy , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Africa South of the Sahara/epidemiology , Cardiac Catheterization/standards , Consensus , Delivery of Health Care, Integrated/standards , Health Services Accessibility/standards , Health Services Needs and Demand/organization & administration , Humans , Incidence , Needs Assessment/organization & administration , Patient Care Team/organization & administration , Percutaneous Coronary Intervention/standards , Prevalence , Thrombolytic Therapy/standards , Time-to-Treatment/organization & administration , Treatment Outcome
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