Pacemaker and ICD Re-use in AFRICA – the Cape Town experience Ashley Chin MBChB, FCP(SA), MPhil, FHRS Cardiologist/Electrophysiologist Groote Schuur Hospital University of Cape Town South Africa PASCAR 2015, Mauritius Outline Current Status of Pacing and ICD use in AFRICA – 2014 PASCAR Survey of Pacing and ICD use in Africa Pacemaker and ICD re-use in Groote Schuur Hospital, Cape Town, South Africa PASCAR fellowship in cardiac pacing “Permanent pacing remains one of the ... Still unavailable to many patients living most cost effective treatments in Africa today... available in modern medicine” 5800 5858 Activitrax® MicroMinix® Thera ® EnPulse® First External Pacemaker PediPautrlsice AGseynnecrhartoorn ous Rate response smRaadlliecra slliyz e bFairsestd ,M Micordoep rswocietcshsoinr-g autoFmualtl icity FiPrasct eLmeaadkleers s 1958 1970 1986 1990 1995 2004 2015 est 1960 1979 1989 1991 1998 2006 First Implantable Pacemaker Du al chamber Rate re sponse via activity M VP, Full rate response & minute ventilation automaticity Chardack-Greatbatch Byrel® Synergist™ Elite™ Kappa® Adapta™ R Sutton, The foundation of Cardiac Pacing 1991 PM implantation rate in EUROPE Brignole et al , 2013 ESC pacing guidelines PACING in AFRICA 11th World Survey of Cardiac Pacing and ICDs in 2009 included 2 African countries POPULATION PM CENTRES PM IMPLANTS PM (million) 2009 2009 (Units per million) SOUTH AFRICA 49 47 2939 60 SUDAN 39 4 180 5 SPAIN 45 116 25595 569 PM implantation rates are very low in 2 African countries compared to other European countries with a similar population Mond et al , PACE, August 2011 2014 PASCAR SURVEY on PACING and ELECTROPHYSIOLOGY in AFRICA ACKNOWLEDGEMENTS: Bongani Mayosi (PASCAR President) Aime Bonny (Chair – PASCAR Task Force on Sudden Cardiac Death) PARTICIPANTS: Ashley Chin (South Africa), Isaac Kofi Owusu (Ghana), Adama Kane (Senegal), Houenassi (Benin), Jeilan (Kenya), A Gehani (Libya), Diakite Mamadou (Mali), Toure Ali Ibrahim (Niger), Sonia Marrakchi (Tunisia), Kamilu Karaye (Nigeria), Maiduguri (Nigeria), Anastaze Dzudie (Cameroon), Tantchou Cabral (Cameroon), Ouankou Debozard (Cameroon), James Russel (Sierra Leone), Icham Bouzelmat (Morocco), Brahim Hamdaoui (Morocco), Awad Mohamed (Sudan) 14 African countries PACING in AFRICA in 2014 COUNTRY PM PM PM/CENTRE PM (2013) Re-used PM CENTRES DOCTORS (2013) Severe shortage SOUTH AFRICA 54 173 144 3859 Yes of PM centres TUNISIA 60 200 2000 No exist in all MOROCCO 7 600-700 countries SUDAN 517 surveyed KENYA 6 20-30 NIGERIA 5 3 Severe shortage SENEGAL 3 11 89 89 Yes (22%) of PM doctors CAMEROON 3 3 26 80 No Mostly low- LIBYA 2 4 50 volume GHANA 2 2 16 implanters BENIN 1 1 19 MALI 1 2 16 PM implantation NIGER 0 0 0 rate is very low SIERRA LEONE 0 0 0 UGANDA Yes 2014 PASCAR SURVEY on PACING and EP in AFRICA PACING in SOUTH AFRICA PM (Units per million) 80 60 Increase in PM implants over 40 time but rates are still low compared to Europe 20 0 1995 1998 2001 2009 2014 Increase in PM doctors: 112 PM doctors (31 centres) in 1998 173 PM doctors (54 centres) in 2014 Scott Millar, S Afr Med J 2001 PACING in SOUTH AFRICA Large geographic and racial discrepancies Few PM doctors in 4 provinces in SA in 2014 (14 406 500 people) 3700 patients/year may have AV block without a PM (1998) Scott Millar, S Afr Med J 2001 ICDs in AFRICA 2009 11th World Survey of Cardiac Pacing and ICDs in included 2 African countries POPULATION ICD IMPLANTS ICD (million) (2009) (Units per million) SOUTH AFRICA 49 308 6 SUDAN 39 2 <1 SPAIN 45 2930 65 Mond et al , PACE, August 2011
Description: