Efforts needed to improve cardiovascular research in Africa

Research published in the journal Circulation: Cardiovascular Quality and Outcomes has highlighted the small number of clinical trials in cardiovascular medicine currently conducted in Africa.

The authors of the research letter, writing from Egypt and the USA, say that though the number of trials taking place in African centres is moving in an upward trend, efforts are still warranted to strengthen the continent’s research infrastructure.

Abdelrahman Abushouk (Cleveland Clinic, Cleveland, USA) and colleagues write that though the continent is home to a population of 1.4 billion, it contributes to ≈2% of published or registered clinical trials. The researchers evaluated the number of African-led clinical trials in cardiovascular medicine over the past three decades, looking at visibility, limitations and funding sources.

“Cardiology research is losing out on a large, diverse, treatment-naive population that could really advance science,” Abushouk told Cardiovascular News. “That is why we pursued this work.”

The analysis found that between 1990 and 2019, a total of 179 trials were published from African countries, 147 (82.1%) of which originated from either Egypt, South Africa or Nigeria, while 37 of Africa’s 54 had not contributed to any research over that time.

On the upside, they note, there does appear to have been an increase in trials from African centres over that time, with 41 between 1990–1999, 30 between 2000–2009 and 108 between 2010–2019. African centres have also contributed to the implementation of 45 multinational trials in that time, the researchers report, including most frequently from South Africa.

On the issue of funding, the researchers have noted that 91 trials did not disclose whether they received funding, while 20 disclosed no external funding. Among the other 68, 35.7% had funding from private sources, 28.6% academic sources, 28.6% governmental sources and 7.1% non-governmental sources.

One factor that may influence the low level of African-led clinical trial output, the researchers hypothesise, may be the small number of cardiologists in the continent, with recent estimates suggesting there are 2,000 practicing cardiologists in Africa, compared to 25,000 in the USA.

“This highlights the need to increase training for cardiovascular researchers that may need to move beyond cardiologists (e.g. research methodologists),” the researchers write.

“Although initiatives, such as the Clinical Trials Community online platform and the Pan-African Clinical Trials Registry are steps in the right direction, multifaceted interventions are still warranted to strengthen Africa’s research infrastructure (e.g. more clinical research sites, standardised regulatory frameworks, and large-scale adoption of electronic medical records), foster Africa’s international collaborations, and improve the visibility of African science (e.g. enhancing open-access publishing and institutional partnerships),” they add.

“I am sure it is not just cardiology, but other specialties as well, that are seeing this as a problem,” the paper’s senior author, Samir Kapadia (Cleveland Clinic, Cleveland, USA) told Cardiovascular News. “It is very clear that we need to improve awareness. These doctors are very talented, they know what needs to be done, but infrastructure needs to be improved to promote research”

The paper’s main African co-author, Ahmed Bendary (Benha University, Benha, Egypt), added: “This research letter is an eye-opener and a wake-up call for the global heart health community. It shows that despite the growing heart disease burden in Africa, there has been limited research from the continent. This should make us realise the need to support and collaborate with African researchers, so we can work together to tackle heart disease more effectively worldwide. It is time to bridge the gap and make a real impact on heart health for everyone.”