Sub-Saharan Africa Study Demonstrates Feasibility of Local Cardiac Pacing Capabilities
While lack of accessibility to cardiac pacing is a pressing issue in many parts of the world, Sub-Saharan Africa lacks total access to this potentially life-saving procedure – despite patient need existing in similar rates worldwide. New findings from the Cardiac Pacing in Sub-Saharan Africa study, published Nov. 18 in the Journal of the American College of Cardiology, demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.
Xavier Jouven, MD, PhD, et al., prospectively analyzed over two decades of data on implanted patients from missions from the Africa-Pace project, which was designed to initiate and build sustainable local and regional capacity for cardiac pacing in the region. This was accomplished by means of partnership with local cardiologists and health care teams providing clinical services, occurring mainly within the framework of public institutions, such as teaching hospitals. Data analyzed spanned the length of the project, which from 1996 to 2018 targeted 14 countries in Sub-Saharan Africa for a total of 64 missions.
The mean age of study participants was 63.9 years, and 62 percent were men. The mean heart rate on the day of implantation was 37 beats/min, and the majority of patients were diagnosed with paroxysmal or permanent complete atrioventricular block (94 percent), with the others having sinus node dysfunction. Nearly all patients were symptomatic.
Results showed that the median wait time for cardiac pacing per mission was 7 days; of the 1,077 patients initially listed, 542 (50.3 percent) were eventually implanted. The majority of the remaining patients had died suddenly while waiting for pacemaker implantation, prior to mission arrival. The median waiting time between diagnosis and intervention was 18.4 months, with successful pacing eventually achieved in all cases, with no periprocedural mortality.
The authors conclude that overall, the program resulted in a significant increase in local implantation rates over time. They add that the key achievement of the program was due to the implantations performed independently by local cardiologists, with one-half of countries now having successfully established their own independent pacing programs.
“This has been possible not only through the training of African cardiologists by proctor missions, but also by the subsequent initiatives of the initially trained African physicians to reach out to neighboring countries, resulting in transfer of knowledge between different developing countries,” the authors explain. “This experience serves as a potential roadmap to help disperse necessary medical technology to all corners of the developing world,” they add.
Keywords: Developing Countries, Atrioventricular Block, Africa South of the Sahara, Africa, Northern, Hospitals, Teaching, Patient Care Team, Pacemaker, Artificial
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