Raising the Bar: Improving the Standard of Cardiology Care in Nigeria

In the battle against the mounting burden of cardiovascular disease (CVD) in Nigeria, a comprehensive approach is imperative. Expanding access to cardiology care throughout the country is a key solution. This entails establishing more cardiology centers staffed with proficient physicians and support teams, while ensuring accessibility for all through HMOs and national insurance. However, it’s not merely a matter of increasing centers or stemming the brain drain; this response necessitates the united efforts and support of diverse stakeholders at clinical, managerial, and governmental levels.

Effective management of heart disease encompasses various aspects, including prevention, early detection, active treatment, palliative care, and long-term symptom control through cardiac rehabilitation. With the establishment of new secondary/tertiary centers, the emphasis shifts to ensuring high-quality care delivery. This entails hospitals providing services that are safe, timely, patient-centered, efficient, and equitable.

Cardiology care in Nigeria and Sub-Saharan Africa draws upon a range of clinical guidelines to ensure quality and evidence-based practice. While international guidelines, such as those provided by the American College of Cardiology/American Heart Association and the European Society of Cardiology, are commonly referenced, their applicability to African or Nigerian patients may be limited. These guidelines are often based on data primarily obtained from populations outside the region, which may differ significantly in genetic makeup, lifestyle factors, and access to healthcare resources. Therefore, there is a growing recognition of the need for locally generated data and guidelines that are specifically validated in African and Nigerian populations.

The World Health Organization offers guidelines tailored to the global health context, addressing prevention and management strategies in resource-limited settings. Locally adapted guidelines, developed by organizations like the Nigerian Cardiac Society and National Medical Associations, account for specific healthcare challenges in Nigeria and, individual countries within Sub-Saharan Africa may have their own national or regional guidelines. Healthcare professionals in the region integrate these guidelines with clinical judgment to deliver optimal cardiology care. Regrettably, the Nigerian healthcare system often falls short of meeting these standards.

A 2019 study by the Department of Medicine at the University of Ibadan aimed to assess the quality of cardiology care in a public Nigerian tertiary hospital. The study involved 28 healthcare professionals, including physicians and allied health professionals from the University College Hospital Ibadan. The findings revealed that the quality of care for cardiac patients in the hospital calls for urgent attention. About two-thirds of the participants reported that treatment guidelines were not followed or adequately monitored within the hospital. As a result, patients were not receiving consistent care, with some not being treated according to the recommended guidelines. These findings suggest similar issues may exist in other parts of the country, considering that this hospital is widely regarded as one of the best in the country.

The standard of care can be influenced by the training, or lack thereof, provided to healthcare professionals. In this particular hospital, many healthcare professionals lack specialized knowledge and expertise in cardiac care. Although they desire more training, they are responsible for seeking out such opportunities independently. Unfortunately, management does not support these efforts, as staff members are not given time off to pursue additional training. Moreover, the quality of care is affected by a shortage of essential resources, including ECG machines (Resting and Stress), Echocardiography machines, pulse oximeters, ambulatory monitoring equipment, stethoscopes, resuscitation drugs, and pulmonary function test machines, all of which are crucial for effective cardiac care.

Furthermore, public hospitals, in particular, face challenges with basic amenities such as electricity and water, which are necessary for running catheterization laboratories, operating theaters, and maintaining proper storage conditions for medications and equipment. These issues extend to the provision of support for general clinics on a daily basis.

While the construction of new secondary or tertiary centers would be advantageous in addressing the increasing burden, it is crucial that these facilities are adequately equipped and staffed with the necessary teams, and that they implement effective policies and standard operating procedures (SOPs) to ensure efficient governance and daily operations.

Iwosan Lagoon Hospitals is a renowned healthcare institution in Nigeria, known for providing high-quality medical services across various specialties. With a focus on patient-centered care, Lagoon Hospitals has established a strong reputation for its commitment to excellence in healthcare delivery.

Iwosan Lagoon Hospitals recently opened a 27-bed multi-specialist hospital and center of excellence for Cardiology Care in Lagos, Nigeria. The facility aims to broaden access to cardiology care while improving the quality of patient care by using international treatment guidelines and standards. This includes implementing guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC), which provide up-to-date, evidence-based knowledge on preventing, diagnosing, and managing cardiovascular diseases. By following these guidelines, the hospital can operate at a high standard, offer patients the best care, and align with international counterparts.

In line with their commitment to enhancing local capabilities, Iwosan Lagoon Hospitals actively supports research initiatives focused on generating data and guidelines specifically tailored to the Nigerian population. In doing so, Iwosan aims to address the limitations of relying solely on international guidelines. This approach not only ensures that healthcare practices align with the unique needs of Nigerian patients but also contributes to the advancement of medical knowledge and the development of more targeted and effective treatments. Through this emphasis on local capabilities and innovation, Iwosan Lagoon Hospitals plays a vital role in improving the quality and relevance of cardiology care in Nigeria.

Teaching and training are key goals at Iwosan Lagoon Hospitals, with accreditation already in place for training medical doctors, nurses, radiographers, and other allied health professionals. This focus on training aims to reduce brain drain and ensure a skilled workforce within Nigeria’s healthcare system.

The newly built Catheterization Laboratory (Cath Lab) at Iwosan Lagoon Hospitals expands the limited number of such facilities in Nigeria. With only five functional Cath Labs in Lagos State and six outside Lagos, this addition is significant. The facility also features an essential diagnostic tool, an MRI device. With these advanced resources, state-of-the-art interventions, surgeries and diagnostic procedures are now being performed at Iwosan Lagoon Hospitals. This reduces the need for Nigerians to travel abroad for quality care, boosts medical tourism within Nigeria, and contributes to the healthcare economy by generating increased revenue.

Dr. Olurotimi Badero, a renowned board-certified Interventional Cardio-Nephrologist, leads the Interventional Cardiology program at Iwosan Lagoon Hospitals. Dr. Badero has gained global recognition for his pioneering contributions to the medical field and specializes in hypertension, a leading cause of cardiovascular disease in Nigeria. He is dedicated to training and mentorship, actively participating in mentorship programs for young physicians and scientists.

Iwosan Lagoon Hospitals adopts a patient-centered approach, providing holistic care to patients. They have implemented channels such as the Patient Care Support (PCS) team and WhatsApp Support Groups to ensure healthcare accessibility and encourage patient feedback. Potential first-time visitors can also book appointments directly via the hospital website, a feature which saves visitors the hurdle of placing repeated calls to the help desk. By placing patients at the center of their care delivery, Iwosan Lagoon Hospitals aims to enhance the overall patient experience and satisfaction.

Key Takeaways from TC Health: The battle against cardiovascular disease in Nigeria and Sub-Saharan Africa necessitates a comprehensive and forward-looking approach. Expanding access to cardiology care and improving the quality of care are critical goals that require the united efforts of various stakeholders. Local capabilities and innovation play a vital role in generating data and guidelines specifically validated for African populations, addressing the limitations of relying solely on international guidelines. By investing in research, training, and infrastructure, the future of cardiology care in Nigeria and Sub-Saharan Africa holds great promise. As the field continues to evolve, collaboration between healthcare institutions, policymakers, and medical professionals will be instrumental in shaping the future of cardiology care in Nigeria and Sub-Saharan Africa, ultimately leading to better outcomes and improved cardiovascular health for the population.

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