English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Not a lot has been written about the organization of or access to cardiac arrhythmia care in Africa. On the other hand, frequent news reports on outbreaks of infectious diseases have demonstrated the plight of many countries, not least in sub-Saharan Africa. These reports have highlighted the paucity of well-developed healthcare systems and infrastructure in dealing with medical crises. Accordingly, such impediments to the delivery of even basic medical care are also likely to hinder the availability of more complex and expensive therapeutic options for arrhythmias. In this issue of EP-Europace, a report from the Pan African Society of Cardiology (PASCAR)-Cardiac Arrhythmia Working Group (CAWG) on the use of cardiac implantable electronic devices (CIEDs) and interventional electrophysiology (EP) procedures 2011– 16 is presented. While the data from this first report on this topic may have some limitations, this is nevertheless both an interesting and a very important undertaking. The PASCAR-CAWG should be lauded for this initiative that gives us a current measure of the status of cardiac arrhythmia therapy in different geographical regions of Africa. The report is based to an extent on the successful template developed by the European Heart Rhythm Association (EHRA) White Book Project, which earlier this year concluded a decade of detailed data collection of arrhythmia procedures in the European Society of Cardiology (ESC) member countries. The EHRA White Book data have given insight into trends in arrhythmia care in Europe, demonstrating great disparity in CIEDs and EP procedure rates across the ESC area. The authors of the PASCAR-CAWG report concluded that the treatment of arrhythmias in Africa during the period surveyed was far from optimal. The paper cites economic reasons, lack of facilities, and shortage of trained physicians as the main reasons. Interestingly, some countries are only able to provide more complex care with the help of visiting physicians or by way of humanitarian missions. The outcome of this report is perhaps not entirely surprising given the recent results from the EHRA White Book. The North African countries Algeria, Egypt, Libya, Morocco, and Tunisia are members of the ESC and have as such been invited to take part in the yearly EHRA White Book data collection. In these North African countries, the use of CIEDs and interventional EP procedures has been significantly lower than in the European ESC countries. However, according to the PASCAR-CAWG report, these countries were among the best-performing countries in Africa. There was significant heterogeneity in both the access to care and the use of CIEDs and EP procedures across the African continent. In fact, the only sub-Saharan country able to provide a full armamentarium of arrhythmia services was South Africa. This underscores the magnitude of the challenge-facing many African countries as they set out to improve and potentially expand arrhythmia care. To an extent, this disparity reflects substantial differences in gross domestic product and healthcare expenditure among the African countries. This variability in access to arrhythmia care is also influenced by complex socioeconomic and political situations as well as huge diversity in the organization of healthcare systems across this large continent. The lack of universal health coverage in most countries is a large roadblock in the step towards providing equity in care. The average life expectancy in Africa is significantly lower than in Europe. According to the World Health Organization statistics, the average life expectancy in Africa was 60.0 years compared with 76.8 years in Europe. In Western societies, arrhythmias such as atrial fibrillation (AF), severe bradycardia due to sinus node or atrioventricular node dysfunction, and ventricular tachyarrhythmias tend to occur much more commonly in the elderly population. This may, in part, explain the lower implant rates and perhaps even a different need for advanced arrhythmia therapy in Africa compared with Europe. However, the higher prevalence of diseases such as rheumatic fever, which is far more common among young Africans than

Promoting cardiac arrhythmia care in Africa: a big challenge that begins with data