Pattern of cardiovascular admissions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South East Nigeria

Trends and outcomes of cardiovascular disease admissions in Lagos, Nigeria: a 16-year review

BACKGROUND

Cardiovascular disease (CVD)-related admissions are on the increase in Nigeria and the rest of Africa. This study was carried out to highlight the burden, patterns and outcomes of CVD admissions in a tertiary hospital over a 16-year period in Lagos, Nigeria.

METHODS

Admissions records of patients admitted into the medical wards within the study period (January 2002 to December 2017) were reviewed and relevant information pertaining to the study objectives was retrieved for analysis.

RESULTS

There were a total of 21 369 medical admissions and 4 456 (20.8%) CVD-related admissions. A total of 3 582 medical deaths were recorded and 1 090 (30.4%) CVD-related deaths. The median age of the patients was 56.6 (46.0-68.0) years and 51.4% of these were males. Stroke, heart failure, hypertensive disease and acute coronary syndrome constituted 51.2, 36.2, 11.3 and 1.6% of all CVD admissions, respectively. There was a cumulative increase in the number of CVD admissions and deaths (p < 0.001, respectively) during the period under review.

CONCLUSIONS

CVD admissions are not only common in Nigeria, but there was also a temporal exponential increase in both the admission and death rates, most likely reflecting the epidemiological transition in Nigeria.

The Pattern of Cardiac Disease Admissions and Outcomes among Medical Admissions in St. Paul Hospital Millennium Medical College: A Retrospective Study

Background

The epidemic of cardiovascular diseases (CVD) is a global phenomenon, and approximately 80% of all cardiovascular-related deaths occur in low and middle-income countries including Ethiopia. The aim of this study was to determine the pattern of cardiac admission and its outcome among the annual medical admissions in Addis Ababa.

Method

This was a retrospective, cross-sectional study to evaluate the pattern of cardiac diseases and outcomes among medical admissions at St Paul Specialized Hospital Millennium Medical College from the 1st of Jan 2020 to the 1st of Jan 2021.

Results

The proportion of cardiac admission was 26% among 1,165 medical admissions. The most common cardiac admission was advanced congestive heart failure (CHF) (74% (224)), followed by hypertensive heart disease (HHD) (48.5%) and valvular heart disease (VHD)(23.5%), respectively. Chronic Rheumatic valvular heart disease (CRVHD) was 91.5% of the total VHD and was significantly higher among rural residents and younger populations (p<0.001). Over 12% of CRVHD patients were complicated with cardio-embolic stroke, constituting one-third of the total annual ischemic stroke admissions. Hypertension ((54%,) (164)) was the leading risk factor and was more common among urban residents (p=0.001). The mean duration of total hospital stay was 18.33 days. In-hospital mortality was 23.8% and was associated with shorter hospital stays (p<0.001). The most common immediate cause of death was sepsis of chest focus with multiorgan failure(27.8%), followed by fatal arrhythmia (20.8%) and brain herniation (15.3%), respectively.

Conclusion

Cardiac diseases are common in the study area causing significant mortality among medical admissions. Therefore, early risk assessment, adequate disease control, and stringent inpatient care should be among the priorities to reduce cardiovascular morbidity and mortality.

Heart failure disease: An African perspective

Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.

Opportunistic screening of cardiovascular disease risk factors in community pharmacies in Nigeria: a cross-sectional study

Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m²) or obese (BMI ≥ 30 kg/m²) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.

Epidemiology of cardiovascular diseases related admissions in a referral hospital in the South West region of Cameroon: A cross-sectional study in sub-Saharan Africa

BACKGROUND

Sub-Saharan Africa (SSA) is experiencing an epidemic of cardiovascular diseases (CVD) as a result of a rapid epidemiological transition. Little is known about the admission for CVD and outcome in rural and semi-urban settings in Cameroon in this era of epidemiological transition. The aim of this study was to determine the frequency and the pattern of CVD admissions in the South West region of Cameroon.

METHODS

This retrospective descriptive study included all adult patients admitted for CVD in the medical unit of the Buea Regional Hospital between Jan 2016 and December 2017.

RESULTS

Out of the 3140 patients admitted, 499(15.9%) had CVD. There were 304(60.9%) females. The mean age was 58.7±16.2 years. There was no age difference between men and women (59.7 years vs 58.1years, p = 0.29). The most commonly affected age group was those aged 50-59 years (22%). Heart failure (38.5%), stroke (33.3%) and uncontrolled hypertension (22.4%) were the most prevalent CVDs. The length of hospital stay ranged from 1 to 37 days with a median length of hospital stay of 7 days. In-hospital case fatality was 78(15.8%). Mortality was higher in women compared to men (9% vs 7%, p = 0.43). The case fatality for stroke was higher compared to case fatality for heart failure (21.7% vs 16.7%, p = 0.23).

CONCLUSION

CVDs are a common cause of hospital admission in this semi-urban setting, dominated by heart failure. Women were disproportionately affected and it was associated with high mortality. Prevention, early detection and management of risk factors for cardiovascular disease are imperative given the growing burden of CVD in SSA to reduce CVD morbidity and mortality.

The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study

Introduction

The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions.

Methods

A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth.

Results

Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively. ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017.

Conclusions

The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences.

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In northern Tanzania, acute coronary syndrome is a rare admission diagnosis

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Heart failure and stroke are the most common admission diagnoses

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The burden of stroke admissions in this community is rising rapidly

Trends in cardiovascular diseases and associated risks in sub-Saharan Africa: a review of the evidence for Ghana, Nigeria, South Africa, Sudan and Tanzania

Background: Sub-Saharan Africa (SSA) countries are facing an epidemiological shift from infectious disease to chronic diseases, such as cardiovascular diseases (CVDs). CVDs incidence in SSA are frequently attributed to the prevalence of hypertension, diabetes, and overweight/obesity. Nevertheless, some researchers contend that CVDs are not a priority public health problem in SSA. Method: This paper systematically reviews the evidence on CVDs and their relation with hypertension, diabetes mellitus and obesity/overweight in Ghana, Nigeria, South Africa, Sudan and Tanzania. The publication's content was analyzed qualitatively using the directed content analysis method and the results were presented in a tabular format. Result: The paper illustrates the rising prevalence of CVDs as well as the three related risk conditions in the selected SSA countries. Conclusion: The review indicates a poor health system response to the increasing risk of CVDs in SSA. The conditions and major drivers that contribute to this underlying increasing trend need to be further studied.

1,8-Cineole Ameliorates LPS-Induced Vascular Endothelium Dysfunction in Mice via PPAR-γ Dependent Regulation of NF-κB

1,8-Cineole (eucalyptol), a monoterpene, has been widely reported for the anti-inflammatory effects. Our previous data confirmed that 1,8-cineole ameliorated the inflammatory phenotype of human umbilical vein endothelial cells (HUVECs) by mediating NF-κB expression in vitro. At present, we investigated the protection effects of 1,8-cineole on vascular endothelium in lipopolysaccharide (LPS)-induced acute inflammatory injury mice and the potential mechanisms involved in the protection in HUVECs. Results from enzyme linked immunosorbent assays revealed that 1,8-cineole suppressed the secretion of interleukin (IL)-6 and IL-8 and increased the expression of IL-10 in the serum of LPS-induced mice. 1,8-Cineole reduced the inflammatory infiltration and the expression of vascular cell adhesion molecular 1 (VCAM-1) in the sections of thoracic aorta in LPS-induced acute inflammatory mice. Western blotting indicated that 1,8-cineole significantly decreased the phosphorylation of NF-κB p65 and increased the expression of PPAR-γ in the thoracic aorta tissue. 1,8-Cineole increased the expression of PPAR-γ in LPS-induced HUVECs. 1,8-Cineole and rosiglitazone reduced the protein and mRNA levels of VCAM-1, E-selectin, IL-6, and IL-8 in LPS-induced HUVECs, which could be reversed by the action of GW9662 (inhibitor of PPAR-γ). 1,8-Cineole and rosiglitazone blocked the LPS-induced IκBα degradation and NF-κB p65 nucleus translocation, which could be reversed by the pretreatment of GW9662 or silence of PPAR-γ gene. In conclusion, 1,8-cineole attenuated LPS-induced vascular endothelial cells injury via PPAR-γ dependent modulation of NF-κB.

Data on the epidemiology of heart failure in Sub-Saharan Africa

In Sub-Saharan Africa (SSA), chronic non-communicable diseases and cardiovascular diseases in particular, are progressively taking over infectious diseases as the leading cause of morbidity and mortality. Heart failure is a major public health problem in the region. We summarize here available data on the prevalence, aetiologies, treatment, rates and predictors of mortality due to heart failure in SSA.

Cardiovascular risk factors in adult general out-patient clinics in Nigeria: a country analysis of the Africa and Middle East Cardiovascular Epidemiological (ACE) study

Background

With globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD).

Objective

To estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria.

Methods

As part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria.

Results

In total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged <45 years; 4% ≥65 years. Over 90% of subjects had ≥1 of 6 selected modifiable cardiovascular risk factors: 138 (45.6%) had 1–2; 65 (21.5%) had 3; 60 (19.8%) had 4; and 11 (3.6%) had 5 concurrent risk factors. Screening identified 206 subjects (68.0%) with dyslipidemia who did not have a prior diagnosis.

Conclusion

Cardiovascular risk factors are highly prevalent in Nigerian subjects attending out-patient clinics. Moreover, many subjects were undiagnosed and therefore unaware of their cardiovascular risk status. Opportunistic screening alongside intensive national, multisectoral education or risk factor education is needed, should be scaled up nationwide and rolled out in both urban and rural communities in Nigeria.

Cardiovascular disease in Africa: epidemiological profile and challenges

From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.