Cardiac Critical Care in Resource-Limited Environments : Lessons from Tanzania

• Cardiac critical care is in its infancy in resource-limited countries.
• Disease prevalence will modulate design and capability of care units.
• Financial constraints and existing healthcare systems will impose limitations.
• Healthcare workforce is insufficient in numbers, skills, and experience.
• Investment in medical education is essential to emergence of cardiac critical care.

The concept of cardiac critical care is emerging as a tool in the management of cardiovascular diseases in many Sub-Saharan African countries. The region is undergoing significant epidemiological transition. There remains a significant burden of infectious and nutritional disease, but cardiovascular disease, notably hypertension and coronary artery disease, as well as other noncommunicable diseases (NCD) are emerging rapidly, placing a double burden on existing healthcare systems. Within this complex, heterogeneous, and changing epidemiologic setting, efforts to diagnose and treat cardiovascular diseases have increased. As more patients are diagnosed with acute cardiac conditions, the number requiring management in a cardiac critical care unit is also increasing. In this review, using the Tanzanian experience, we attempt to chronicle the appearance of cardiac critical care services and the many challenges to their implementation in a resource-limited environment.