Implementation of cardiovascular disease risk prediction scores in Sub-Saharan Africa: a scoping review.

Abstract

Background: Cardiovascular disease (CVD) risk prediction scores are widely recommended to guide primary prevention, yet their use in routine care across sub-Saharan Africa (SSA) remains limited. As the number of available scores continues to increase, understanding how they are implemented is important in closing the gap between policy and practice. This scoping review aims to map and synthesise the available literature on the implementation of CVD risk prediction scores in SSA.

Methods: This review was conducted in accordance with JBI methodology. MEDLINE, Embase, Global Health (Ovid), CINAHL, Scopus and ProQuest Dissertations and Theses Global were searched. An Implementation Research Logic Model was used to structure data charting and synthesis across implementation determinants, strategies and outcomes.

Results: Of the 4930 publications screened, 41 were included, representing 34 unique evidence sources across ten countries. Four use cases for CVD risk prediction scores were identified: (1) economic and policy considerations; (2) screening for high CVD risk and referral; (3) communication of risk and (4) treatment of high-risk individuals. The most frequently reported barriers to the use of risk scores related to health system and organisational challenges. Implementation strategies primarily focused on task-shifting, training, and short-term material or technological support for community health workers, whereas few studies evaluated strategies to support the uptake of CVD risk scores in health facilities. While feasibility and acceptability outcomes were widely studied, evidence on long-term sustainability of CVD risk scores was limited.

Conclusion: The use of an Implementation Research Logic Model enabled structured synthesis of a heterogeneous and under-theorised evidence base, revealing a mismatch between the breadth of implementation determinants and the narrow range of strategies used to address them. The potential of CVD risk prediction scores, and other clinical prediction tools, to strengthen preventive care in SSA is unlikely to be realised without effective integration into routine health services. Therefore, moving beyond short-term, task-shifted screening pilots toward sustainable implementation approaches addressing the complete CVD care pathway will be essential to ensure that both existing and emerging risk prediction tools translate into equitable improvements in cardiovascular outcomes.