Herzinsuffizienz in Afrika?
Abstract
Zusammenfassung. Die Mortalität durch Herzinsuffizienz ist in Afrika doppelt so hoch wie in anderen Ländern mit niedrigem oder mittlerem Einkommen und fünfmal so hoch wie in der westlichen Welt. Die häufigste Ursache einer Herzinsuffizienz ist die arterielle Hypertonie, gefolgt von Kardiomyopathien und rheumatischer Herzkrankheit. Bei der Diagnosestellung liegt meist schon eine fortgeschrittene Herzerkrankung vor. Gerade bezüglich der arteriellen Hypertonie sind sich nur wenige ihrer Krankheit bewusst, noch weniger sind behandelt, und die wenigsten haben eine gut kontrollierte Hypertonie. Die Vernachlässigung von chronischen, nicht-übertragbaren Krankheiten in Afrika führt zu ungenügendem Wissen, ungenügenden diagnostischen Mitteln, ungenügender Prävention und limitierten Behandlungsmöglichkeiten, sodass die üblichen in den Industrieländern angewandten Richtlinien kaum umsetzbar sind. Aufklärung der Bevölkerung über Prävention und Behandlung, Ausbildung des Gesundheitspersonals, Implementierung von diagnostischen Mitteln und die Behandlung von Hypertonie und Herzinsuffizienz sind dringend notwendig.
Abstract. In Africa, mortality due to heart failure is twice as high as in other low- to middle-income countries and five times as high as in high-income countries. Arterial hypertension is by far the most common cause of heart failure, followed by cardiomyopathies and rheumatic heart diseases. At diagnosis, most patients suffer already from an advanced disease stage. Only a few patients are aware of arterial hypertension, and few are treated and have their hypertension well controlled. Only a minority of patients have a well-controlled hypertension. The neglect of chronic non-communicable diseases on the health agenda leads to poor awareness, poor diagnostic resources, preventions strategies and treatment options. International guidelines cannot be properly followed in these circumstances. Information at community level and in healthcare facilities is urgently needed as well as training of healthcare staff, implementation of improved diagnostics and treatment of arterial hypertension and heart failure.
Résumé. Le taux de mortalité due à l’insuffisance cardiaque en Afrique est deux fois plus élevé que dans les autres pays à revenu faible ou intermédiaire et cinq fois plus élevé que dans le monde occidental. La cause la plus fréquente d’insuffisance cardiaque est l’hypertension artérielle, suivie des cardiomyopathies et des cardiopathies rhumatismales. Au moment du diagnostic, une maladie cardiaque avancée est généralement déjà présente. Surtout en ce qui concerne l’hypertension artérielle, peu sont au courant de leur maladie, encore moins sont traités et peu ont une hypertension bien maîtrisée. La négligence des maladies chroniques non transmissibles en Afrique conduit à des connaissances insuffisantes, à des outils de diagnostic inadéquats, à une prévention inadéquate et à des options de traitement limitées, de sorte que les directives habituelles appliquées dans les pays industrialisés ne peuvent guère être appliquées. L’éducation de la population en matière de prévention et de traitement, la formation du personnel de santé, la mise en place d’outils de diagnostic et le traitement de l’hypertension et de l’insuffisance cardiaque sont des besoins urgents.
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