title: Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Maurice
authors.initials: M
authors.lastname: Kakou-Guikahue
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Roland
authors.initials: R
authors.lastname: N'Guetta
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Anzouan-Kacou
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Euloge
authors.initials: E
authors.lastname: Kramoh
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: Raymond
authors.initials: R
authors.lastname: N'Dori
authors.affiliation: Department of Cardiology, hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Serigne Abdou
authors.initials: SA
authors.lastname: Ba
authors.affiliation: Department of Cardiology, hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Maboury
authors.initials: M
authors.lastname: Diao
authors.affiliation: Department of Cardiology, hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Sarr
authors.affiliation: Department of Cardiology, hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Abdoul
authors.initials: A
authors.lastname: Kane
authors.affiliation: Department of Cardiology, hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Adama
authors.initials: A
authors.lastname: Kane
authors.affiliation: Department of Cardiology, CHU de Lomé, Lomé, Togo.
authors.forename: Findide
authors.initials: F
authors.lastname: Damorou
authors.affiliation: Department of Cardiology, CHU Ignace Deen, Conakry, Guinea.
authors.forename: Dadhi
authors.initials: D
authors.lastname: Balde
authors.affiliation: Department of Cardiology, hôpital de Bamako, Bamako, Mali.
authors.forename: Mamadou Bocary
authors.initials: MB
authors.lastname: Diarra
authors.affiliation: Department of Cardiology, CHU de Nouakchott, Nouakchott, Mauritania.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Djiddou
authors.affiliation: Department of Cardiology, CHU de Brazzaville, Brazzaville, Congo.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Kimbally-Kaki
authors.affiliation: Department of Cardiology, CHU de Ouagadougou, Ouagadougou, Burkina-Faso.
authors.forename: Patrice
authors.initials: P
authors.lastname: Zabsonre
authors.affiliation: Department of Cardiology, CHU de Niamey, Niamey, Niger.
authors.forename: Ibrahim Ali
authors.initials: IA
authors.lastname: Toure
authors.affiliation: Department of Cardiology, faculté des Sciences et de la Santé, Cotonou, Benin.
authors.forename: Martin
authors.initials: M
authors.lastname: Houénassi
authors.affiliation: Department of Cardiology, hôpital Fattouma Bourquiba, Monastir, Tunisia.
authors.forename: Habib
authors.initials: H
authors.lastname: Gamra
authors.affiliation: Department of Cardiology, Clinique Chifa, Marrakech, Morocco.
authors.forename: Bachir
authors.initials: B
authors.lastname: Chajai
authors.affiliation: Interventional Cardiology, hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Gerardin
authors.affiliation: Interventional Cardiology, hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Pillière
authors.affiliation: Department of Cardiology, hôpital Bichat, 75018 Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Aubry
authors.affiliation: Department of Cardiology, hôpital Corentin-Celton, 92130 Issy-les-Moulineaux, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Iliou
authors.affiliation: Department of Cardiology, hôpital de la Salpêtrière, 75013 Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Isnard
authors.affiliation: Department of Cardiology, hôpital de la Salpêtrière, 75013 Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Department of Cardiology, CHU de Dijon, 21000 Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Department of Cardiology, Cardiology, 84200 Carpentras, France.
authors.forename: Edmond
authors.initials: E
authors.lastname: Bertrand
authors.affiliation: Department of Cardiology, CHU de Brabois, 54500 Nancy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: Department of Cardiology, hôpital René-Muret, 93270 Sevran, France. Electronic address: jean-jacques.monsuez@aphp.fr.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Monsuez
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017954:Africa South of the Sahara / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000592:standards; D032921:Consensus; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D003906:Developing Countries; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D015994:Incidence; D020380:Needs Assessment / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D062645:Percutaneous Coronary Intervention / Q000592:standards; D015995:Prevalence; D015912:Thrombolytic Therapy / Q000592:standards; D061665:Time-to-Treatment / Q000458:organization & administration; D016896:Treatment Outcome
keywords: Acute coronary syndromes; Afrique subsaharienne; Infarctus du myocarde; Myocardial infarction; Sub-Saharan Africa; Syndromes coronaire aigu