The National Cardiothoracic Centre, Accra Ghana: Proceedings of the second International Update Course in Cardiology - improving the coverage of cardiology services

Many developing countries now face the growing phenomenon of the double burden of disease. Most are still grappling with infectious diseases resulting from poor environmental sanitation and lack of access to good drinking water like malaria, cholera, and enteric fever. At the same time changes in diet and lifestyle in general in these countries is resulting in increasing numbers of people with obesity, sedentary life styles, increased salt intake from fast foods, increased smoking and consumption of alcohol and fizzy drinks, hypertension and diabetes. To increase the scope and depth of cardiovascular care in Ghana, the National Cardiothoracic Centre, (NCTC), organised the 2nd International Update Course in Cardiology for cardiologists and general practitioners, with emphasis on a practical approach to cardiology. Post conference evaluation indicated that the course was very useful especially for practitioners in district and regional hospitals. Close to 98% of the participants revealed that the update course will greatly impact positively on their management of cardiovascular diseases

Indications for and the diagnostic yield of 24-hour Holter monitoring: a prospective study at the Korle Bu Teaching Hospital

Background: Holter monitoring (HM) is an important tool used to evaluate symptoms suspected to be caused by arrhythmias. This study was aimed at determining the diagnostic yield of Holter monitoring among symptomatic and asymptomatic patients undergoing HM at the Korle-Bu Teaching Hospital.Methods: This was a prospective study among 400 consecutive symptomatic and asymptomatic patients undergoing HM from August 2006 to December, 2009 at the Korle-Bu Teaching Hospital. Data from the Holter study were analyzed, and symptoms linked to arrhythmias were evaluated to determine the diagnostic yield of HM in symptomatic and asymptomatic patients. Results: The mean age of the patients was 51.81 ± 16 years. The most common indications (symptoms) for HM were palpitation (62.9%) and dizziness (34.0%); about half (53.3%) of the symptomatic patients had only one indication. Among the symptomatic group, 28 in 115 symptoms were linked to arrhythmias giving a diagnostic yield of 24.3% whereas in the asymptomatic group 1 in 33 of symptom was linked to arrhythmia giving a diagnostic yield of 3.0%. The study found an overall diagnostic yield of 19.6%.Conclusion: HM as a regular health check for the general population (asymptomatic cohorts) is not cost effective and does not provide significant data to influence care except when the subject is found to have symptoms.Funding: Funded by the AuthorsKeywords: arrhythmias, indications, Holter monitoring, diagnostic yield, Ghan

Outcome of life-threatening arrhythmias among patients presenting in an emergency setting at a tertiary hospital in Accra-Ghana

Funding Information: We express our appreciation to the authorities at the Korle-Bu Teaching Hospital for their support and to the participants of this important study. Publisher Copyright: © 2022, The Author(s).Peer reviewedPublisher PD

Endovascular Recanalization and Angioplasty of a Lengthy, 25 Years Old Superficial Femoral Artery Occlusion

Introduction: Often physicians and patients believe that occluded vessels could not be recanalized because an occlusive lesion is too long or exists over a very long period. We report a successful recanalization of a lengthy, quarter-century old superficial femoral artery occlusion through a percutaneous transluminal angioplasty.Report: We present the recanalization and angioplasty of the superficial femoral artery in a patient with a 37 cm long and 25 years old superficial femoral artery occlusion with limb ischemia, and who was considered as a high surgical risk. Through a subintimal dissection plane and with subsequent Pacific-balloon dilatation, two stent grafts were deployed to maintain patency. The post-intervention angiography and ankle-brachial index (ABI) showed a satisfactory primary outcome.Discussion: The recent guidelines recommend the endovascular therapy as the preferred strategy in patients with long and complex femoropopliteal lesions, an adequate recommendation as our case demonstrates. This case demonstrates that neither lesion length nor duration of an occlusion should be a cause to withhold an endovascular treatment.</p

Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trialsResearch in context

Summary: Background: Digital health interventions can be effective for blood pressure (BP) control, but a comparison of the effectiveness and application of these types of interventions has not yet been systematically evaluated in low- and middle-income countries (LMICs). This study aimed to compare the effectiveness of digital health interventions according to the World Health Organisation (WHO) classifications of patients in terms of BP control, lifestyle behaviour changes, and adherence to medication in patients with hypertension in LMICs. Methods: In this systematic review and meta-analysis, we searched the PubMed, Scopus, Web of Science, Embase, CINAHL, and Cochrane Library databases for randomised controlled trials (RCTs) published in English, comprised of adults (≥18 years old) with hypertension and the intervention consisted of digital health interventions according to WHO's classifications for patients in LMICs between January 1, 2009, and July 17, 2023. We excluded RCTs that considered patients with hypertension comorbidities such as diabetes and hypertension-mediated target organ damage (HMTOD). The references were downloaded into Mendeley Desktop and imported into the Rayyan web tool for deduplication and screening. The risk of bias was assessed using Cochrane Risk of Bias 2. Data extraction was done according to Cochrane's guidelines. The main outcome measures were mean systolic blood pressure (SBP) and BP control which were assessed using the random-effect DerSimonian-Laird and Mantel-Haenszel models. We presented the BP outcomes, lifestyle behaviour changes and medication adherence in forest plots as well as summarized them in tables. This study is registered with PROSPERO, CRD42023424227. Findings: We identified 9322 articles, of which 22 RCTs from 12 countries (n = 12,892 respondents) were included in the systematic review. The quality of the 22 studies was graded as high risk (n = 7), had some concerns (n = 3) and low risk of bias (n = 12). A total of 19 RCTs (n = 12,418 respondents) were included in the meta-analysis. Overall, digital health intervention had significant reductions in SBP [mean difference (MD) = −4.43 mmHg (95% CI −6.19 to −2.67), I2 = 92%] and BP control [odds ratio (OR) = 2.20 (95% CI 1.64–2.94), I2 = 78%], respectively, compared with usual care. A subgroup analysis revealed that short message service (SMS) interventions had the greatest statistically significant reduction of SBP [MD = −5.75 mm Hg (95% Cl −7.77 to −3.73), I2 = 86%] compared to mobile phone calls [MD = 3.08 mm Hg (−6.16 to 12.32), I2 = 87%] or smartphone apps interventions [MD = −4.06 mm Hg (−6.56 to −1.55), I2 = 79%], but the difference between groups was not statistically significant (p = 0.14). The meta-analysis showed that the interventions had a significant effect in supporting changes in lifestyle behaviours related to a low salt diet [standardised mean difference (SMD) = 1.25; (95% CI 0.64–1.87), I2 = 89%], physical activity [SMD = 1.30; (95% CI 0.23–2.37), I2 = 94%] and smoking reduction [risk difference (RR) = 0.03; (95% CI 0.01–0.05), I2 = 0%] compared to the control group. In addition, improvement in medication adherence was statistically significant and higher in the intervention group than in the control group [SMD = 1.59; (95% CI 0.51–2.67), I2 = 97%]. Interpretation: Our findings suggest that digital health interventions may be effective for BP control, changes in lifestyle behaviours, and improvements in medication adherence in LMICs. However, we observed high heterogeneity between included studies, and only two studies from Africa were included. The combination of digital health interventions with clinical management is crucial to achieving optimal clinical effectiveness in BP control, changes in lifestyle behaviours and improvements in medication adherence. Funding: None

Self-reported hypertension as a predictor of chronic health conditions among older adults in Ghana: analysis of the WHO Study on global Ageing and adult health (SAGE) Wave 2

Introduction:&nbsp;hypertension has been identified as a significant predictor of many chronic health conditions. Body Mass Index (BMI) and Quality of Life (QoL) are key determinants of hypertension especially among elderly populations. In this study, we examined the effect of self-reported hypertension (SRH) on chronic health conditions and quality of life among older adults in Ghana. Methods:&nbsp;the WHO Study on Global Ageing and Adult Health Wave 2 data for Ghana, collected from 2014 to 2015 was applied in this study. Data for older adults aged 50 years and above were analyzed. Weighted descriptive and inferential analyses were performed using Stata 14. We predicted any potential associations between SRH and chronic health conditions using a corrected chi-square and Coarsened Exact Matching with adjusted odds ratios. Results:&nbsp;the prevalence of SRH among older adults in Ghana was 15.8%. This was significantly associated with sex, marital status, religion, place of residence, working status, location/region, health status BMI, and quality of life (QoL). In all, older adults with poor health status, obese state and high QoL had 3.15, 2.17 and 2.76 odds of SRH respectively [AOR(95%CI)p-value=3.15(1.65-6.02)0.001, 2.17(1.31-3.59)0.003 and 2.76(1.04-7.31)0.041)]. In addition, older adults with SRH were at increased risk of reporting chronic conditions such as stroke, angina, diabetes and cataract. Conclusion:&nbsp;overall, a key observation from this analysis is that SRH (and not only clinically diagnosed hypertension) is significantly associated with co-morbidities. In Ghana, older adults with SRH have increased risk of co-morbidities including diabetes, stroke, angina, and cataract. Interventions to improve the awareness and early detection of hypertension at the population level is key. Controlling hypertension at the population level will reduce prevalence of chronic conditions and increased protection

A multilevel and multicenter assessment of health care system capacity to manage cardiovascular diseases in Africa: a baseline study of the Ghana Heart Initiative

Abstract Introduction Cardiovascular diseases (CVD) remain the leading cause of death worldwide, with over 70% of these deaths occurring in low- and middle-income regions such as Africa. However, most countries in Africa do not have the capacity to manage CVD. The Ghana Heart Initiative has been an ongoing national program since 2018, aimed at improving CVD care and thus reducing the death rates of these diseases in Ghana. This study therefore aimed at assessing the impact of this initiative by identifying, at baseline, the gaps in the management of CVDs within the health system to develop robust measures to bolster CVD management and care in Ghana. Methods This study employed a cross-sectional study design and was conducted from November 2019 to March 2020 in 44 health facilities in the Greater Accra region. The assessment covered CVD management, equipment availability, knowledge of health workers in CVD and others including the CVD management support system, availability of CVD management guidelines and CVD/NCD indicators in the District Health Information Management System (DHIMS2). Results The baseline data showed a total of 85,612 outpatient attendants over the period in the study facilities, 70% were women and 364(0.4%) were newly diagnosed with hypertension. A total of 83% of the newly diagnosed hypertensives were put on treatment, 56.3% (171) continued treatment during the study period and less than 10% (5%) had their blood pressure controlled at the end of the study (in March 2020). Other gaps identified included suboptimal health worker knowledge in CVD management (mean score of 69.0 ± 13.0, p < 0.05), lack of equipment for prompt CVD emergency diagnosis, poor management and monitoring of CVD care across all levels of health care, lack of standardized protocol on CVD management, and limited number of indicators on CVD in the National Database (i.e., DHIMS2) for CVD monitoring. Conclusion This study shows that there are gaps in CVD care and therefore, there is a need to address such gaps to improve the capacity of the health system to effectively manage CVDs in Ghana

Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis

Background: The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana. Methods: We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model. Result: Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66). Conclusion: The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors