Chronic coronary syndrome in Africa: current management and service challenges, and opportunities for optimizing patient care.

African populations have traditionally been considered at relatively low risk of cardiovascular diseases (CVD), such as chronic coronary syndrome (CCS), but this is rapidly changing in association with ageing populations, uncontrolled urbanization and lack of control of classical CV risk factors. In sub-Saharan Africa, CVD deaths have increased by more than 50% in the past three decades. For CCS care, limited availability of clinical expertise, diagnostic facilities, and access to optimal medical therapy (OMT), lack or inadequate reimbursement of healthcare costs, and scarcity of universal health coverage (UHC) are major challenges. Cardiologists from 11 African countries, meeting through the AFEX: ACT ON Angina programme, with the endorsement of the World Heart Federation, identified the need to: engage clinicians, patients, and the media to raise awareness of CCS and angina, and encourage lifestyle modification and risk factor control, as well as early referral of high-risk individuals; develop care pathways to address growing demand, including cross-border and online collaboration where local expertise is unavailable; optimize the use of treatment budgets by adapting and implementing international guidelines according to local priorities, and avoiding prescription of nonevidence-based medicines; initiate collaborative research into the nature of CCS in African countries and potential differences in risk factors, presentation, and treatment response compared with Europe and North America whose experience forms the basis of international guidelines. A roadmap is proposed to guide future developments in CCS care and support best practices across Africa.