Burden, awareness gaps, and delayed diagnosis across major cardiovascular diseases in a conflict-affected low-income setting
S SidiqiAbstract
Background
Major cardiovascular diseases, including coronary artery disease, congenital heart disease, rheumatic heart disease, and hypertension, are leading contributors to premature mortality in conflict-affected low-income settings. However, the combined impact of disease burden, public awareness gaps, and delayed diagnosis across these conditions remains insufficiently characterized. Recent expansions in tertiary cardiac services and workforce development initiatives have improved access to care, yet the influence of healthcare system capacity on early detection and disease progression remains poorly defined.
Purpose
The purpose of this study is to evaluate the burden, awareness levels, and diagnostic delay across major cardiovascular diseases using integrated clinical and population-based datasets.
Methods
An integrated analysis was conducted using multiple contemporary datasets, including a national cardiovascular overview (2025), a retrospective cohort of 4,830 congenital heart disease patients (2022–2024), a cross-sectional survey assessing myocardial infarction symptom awareness among 489 adults (2024), a prospective case–control study evaluating risk factors for congenital heart disease (2025), workforce and infrastructure reports, and global burden estimates. Outcomes encompassed mortality, healthcare workforce density, awareness levels, and the timing of cardiovascular disease diagnosis.
Results
Cardiovascular disease accounted for 47,557 deaths in 2021, with an age-standardized mortality rate of 567 per 100,000 population. Rheumatic and congenital heart diseases were frequently diagnosed at advanced stages, particularly among women. Healthcare capacity was limited, with 0.39 hospital beds per 1,000 population, 2.5 physicians per 10,000 people, and 0.2 cardiologists per 100,000 population. Only 22.3% of surveyed individuals demonstrated high awareness of myocardial infarction symptoms. In cases of congenital heart disease, 58.4% were found to have the condition after infancy, and 13.1% of those who started with non-cyanotic defects developed cyanosis due to late diagnosis, leading to psychological trauma from conflict, which affects one in five people, making the risk of heart disease even higher.
Conclusion
Health system fragility in resource-limited settings is associated with substantial cardiovascular mortality, low public awareness, and delayed diagnosis across major cardiovascular diseases. Strategies focusing on workforce expansion and early detection may reduce disease severity and improve clinical outcomes.Figure of CHD delayed diagnosisFigure of MI awareness