National Guidelines for the Management of Cardiovascular Diseases

Objectives

The guideline seeks to standardise cardiovascular disease risk assessment and management across Ghana, contributing to reduced morbidity and mortality and supporting the national objective of reducing chronic non-communicable diseases, unhealthy lifestyles and their effects on quality of life.[1]It provides a comprehensive clinical framework spanning risk assessment, prevention, emergency care, diagnosis, treatment, referral and patient education for cardiovascular conditions prevalent in Ghana.[2][3][4]

• Strengthen early detection and risk-based management of hypertension, overweight or obesity, diabetes, dyslipidaemia, tobacco use, harmful alcohol consumption, inactivity and other modifiable cardiovascular risks.[5][6]
• Use total cardiovascular-risk assessment, including the World Health Organization and International Society of Hypertension Africa zone D chart appropriate to Ghana, to estimate 10-year risk of heart attack or stroke and guide prevention and treatment intensity.[7]
• Promote lifestyle modification through healthy eating, salt reduction, weight control, physical activity, tobacco cessation, moderated alcohol use and stress management adapted to individual capabilities, co-morbidities and socioeconomic circumstances.[8][9]
• Manage priority conditions across the cardiovascular continuum, including cardiac arrest, hypertension, stroke, coronary artery disease and myocardial infarction, heart failure, venous thromboembolism, acute rheumatic fever, rheumatic heart disease, infective endocarditis and arrhythmias.[10]
• Improve prevention of recurrent disease through secondary prevention, including risk-factor control, appropriate antiplatelet or anticoagulant treatment, lipid-lowering therapy, blood-pressure management, rehabilitation, patient education and timely review.[11][12]
• Build preparedness for cardiac arrest and other acute cardiovascular emergencies, with rapid cardiopulmonary resuscitation, defibrillation for shockable rhythms, management of reversible causes and referral after return of spontaneous circulation.[13][14]
• Support disease-specific clinical objectives, including control of blood pressure at target levels, prevention of stroke complications and recurrence, relief of ischaemic-heart-disease symptoms, reduction of heart-failure mortality and hospitalisation, and prevention of recurrent acute rheumatic fever and rheumatic heart disease.[15][16][17][18][19]

Implementation

Implementation is based on nationally approved, evidence-graded guidance that differentiates care by facility capability, from community and primary-care settings through health centres and district hospitals to regional, teaching and specialist services.[20][10]Recommendations are organised for all levels of care, facilities without a doctor, facilities with a doctor, facilities with a physician specialist or family physician, and facilities with cardiologists and sophisticated equipment.[10]

• Deliver care through tiered assessment, stabilisation, investigation, treatment and referral pathways, enabling facilities without doctors to provide basic emergency care and screening while transferring patients requiring diagnostic capacity or specialist management.[21][22]
• Equip facilities according to their level of care with appropriate diagnostic tools, medicines and emergency resources, ranging from blood-pressure measurement, basic laboratory testing and essential medicines to electrocardiography, imaging, echocardiography, catheterisation, telemedicine and specialist medicines.[21]
• Train healthcare workers and wider community groups in basic life support, first aid and advanced cardiac life support according to role, and establish emergency-response teams, automated external defibrillators in large institutions, and equipped ambulance services.[21][23]
• Maintain an emergency-response capability able to respond within five minutes on every day and shift with appropriate skills, equipment and medicines.[23]
• Apply clinical protocols for risk classification and follow-up, including blood-pressure measurement and home or ambulatory monitoring, lipid testing after statin initiation or adjustment, anticoagulation monitoring, and condition-specific diagnostic scores such as Wells, ABCD2, ROSIER, CHA₂DS₂-VASc and HAS-BLED where relevant.[24][25][26][16][11][27][28]
• Use referral criteria when expertise, medicines, equipment or investigations are unavailable, when cases are uncontrolled or complicated, or when patients request a second opinion or another level of care.[29]Receiving facilities should be notified in advance, and referral documentation should include clinical history, findings, tests, treatment and provisional diagnosis.[29]
• Use Ghana Health Service referral and feedback forms to document patient details, referral reasons, diagnoses, treatment, outcomes, follow-up recommendations and responsible officers; complete feedback forms in duplicate and return them to the initiating facility.[30]
• Draw on governance and technical contributions from the Ministry of Health, Ghana Health Service, Non-Communicable Disease Control Programme, Ghana Heart Initiative Governance Committee, professional societies, teaching hospitals, universities, insurers, civil-society and faith-based organisations, traditional leadership, and international partners.[31][32][2]
• Use evidence ratings to distinguish recommendations supported by multiple randomised clinical trials or meta-analyses, single randomised or large non-randomised studies, and expert consensus or smaller observational evidence.[10]

