In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis

OBJECTIVE: There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. METHODS: PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I(2)-statistic were used to assess heterogeneity. Egger’s and Begg’s tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). RESULT: Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17–0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05–0.23) compared to referral hospitals (PP = 0.24; CI: 0.17–0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19–0.27) and Northern Africa (PP = 0.22; CI: 0.16–0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. CONCLUSION: All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.