Monitoring & Evaluation

Monitoring is primarily embedded in clinical assessment, treatment response, referral and follow-up rather than in a document-wide performance-management system. The supplied material does not define programme-level indicators, reporting schedules, surveillance architecture, evaluation designs, audit processes or named accountability bodies.[1][20][10][30]

• Assess cardiovascular risk using World Health Organization risk-prediction tools, including estimated 10-year risk, and use risk categories to guide preventive and treatment decisions.[6][7]
• Track modifiable risk factors and treatment targets, including blood pressure, glycaemic control, lipids, weight, physical activity, diet, tobacco exposure and sedentary behaviour.[9][33]
• Monitor lipid-lowering treatment through adherence, lifestyle change and low-density lipoprotein cholesterol reduction; repeat lipid testing 4 to 12 weeks after starting or adjusting a statin and then every 3 to 12 months as needed.[25]
• Monitor hypertension through correctly repeated facility blood-pressure measurements, ambulatory blood-pressure monitoring or home blood-pressure monitoring, with defined office and out-of-office thresholds.[15][24]
• Review hypertension treatment response after two to four weeks and refer patients whose blood pressure remains uncontrolled despite adequate treatment.[22][34]
• Monitor medication safety in resistant hypertension, including kidney function and serum potassium where clinically relevant, and confirm adherence before classifying treatment as ineffective.[35][36]
• Apply clinical monitoring in emergencies, including vital signs during hypertensive emergencies, cardiac-arrest measures such as pulse, blood pressure and end-tidal carbon dioxide, and immediate stroke observations including blood pressure, pulse, respiratory rate, temperature and blood glucose.[37][38][39]
• Use disease-specific diagnostic and prognostic tools, including the ABCD2 score after transient ischaemic attack, the ROSIER scale for suspected stroke, the Wells scores for deep-vein thrombosis and pulmonary embolism, and the Pulmonary Embolism Severity Index for pulmonary embolism.[16][11][40][41]
• Monitor anticoagulation through international normalised ratio testing for warfarin, generally targeting 2 to 3, alongside dose adjustment and review of bleeding risk.[26][42][28]
• Use specified follow-up intervals where provided, including reassessment within four weeks after mitral-valve discharge, regular clinical and echocardiographic follow-up during the first year after infective-endocarditis treatment, and repeat testing in acute rheumatic fever where indicated.[43][44][45][46]
• Document referral, management and feedback through Ghana Health Service referral and referral-feedback forms, which record clinical findings, investigations, diagnoses, treatment, outcomes, follow-up arrangements and responsible officers.[30]

Costing & Financing

No document-level budget, costing methodology, financing plan, funding allocation, resource-mobilisation strategy, quantified funding gap or economic assumption is specified in the supplied material.[1][20][47][30]

• Identify substantial service inputs, including diagnostic equipment, essential medicines, laboratory testing, imaging, specialist referral, emergency teams, ambulances, automated external defibrillators, training and cardiovascular rehabilitation or multidisciplinary care, but provide no prices or financial allocations.[21][23][39][11]
• Recognise access constraints where advanced interventions are not widely available, including intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke.[48]
• Note that magnetic resonance imaging availability and cost limit its use in acute stroke in Ghana, whereas non-contrast head computed tomography is described as relatively more available and more rapidly obtained.[49]
• Recognise that stroke complications are associated with higher care costs, longer hospital stays, readmissions, delayed rehabilitation and increased mortality, without a monetary estimate.[50][11]
• Consider cost and socioeconomic circumstances among factors influencing treatment selection for coronary disease and stroke prevention, while the material provides no affordability thresholds or financing mechanism.[12][51]